PCORI-Feedback_final

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					                                   Research Agenda Priorities Draft

                     Feedback from The Florida State University College of Medicine


PCORI is setting national priorities for research and is creating a research agenda in which
meaningful patient engagement is at the core of all stages of research. The stated goal is to
transform the research process such that patients and clinicians are integrated in all aspects of the
process in order to have a much greater impact on outcomes in families and communities than we
have seen to date. We wholeheartedly agree with the goals and five priority areas. We would like
to suggest some possible mechanisms for implementation and prioritization that, in our opinion,
would increase the effectiveness of the program in reaching the PCORI stakeholders and
improving health care for more people.

In order to gain allegiance with stakeholders to have such a meaningful improvement in outcomes,
PCORI research priorities must mobilize clinicians and families well outside of specialty, tertiary
and traditional academic medical centers. For example, medical ecology studies show that less
than 1 in 1000 persons in the US are hospitalized in an academic medical center (Green et al.,
NEJM, 2001). In order to accomplish its goal, PCORI must prioritize research that can be feasibly
conducted far outside academic medical centers and truly within communities. To achieve this, it
will be necessary to include the direct involvement of physicians and other caregivers who practice
and are embedded within communities. This will allow for the most rapid and far reaching
engagement of the stakeholders prioritized by PCORI (patients, physicians, families). Therefore,
research which builds upon existing networks of relationships with community physicians in
underserved, rural, and otherwise diverse parts of the US will bypass specialty care centers. This
approach will allow for meaningful patient and caregiver engagement in research in a way that is
not possible in traditional comparative effectiveness research settings, i.e., research stemming
from and focused within traditional academic medical centers. Crucially, this bypass will provide an
avenue for the patient, the family, and the physician/caregiver to become truly involved in the
prioritization of research and research goals.

Funding research within settings that have existing networks of clinicians embedded in
communities where the majority of patients in the US are seen should be a PCORI priority.
Prioritization of research in these settings will have higher impact on outcomes for all five PCORI
priority areas. For example, in order to meaningfully address health disparities, research must
center on communities that reach under-served populations who, by definition, do not seek care in
traditional medical centers, specialty care, and are unlikely to participate in clinical trials or
comparative effectiveness research studies. Workforce development research and related
activities led by PCORI which specifically include patient-centered physician training models must
strive to recruit and train clinicians from underrepresented groups. Prioritization of innovative
physician training research is therefore essential to the success of PCORI’s stated mission.
Specific examples of such training programs would be: 1) Centers of Excellence in physician
workforce development aimed to train physicians, especially those from underrepresented groups
in true patient-centered care with a coordinated involvement in patient centered research, 2)
Clinical and research training, in truly community-based primary care settings that provide
comprehensive care, and 3) Physician and researcher accessing to practice networks that engage
patients and their families in community settings. Developing skills at an early stage in training for
organizing care around patients and establishing partnerships with their physicians will lend the
most effective patient centered, culturally relevant care for the future.

We will look forward to the evolution of PCORI and our shared mission of innovating approaches to
true patient-centered approaches to health care in order to substantially impact our nation’s health.
We thank you for the opportunity to provide feedback.



Sincerely,

John Fogarty, MD, Dean and Professor
Myra Hurt, PhD, Professor and Senior Associate Dean for Research and Graduate Studies
Richard Nowakowksi, PhD, Randolf L Rill Professor and Chair, Department of Biomedical Sciences
Les Beitsch, MD JD, Associate Dean for Health Affairs
Amy Wetherby, PhD, Distinguished Research Professor and Director, Autism Institute
Joedrecka Brown, MD Associate Professor, Department of Family Medicine and Rural Health
Heather A. Flynn, PhD, Vice Chair for Research, Department of Medical Humanities and Social
Sciences

				
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