Telehealth to Optimize Management of Multiple Chronic Conditions Among Vulnerable Populations in Primary Care -- Cycle 3 2023

The Patient-Centered Outcomes Research Institute (PCORI) is seeking to fund high-quality, comparative clinical effectiveness research (CER) projects that focus on different approaches to incorporating access to and use of telehealth to optimize management of multiple chronic conditions in primary care, particularly among vulnerable populations.

Research Initiative Highlights

The COVID-19 pandemic compelled a rapid expansion of the use of telehealth modalities for remote care delivery. With this expansion of use, a clear need has emerged to identify the most effective, evidence-based ways to incorporate telehealth as part of routine clinical workflow to facilitate optimal chronic disease management beyond the pandemic and, specifically, among individuals with multiple chronic conditions in primary care settings. The use of telehealth modalities also has the potential to overcome barriers of distance and access to care, but future research should address the disparities that exist in access to and use of telehealth and ensure that any expanded use of telehealth ultimately mitigates, and does not exacerbate, existing documented health disparities among vulnerable populations (those who are elderly, rural dwelling, and/or low income; those in racial/ethnic minority groups; those with low health and/or limited digital literacy; those with physical, intellectual, or developmental disabilities; those living in unstable circumstances; and/or those with limited English proficiency).

This Targeted PCORI Funding Announcement is soliciting applications that respond to the following question: What is the comparative clinical effectiveness of different approaches to incorporating access to and use of telehealth to optimize management of multiple chronic conditions in primary care, particularly among vulnerable populations?

Applications should focus on community-dwelling individuals with multiple chronic conditions and should be powered to allow for conclusions regarding one or more vulnerable populations of interest. Broad, inclusive studies powered for one or more vulnerable population subgroups are encouraged, but those limiting the study population to one or more of those subgroups alone are also acceptable. Potential comparisons may include studying the comparative clinical effectiveness of telehealth modalities to optimize care delivery (e.g., utilizing telehealth to augment evidence-based models of care delivery for chronic disease management), engaging support personnel to facilitate telehealth use (e.g., strategies involving the use of interpreters), or comparing different state-level public policy regarding telehealth (e.g., regulatory changes involving payment parity across states that directly influence access to care and health outcomes). The focal setting should be primary care, but studies can incorporate home-based care and include specialty care as appropriate.

Applicants are encouraged to propose multisite individual, or cluster randomized clinical trials or natural experiments and are strongly encouraged to assess issues of intervention implementation with an aim of facilitating widespread uptake of findings after completion of the study. Toward that end, hybrid type I and hybrid type II designs may also be considered appropriate. Applicants are also encouraged to conduct analyses to evaluate the relative clinical effectiveness by telehealth modality as appropriate (e.g., audio-only versus video). Applicants should plan to include periodic outcome assessments with follow-up through at least 12 months from baseline and to propose well-justified outcomes that are clinically meaningful, considered important by patients, and can be impacted by interventions evaluated in CER studies of a maximum duration of five years.

For questions regarding this funding announcement, please reach out to [email protected].