The Benefits Accumulate
From our first solicitations for research proposals, we asked applicants to involve patients, clinicians, and other stakeholders in forming research teams and selecting the research questions and outcomes that mattered most from the patient perspective. And with patients, clinicians, and other stakeholders joining scientists on our review panels, we selected the applications that followed these instructions.
We see the benefits of this approach in many of the more than 30 studies with important CER results published to date. It’s clear that some of the study outcomes are far more relevant to patients than the ones researchers alone might have chosen, making the findings particularly useful in helping patients and their clinicians choose among different care options.
PCORI-funded studies have recently published important results on conditions including hepatitis C, chest pain, type 2 diabetes, and childhood obesity. (Getty)
Two examples are the PCORI-funded studies I mentioned in April that compare treatment approaches for men with localized prostate cancer. You can hear from the researchers and one of their patients in a recent PCORI Blog post. Another example is a recent article in JAMA Internal Medicine concluding that the daily finger sticks many people with diabetes use to check their blood sugar levels offer little value for those who have type 2 diabetes and are not using insulin. This practice has always posed a dilemma for patients because finger sticks are uncomfortable and can cause anxiety, the self-monitoring supplies are costly, and it’s not very clear what to do with the results.
Now, in a PCORI-funded study, Katrina Donahue, MD, MPH, and colleagues at the University of North Carolina at Chapel Hill found that routine daily testing did not lead to better control of glucose or other benefits—a result not clearly established before. This means that for many diabetic patients who are not taking insulin, clinicians may be able to advise them that self-monitoring can be greatly reduced or stopped altogether.
These studies show, better than I ever could have predicted when PCORI began funding studies, what happens when patients' interests come first in planning and conducting comparative clinical effectiveness research.
We also saw important new secondary findings coming out of a study led by Erik P. Hess, MD, MS, of the Mayo Clinic. That study tested the effectiveness of a simple decision aid in safely reducing how often patients choose to be admitted for further tests after visiting an emergency department for chest pain that proves not to have been caused by a heart attack. Hess had already reported in The BMJ that patients who used the aid in conversations with clinicians were less likely to stay overnight but developed no additional heart problems in the weeks that followed, as compared with patients who received only usual care.
Shortly after that article appeared, my wife and I were having dinner with friends. When I told them about this study, one said, “That happened to me!” She had experienced chest pain and went to the hospital; tests showed no heart attack, but hospital staff urged her to stay overnight for a stress test in the morning. As a nurse, she knew she was at very low risk and refused, signing out of the hospital against medical advice. Two days later, outpatient tests showed no signs of heart disease. “I saved a lot of money and avoided a night in the hospital,” she told me. “This study makes me feel better about that decision.”
Now, in a paper published in Medical Decision Making in May, these Mayo researchers added to that finding. Their new analysis found patients in different sociodemographic groups experienced similar benefit from the decision aid, but those more skilled in using numbers tended to come away more knowledgeable about their heart risk and healthcare options than did people who were less skilled.
It’s clear that some of the study outcomes are far more relevant to patients than the ones researchers alone might have chosen, making the findings particularly useful in helping patients and their clinicians choose among different care options.
Results That Matter
Here are some other recently published articles of note on PCORI-funded studies that we think can help patients and those who care for them make better-informed decisions.
A Growing Collection
These latest articles add to the growing collection of published evidence indicating that even in our earliest days, we were funding meaningful outcomes research designed to help patients and those who care for them make better-informed decisions. As the years have progressed—and as we’ll surely see in future publications and the study results summaries being posted on the PCORI website—we’ve been able to zero in more and more on the questions that patients and other healthcare stakeholders tell us are important to them. These include such issues as how to best manage chronic pain and opioid use, determine the most effective and patient-centered treatment options for multiple sclerosis, and support adolescents with sickle cell disease as they transition to adulthood.
I hope you’ll check back regularly as we continue to report to you on those and other studies that we believe have the potential to change clinical practice and improve patient care and outcomes.
