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PCORI Launches Comment Period on Research Priorities

By John Reichard, CQ HealthBeat Editor

January 23, 2012 -- How in the world are research studies funded by the Patient-Centered Outcomes Research Institute (PCORI) under the health care law actually going to bend down the health care spending curve in the United States?

It's still too early to get concrete examples pinpointing specifically how that might happen, even though the organization formally released a document last week listing its research priorities.

The draft shows that the organization, PCORI, is planning to cast a very wide net in funding research to identify the best ways to improve health care treatment.

PCORI is the health care law's response to the view of many policy analysts and researchers that there is way too little information available on what treatments work best in health care and that much of medical spending in the United States is wasted. The field is sometimes known as CER, or comparative effectiveness research.

The research areas PCORI listed are an example of the many factors that determine how well health care works. For example, it isn't just a matter of whether treatment A works better than treatment B for a particular medical condition, although that is an oft-cited example to illustrate what is meant by comparative effectiveness research.

It's also a function of how a health system organizes the delivery of care to ensure that it is well coordinated, whether doctors change the way they practice medicine based on studies that reach conclusions on which treatments work best, and in what ways barriers such as language or transportation prevent particular socioeconomic groups from getting effective treatment.

"PCORI, at this early stage of its work and of patient-centered outcomes research as a discipline, does not want to focus on a narrower set of questions or health care conditions, nor does it want to exclude any diseases or conditions," the organization said in the 22-page "Draft National Priorities for Research and Research Agenda."

PCORI proposes the following five priorities for the research it funds: comparative assessments of prevention, diagnosis, and treatment options (40 percent of its funding); improving health care systems (20 percent); best ways of communicating and disseminating research (10 percent); addressing treatment disparities among various socioeconomic groups (10 percent); and "accelerating patient-centered and methodological research" (20 percent).

Efforts by other organizations to establish CER research priorities "have focused on specific high-prevalence or high-cost conditions," the document noted. But "PCORI's priorities and agenda do not place such limits on the scope of research that will be supported." The various criteria the health care law (PL 111-148, PL 111-152) laid out for PCORI to consider in funding studies, "when considered together, do not point strongly to such conditions, but suggest that a more diverse research portfolio that considers a range of conditions, interventions, and research methods, may be more appropriate," the draft says.

The comment period ends March 15. Then PCORI will update its research priorities based on the comments and issue a revised statement of its priorities in April. After that it will invite researchers to propose specific studies with the goal of committing up to $120 million in funding this year.

Then exactly how the research could have an impact on spending may be more clear. But it's apparent that studies comparing one drug to another or a drug to a medical device won't dominate the research plan. That's a victory for product makers who feared that CER would be heavily weighted in that direction.

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