Results That Make a Difference

Evidence That Helps

PCORI supports research that can provide evidence to help patients and clinicians make better-informed decisions about health and health care. A study we funded at the University of Rochester has done that. The research team reports in Neurology that it’s feasible to provide specialty care to patients with Parkinson’s disease in their homes, via “virtual house calls.”

People with Parkinson’s disease develop movement problems, so getting to a doctor can be difficult, and specialists are often a long way from home. The Rochester research team randomly assigned 195 people to receive usual care with or without virtual house calls using video conferencing. Almost all—90 percent—of the virtual visits took place as scheduled, demonstrating the program’s feasibility. The two groups rated their symptoms and quality of life similarly, but the virtual appointments saved patients a median of 88 minutes per visit compared with usual care.

With this information in hand, patients, their clinicians, and their health systems can look to telehealth as an alternative to time-consuming office visits, and health plans can be assured that paying for these visits will achieve outcomes that are just as good while saving their patients time and money. The research team has already embarked on a new PCORI-funded project to provide virtual care across the state of New York. 

Preventing Blood Clots

We’re very pleased to see the results of a study at Johns Hopkins University that could have a substantial impact on a major health problem. The research team reports in PLOS ONE that better educating nurses about preventive treatment can help hospitalized patients avoid one form of potentially fatal blood clots, venous thromboembolisms (VTE), which usually start in in the leg but can break off and lodge in the lungs.

Each year, as many as 100,000 Americans die of VTEs. These deaths are largely preventable with modern blood thinners. Hospitalized patients are at elevated risk of VTE, and a small but important fraction of patients miss blood-thinner doses. In the PCORI-funded study, nurses on 21 floors of a university hospital received one of two web-based education programs about the value of preventive medicine. One program consisted of slides and narration, while the other was more interactive.

On all floors of the hospital, patients missed fewer doses of blood thinners after the nurses completed the education programs. Results were similar regardless of the type of program, although nurses found the interactive module more engaging.

The team has also found that educating patients themselves makes a difference in reducing the number of missed doses of the preventive treatment. The research team is now expanding their program with a second PCORI award to refine, adapt, and extend both parts of their approach throughout the academic hospital and in a community hospital.

Helping Older People Walk More Easily

As the population ages, falls become an ever-growing cause of injury and death. That’s why a study led by a team at the University of Pittsburgh could prove very important. The team reports in JAMA Internal Medicine that a group exercise class focusing on stepping and coordination, in addition to strengthening, helped older adults increase their walking speed. Researchers have previously found that a slow gait comes with higher risk of disability, morbidity, and even early death.

The 298 people in the study were, on average, 80 years old and lived in independent living facilities and senior housing. Half took exercise classes that emphasized coordination, included stepping patterns and walking patterns, and required participants to stand for most of the class. The other half took seated classes typical of programs that older adults take to improve strength, endurance, and flexibility. After 12 weeks of twice-a-week classes, participants in the coordination class had improved their gait speed, but strength-class participants had not.

Making the Most of Evidence

I’m especially excited to share with you the first results from a project we’re piloting, in which we fund reanalyses of data from large clinical studies. The idea is that most research findings tend to give average treatment effects, but patients and doctors need more-personalized results that can take into account patients’ characteristics and preferences. Taking a closer look at large clinical data sets may be able to offer that.

We funded a team to reanalyze data from a study of 3,876 people who had insulin resistance—an impairment in blood sugar control that can lead to diabetes—and had had a stroke or ministroke. The original study found that a medicine to treat high blood sugar can reduce the risk of having another stroke or a heart attack. The questions that a team from Tufts Medical Center, Yale School of Medicine, and elsewhere asked in a reanalysis was: Do some people benefit more from these treatments? And do some people risk more harms from the treatments’ side effects?

The research team reports in JAMA Neurology that patients at higher risk of stroke or heart attack are likely to benefit more from the medicine than patients at lower risk. Unfortunately, they also bear a higher risk of a treatment side effect: bone fracture. Clinicians may find these results of great interest to discuss with patients in choosing treatment after a stroke.

Putting Results to Work

PCORI funds research that provides evidence people need, and we also strive to get those findings into the hands of those who can use them. Examples of this work include two new continuing education activities to help clinicians stay up-to-date on the latest research results. One activity provides information about results of a PCORI-funded study on treatments for stroke survivors.  A second activity will launch shortly about two PCORI-funded studies I’ve told you about in a previous blog, shedding light on treatment trade-offs for men with localized prostate cancer. These two studies offer some clear take-home messages for men and their doctors to consider when choosing whether to undergo surgery, radiation, or active surveillance.

In addition to the continuing education activities on findings about for prostate cancer treatments, we’ve prepared the first in what will be an ongoing series of Evidence Updates on our funded studies’ results. These information sheets inform patients and clinicians about what important research results mean for their own decision making. We’re working with the American Urological Association and Men’s Health Network to get the information to patients and doctors who could use it. Ultimately, that’s our goal for the evidence our funded studies produce: informing decision making about health and health care.

We look forward to sharing more results with you in the coming months, and we hope to see you at our Annual Meeting.