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April 4, 2013

Pitt, UPMC form collaborative research group

This week Pitt and UPMC formalized a research partnership that has been under construction for more than two years and already has resulted in major federal grants. It represents a significant shift toward research focused on health-care reform efforts, particularly comparative effectiveness research (CER) and patient-centered outcomes research (PCOR).

This new UPMC-Pitt Collaborative Work Group represents “a real sea change in health-care research,” said Donna Keyser, senior director of the UPMC Center for High-Value Health Care (part of the UPMC Health Plan), who is co-chairing the effort with Everette James, associate vice chancellor for health policy and planning for the Schools of the Health Sciences. “It’s about changing and improving the health-care system as opposed to traditional research such as benchside research or randomly controlled clinical trials.”

The partnership was announced at a meeting on April 3.

The work group also includes chairs of Pitt departments that work on health-care issues, as well as the Center for Research on Health Care, the Clinical and Translational Science Institute and other researchers, especially those from the Graduate School of Public Health. It is led by a steering committee that includes Arthur Levine, senior vice chancellor for the Health Sciences and dean of the medical school; Diane Holder, president of UPMC Health Plan, and Steven D. Shapiro, executive vice president of UPMC, its chief medical and scientific officer and president of the Physician Services Division.

“The idea is that together the health system and the University … can really position themselves to be more strongly competitive if we work together” in seeking this new research funding, Keyser said. “We have a real competitive advantage together. We’re in a very good position to be a leader in health-care reform.

“Even foundations are interested in funding investigations of how you change how care is paid for in order to improve the U.S. health-care system,” she added. While money for basic science research is diminishing from the National Institutes of Health, money for research aimed at translating research into better practices “is only increasing … creating new opportunities for health-care centers and altered opportunities for research institutions.”

The Affordable Care Act (ACA), or Obamacare, established the non-profit Patient-Centered Outcomes Research Institute (PCORI) in 2010, which will have an estimated $3.5 billion in federal funding to distribute through 2019. PCORI will target studies that seek more input from patients and clinicians on treatment effectiveness to improve the quality of care and reduce its cost. It is just one of several recent federal agencies, including the Centers for Medicare and Medicaid Services, created by the ACA to increase funding for such research.

In the most recent round of PCORI grants, awarded in December, two Pitt/UPMC projects garnered almost 10 percent of the funding awarded to 25 projects, out of 500 proposals submitted.

School of Health and Rehabilitation Sciences faculty member  Michael Schneider’s project will study senior citizens’ involvement in community exercise programs to evaluate non-surgical treatment methods for patients with lumbar spinal stenosis.

James Schuster, chief medical officer of UPMC’s Community Care Behavioral Health, received $1.7 million in PCORI funding to examine two different behavioral-health interventions for adults with serious mental illness. These adults die at a much younger age than the general population due to tobacco use and obesity, Schuster said. Both interventions involve training mental-health case managers and peer-support staff to work as “health-care navigators,” he said, providing wellness and health-care information to patients and acting as advocates for their health-care needs. Half those in the study will then be given self-management toolkits to use; the other half will stay in contact with a nurse in the mental-health center where they previously had received treatment.

Crucial for their PCORI application, Schuster said, was the collaboration with Pitt’s Charles Reynolds, a faculty member in geriatric psychiatry and in neurology and neuroscience in the School of Medicine, among his several appointments, and with Tracy Carney, manager of peer support services at CMSU Service System, which covers Columbia, Montour, Snyder and Union counties in central Pennsylvania, where the study will be piloted. Eventually the research will encompass 11 sites throughout the state.

To secure funding, Schuster’s team also worked with UPMC’s Community Care, the Behavioral Health Association of Rural Pennsylvania and Pitt’s Graduate School of Public Health.

“This is an example of how UPMC has been able to identify a health-care need and bring academic expertise to help address it in a real-world setting,” Schuster said.

Loren Roth, associate senior vice chancellor for clinical policy and planning in the Health Sciences and a psychiatry faculty member, who is senior adviser for quality at UPMC Health Plan, added: “It’s an exciting example of the successes of both UPMC and Pitt in this growing area of research importance.”

Roth is a member of the UPMC/University collaborative steering committee that gave the Work Group its mandate. “The strong affiliation between Pitt and UPMC has historically emphasized Pitt’s special expertise in research and education, coupled with UPMC’s clinical-care delivery system,” he said. “Now is a great time for integration of these capacities and expertise to be fully and successfully competitive in today’s research-funding and care-financing systems, and especially as it relates to changes in health-care delivery and financing.”

According to Sally C. Morton, who directs Pitt’s Comparative Effectiveness Research Core (CERC), established in 2011 to help University and UPMC researchers collaborate and seek funding, together the two institutions “provide a petri dish, if you will — a wonderful microcosm of what is going on. If we can get great data, we can drive health-care reform.”

The concept of comparative effectiveness research, she said, “got muddled a little” when anti-Obamacare politicians began talking as if CER would lead to health-care rationing and “death panels.”

“Is this about taking care away from you or providing less care? No,” she said. “It provides head-to-head treatment comparisons.”

But thanks to political fallout, patient-centered outcomes research, or PCOR, is being emphasized a bit more by the federal government. PCOR “is all about asking patients to be part of the prioritization of research questions and to be part of the research.” The idea of CER, she explained, still will be to devise the best ways “to take the results of research, and get them into practice, and convince people who are delivering the care that this is the way to deliver the care.

“It is very easy to do research but very hard to change behavior and everybody knows that,” said Morton, chair of biostatistics in the Graduate School of Public Health and the statistician on Schuster’s PCORI-funded project. “PCORI is very aware of this challenge,” and is funding awareness-building programs for its funded research as well, she said.

The nation’s high costs for health care “wouldn’t bother me if we were healthier,” she added, “but we’re not.” If we wait to fix the situation, “we’ll make decisions based on necessity, because the costs are too high. I’d rather we not get backed into a corner. People in health services research, we realize the time is now. This is terribly important for the nation. Continued heath-care costs with the national growth we’ve seen over the past few years will cripple the nation.”

In October, the Centers for Medicare and Medicaid Services funded another project that resulted from the newly formed UPMC-Pitt Collaborative Work Group. It is a collaboration among UPMC Community Provider Services and its Aging Institute and Palliative and Supportive Care Institute, Excela Health, Heritage Valley Health System, Jewish Healthcare Foundation and Robert Morris University to investigate ways to increase the quality of local nursing homes.

This “Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents,” dubbed RAVEN, hopes to reduce costs and improve care through a variety of interventions, from improving communications among nursing-home staff about residents’ changing medical conditions to improving management of residents’ prescription drugs.

Said lead RAVEN investigator Kathryn Lanz, director of geriatric services and education at the palliative support center: “After blending the needs of the nursing home residents with the scientific evidence that is proven to reduce unnecessary hospitalizations, we realized it was going to require a community effort to make this a success.

“Thinking outside the box and creating a grand partnership is really what got us this funding,” Lanz added. “We’re even partnering with other health systems. When it comes to the community, you really need to think outside your health system.

“It is clear to me, more now than ever, that we have systemic support to work together, capitalizing on each other’s strengths, and sharing resources (such as IT, administration, pharmacy, educators, clinicians, analysts, informatics and finance) from various departments, in various different organizations,” she concluded. “Academic excellence helps draw people into the health system and having a system that is eager to innovate and improve care draws academic excellence. We must start the conversations with each other, learning one another’s strengths and step outside and see what is going on in the community. The relationship potentials for research are limitless in western Pennsylvania.”

—Marty Levine

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