Final Research Report

View this project's final research report.

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:

  • Reviewers noted a significant rate of cross contamination in the study because providers in the control group used some of the features of the intervention. They suggested that future studies of this tool should be cluster randomized to avoid this contamination, and that this problem likely limited the generalizability of results. The researchers added these concerns to the study limitations.
  • Reviewers expressed concern about the high rate of missing data in primary outcomes, which was about 38 percent of participants. Also, reviewers expressed concerns that the study did not appear to account for the missing data or discuss the potential for biased outcome measures in the study population. The researchers added to the report their initial expectations regarding recruitment and retention, indicating that they expected a high rate of non-completion. The researchers also stated that they planned to input the missing data in future analyses in order to test for the effect of the missing data.
  • Reviewers expressed concern that the report focused too much on secondary and exploratory results related to group differences in patient ratings of the provider. The reviewers raised questions about these results because randomization was at the patient, not the provider level. Since the researchers did not randomize the providers, patient expectations or other patient characteristics may have differed by provider and therefore, may explain the difference in ratings. The researchers revised their conclusions and emphasized that the provider effects should be considered exploratory and in need of further research.

Conflict of Interest Disclosures

Project Information

Clete Kushida, MD, MS, PhD
Stanford University School of Medicine
Sustainable Methods, Algorithms, and Research Tools for Delivering Optimal Care Study (SMART DOCS)

Key Dates

May 2013
September 2018

Study Registration Information


Has Results
Award Type
Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
Populations Populations PCORI is interested in research that seeks to better understand how different clinical and health system options work for different people. These populations are frequently studied in our portfolio or identified as being of interest by our stakeholders. View Glossary
Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: March 4, 2022