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Research Institute Will Help Identify, Fund Research Initiatives
Institute Is Likely to Influence Coverage Decisions, Say Experts
The PCORI will operate as an independent nongovernmental body, encompassing both the public and private sectors. It will focus on evidenced-based research, which is defined as research that evaluates and compares health outcomes and the clinical effectiveness, risks and benefits of two or more medical treatments or services. This also is known as comparative effectiveness research. In time, the institute should be able to help identify what treatments work best for which populations and under what conditions, say experts in this area.
"This is going to be a staged process and not something that produces immediate effects," said Gail Wilensky, Ph.D., an economist and former administrator of the Health Care Financing Administration -- now known as CMS -- under former President George H.W. Bush. "I would like to see the institute better disseminate what is known about alternative ways to treat various medical conditions as well as make significant investments in looking at different ways to treat medical conditions that are not funded adequately."
The institute will carry out a variety of functions, including
- identifying national priorities for research by taking into account factors of disease incidence, prevalence and burden in the United States;
- establishing a 15-member methodology committee to develop and periodically update scientifically based methodological standards for research conducted through the institute;
- funding and conducting research with federal agencies, academic centers and institutions, and other entities;
- disseminating findings to all stakeholders in an understandable manner; and
- ensuring transparency by requiring public input.
AAFP Has Long Record of Support for Evidence-based Research
As part of the Academy's evidence-based research activities, Ted Epperly, M.D., of Boise, Idaho, who was AAFP president at the time, testified before the Institute of Medicine, or IOM, in 2009 on the importance of evidence-based research in improving quality, reducing costs and enhancing access to care in the United States.
Epperly stressed how important comparative effectiveness research was to AAFP members because family physicians see patients with common problems, and evidence-based research on these problems often is lacking. At that time, the IOM was gathering information from the AAFP and others for a report on research-based spending priorities. The IOM report, which was issued in June 2009, is expected to influence much of the Patient-Centered Outcomes Research Institute's work.
In addition, the AAFP has nominated several physicians for the institute's governing board.
Key Source of Information
"The institute is meant to be a kind of coordinating function for how the federal government, as well as the private sector, prioritizes (comparative effectiveness research)," said Kavita Patel, M.D., director of the health policy program for the New America Foundation in Washington. "What we have right now is a lot of disparate entities -- including the federal government -- doing (comparative effectiveness research) in a lot of different places. This is designed to try and have a focused agenda."
The institute also should bring more uniformity to the way public and private entities conduct and evaluate evidence-based research, which would strengthen and add credence to recommendations issued by the institute. This should help reduce unwarranted diagnostic and practice variations and make physicians' jobs easier, said Wilensky.
"I think (the institute) has the potential of helping physicians and patients in learning how to treat and be treated in a smarter way and to help us as a country learn how to spend smarter, as well," she said.
For example, according to Wilensky, health care spending has grown approximately twice as fast as the economy for the past 40 years, a pace that jeopardizes the nation's fiscal health. "It does not make any sense," said Wilensky. "We do not have the kind of health outcomes to suggest that (spending) has been an appropriate differential."
"I would not want to go forward in a serious effort to improve our health care system without a significant investment in best practice research and in the dissemination of that research," said Nichols.
The institute will attempt to build on comparative effectiveness research investments made by the American Recovery and Reinvestment Act of 2009, which directed the Institute of Medicine to issue a list of 100 priority topics for comparative effectiveness research. That list, which was issued in June 2009, could influence much of the PCORI's work.
Wilensky, meanwhile, said the institute must accomplish a few key tasks to be successful. It must look at alternative ways to treat major medical conditions so the United States can stop spending a lot of money on a variety of treatments, not all of which lead to better-quality health care.
In addition, the institute must disseminate existing information on health care treatments and generate new information about what works best under what circumstances, said Wilensky.
She is aware that some stakeholders may oppose establishing the institute because they believe it will generate information that could lead to health care rationing. However, Wilensky said the institute could help disseminate better information and better incentives. "Could we misuse the information? Sure," she said. "We could misuse any information, but we can make bad decisions even without information."
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