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January 23, 2014

More funds for patient-centered outcomes research

A Pitt/UPMC research collaborative, formalized last April, has once again garnered funding from the Patient-Centered Outcomes Research Institute (PCORI), a creation of the Affordable Care Act. The research will continue the collaborative’s focus on reforming health care and on comparative effectiveness research (CER), which examines the efficacy of medical treatments.

“It’s very exciting as an individual researcher to see the potential impacts on patients’ lives due to this work,” says Sally C. Morton, director of Pitt’s Comparative Effectiveness Research Core (CERC), begun three years ago to aid University and UPMC researchers in mutual research efforts. “The success is partly due to the commitment UPMC and Pitt made to this work.”

The three new projects chosen by PCORI were among 82 selected from 624 proposals:

•  “A Path Towards a Learning Health System in the Mid-Atlantic Region” brings Pitt and UPMC together with Johns Hopkins, Penn State and Temple to form a single clinical data research network — one of 11 PCORI is funding — to improve data collection for CER. The project is led by medicine faculty member Rachel Hess and will gather information from more than 2.5 million patients in seven states and the District of Columbia.

•  “Amplifying the Patient’s Voice: Person-centered Versus Measurement-based Approaches in Mental Health” will be led by psychiatry faculty member Kim MacDonald-Wilson, who also is part of UPMC’s Center for High-Value Health Care (CHVHC,  part of its insurance services division) and senior director of recovery and wellness transformation at Community Care Behavioral Health. This project aims to assess how these two models of care affect communication and shared decision-making between adults on Medicaid who have a serious mental illness and their prescription providers.

•  “Modeling Strategies for Observational CER — What Works Best When?” is under the direction of Douglas Landsittel, faculty member in the Division of General Internal Medicine. Landsittel and his colleagues will look for the best ways to analyze CER data, including devising optimal research questions for observational studies.

The UPMC-Pitt collaborative work group is co-chaired by Everette James, associate vice chancellor for health policy and planning for the Schools of the Health Sciences, and Donna Keyser, senior director of CHVHC.

Patient-centered outcomes research, says Keyser, “is such a new and important focus of research that has heretofore not been here. The awards are a continued endorsement of our unique opportunities, which really [employ] all the strengths of our integrated health care system … and the added value of close partnership with academic experts.”

Says Jane Kogan, director of grants and contracts for the CHVHC: “We’ve been waiting a long time for a funding entity like PCORI to come on the scene … The PCORI funds give us a unique opportunity to bring additional resources to the work we are already doing.”

Each school involved in the first project — creating the data center — was asked to focus on collecting information about obesity among the patients it sees as well as on two other conditions, including a rare disease. The Pitt/UPMC collaborative will be amassing data on pulmonary disease and atrial fibrillation (irregular heartbeat).

The real challenge for the project’s five-institution team over the next 18 months, says Kogan, “is making the data comparable and making the systems talk to each other.”

She reports that these collaborators already are working toward future projects: “It’s important for success at PCORI to show not only a good regional understanding but a regional collaboration.”

The second project, focused on mental health care, will help caregivers and medical insurance payers improve efficiencies and understand options for the growing group of individuals insured by Medicaid, she says: “This is unprecedented. It is really an opportunity around creating information that … can be delivered across all health care systems and address the needs of all stakeholders involved.”

Morton is co-investigator on the final project, which analyzes observational data about how different treatments work in patients. “It’s right on the cutting edge of comparative effectiveness research because we believe that, to really answer the questions that matter to patients, we’re going to have to use observational data,” she says. However, she adds, “there are problems with such data. When we look at the outcomes of observational studies, we’re not sure that the results we see … are due to the interventions themselves or that the patients are different (in) each intervention.” Perhaps sicker patients chose surgery, for instance, and are worse at the end of this type of treatment because they were worse when diagnosed, compared to patients diagnosed earlier, who then chose a “watch and wait” strategy with the help of their physicians.

“Our hope for the future,” concludes Keyser, “is that we will be able to continue to grow this very important collaboration between UPMC, the University and other stakeholders across the state and across the nation.”

—Marty Levine