The Patient-Centered Outcomes Research Institute (PCORI) board of governors recently approved $27 million in grant funding for several patient-centered research studies that take advantage of the expanding informatics infrastructure of PCORnet, the National Patient-Centered Clinical Research Network.
The comparative effectiveness studies taking place across PCORnet’s Clinical Data Research Network are:
• A Non-Inferiority Comparative Effectiveness Trial of Physician-Led vs. Nurse-Led Home-Based Palliative Care in Older Adults with Advanced Illness and Their Family Caregivers: This project will compare a conventional physician-led home-based palliative care (HBPC) model that includes routine physician home visits to a contemporary more efficient nurse-led HBPC model that leverages experience and training of nurses and remote physician supervision to facilitate greater access to palliative care services. This study will take place in sites across the Partners Patient Outcomes Research to Advance Learning (PORTAL) Clinical Data Research Network (CDRN).
• Population-Based Comparison of Evidence-Based, Patient-Centered Advance Care Planning Interventions on Advance Directive Completion, Goal Concordant Care and Caregiver Outcomes for Patients with Advanced Illness: This project will compare three practical approaches to advance care planning (ACP) for patients with cancer, heart, and lung disease at 27 clinics at three University of California (UC) sites (UCLA, UCSF, and UCI) that are part of the pSCANNER CDRN. Outcomes for ACP and treatment will be collected for all patients with advanced illness in these participating clinics.
• Provider-Targeted Behavioral Interventions to Prevent Unsafe Opioid Prescribing for Acute Non-Cancer Pain in Primary Care: This project, occurring in three health systems that participate in the PaTH CDRN, will look at the comparative effectiveness of different health system strategies to prevent unsafe opioid prescribing while ensuring access to non-opioid methods for pain management. The project team will assess whether behavioral science-based interventions can “nudge” providers toward more evidence-based care for patients with acute non-cancer pain. The multidisciplinary research team will work closely with a stakeholder advisory committee comprised of patients, patient advocates, primary care providers, pain medicine specialists, payers, health system executives, experts in behavioral science, and regional and national organizations.
• Statistical Methods and Designs for Addressing Correlated Errors in Outcomes and Covariates in Studies Using Electronic Health Records Data: This project will develop statistical methods that allow researchers to obtain accurate estimates using data that have been only partially validated and to better understand which patient records should be validated to optimize resources. It will then apply the methods to a real-world study using EHR data from the Mid-South CDRN that is identifying factors that affect risk of early childhood obesity.
• Comparative Effectiveness of an Exercise Intervention Delivered via Telerehabilitation and Conventional Mode of Delivery: This project will aim to address exercise challenges for those with multiple sclerosis (MS). For a variety of reasons, many people with MS do not exercise, which can lead to increased health challenges. In partnership with PCORnet’s iConquer, the study will compare an individual exercise program followed at home or at an exercise facility by people with MS. Based on findings, tools will be developed to help educate the MS community so patients for whom it is difficult to go to an exercise facility regularly can have access to the program at home.