Some adults and youth with severe obesity are unable to lose enough weight with diet and exercise to improve their health. There are different types of weight loss, or bariatric, surgeries that may help them lose weight and address other issues related to obesity, such as diabetes. However, such surgeries carry various risks.
A PCORI-funded study led by researchers at Kaiser Permanente Washington Health Research Institute compared two of the most common types of bariatric surgery: (1) Roux-en-Y gastric bypass (RYGB), or gastric bypass, and (2) sleeve gastrectomy (SG), or sleeve surgery. In a January 2020 JAMA Surgery article, the research team detailed five-year outcomes of patients who underwent either RYGB or SG, finding that RYGB patients were significantly more likely than SG patients to end up back in the hospital in the years following surgery. In a March 2020 JAMA Surgery article, the team discussed diabetes remission outcomes among patients who underwent RYGB and SG surgeries.
The research team's PCORI-funded Implementation project is designed to make the results of the original research study part of the decisions patients make with their doctors about weight loss surgery.
Learn more about how this study used vast data from PCORnet®, The National Patient-Centered Clinical Research Network, to study outcomes among the three most common weight-loss surgeries. In addition, find out more in this Q&A with study Principal Investigator David Arterburn, MD, MPH, about the study's findings and bariatric surgery guidelines for patients with type 2 diabetes. Hear more about the research study and Implementation project from Dr. Arterburn through these four videos.
A pair of Evidence Updates is now available that can help clinicians and patients work together to make informed decisions regarding patient care.
African-American children are more likely than other children to have asthma and to get sicker and die from it. For their PCORI-funded study, researchers at Washington University in St. Louis enrolled 206 African American children and teens ages 6-17 with mild persistent asthma.
Results from the study support existing evidence that children with mild asthma can self-manage their condition by using medications when their symptoms occur. This contrasts with the traditional method of taking a medication daily, regardless of symptoms, and using an inhaler when symptoms arise. As reported in The Journal of Allergy and Clinical Immunology, the study focused exclusively on African-American children, who have traditionally been underserved in research and have had worse asthma-related health outcomes than other children.
A pair of Evidence Updates is now available to help support conversations between parents and clinicians about choosing the best option for managing mild persistent asthma in children.
Depression is common among patients with kidney failure and is associated with poor outcomes including higher risk of kidney function decline, hospitalization, and death. A PCORI-funded research team at the University of Washington studied patients with kidney failure undergoing maintenance hemodialysis.
The team found that patients with depression who received the antidepressant medicine sertraline had modestly better depression scores and improvements in other patient-reported outcomes, compared with patients with depression who received cognitive behavioral therapy. However, patients on sertraline also reported more frequent mild to moderate adverse events, according to the findings published in the Annals of Internal Medicine.
A pair of Evidence Updates is now available to help support conversations between patients and/or their caregivers and clinicians about treating depression while receiving maintenance hemodialysis.
People with cardiovascular disease who took aspirin to lower their chances of having a heart attack or stroke experienced similar health benefits, including reduced death and hospitalization, whether they took a high or low dose of the medication, according to findings from the PCORI-funded ADAPTABLE Study, the largest aspirin dosing trial conducted in routine care and clinical settings. The results were presented at ACC.21 – the American College of Cardiology’s 70th Annual Scientific Session – and simultaneously published in the New England Journal of Medicine in May 2021.
The study is also the first randomized controlled trial conducted using PCORnet®, the National Patient-Centered Clinical Research Network. Read more about the study in this PCOR Blog post and watch a video featuring the study's co-investigator. In addition, learn more about the findings in this news release, at TheAspirinStudy,org or through these English or Spanish results summaries.
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People with serious mental illnesses often struggle to receive care to address common chronic physical health problems. Certain serious mental illnesses may make it hard for people to work or live on their own or to arrange for health care. These problems can be worse if language or cultural issues are barriers to receiving care.
This PCORI-funded study's research team compared two types of care to help these patients: integrated care—physical and mental health care at the same clinic—and integrated care with a peer navigator. Peer navigators have backgrounds similar to patients and help patients find and use healthcare services. Overall, people who worked with peer navigators improved more than people who didn’t, reporting better physical health and empowerment. They also scheduled more appointments with clinicians, which could help them avoid emergency room visits.
In this PCORI Story, read about how this project and three others are testing ways to help people with serious mental illness get the physical health care they need.
Parkinson’s disease is the second most common neurodegenerative condition in the United States, affecting 1 to 2 percent of people over age 60. This disease can cause poor balance; shaking in the hands, legs, or face; and pain, fatigue, dementia, and depression. Progress has been made in treating patients’ motor symptoms. But gaps remain in addressing other patient concerns.
This PCORI-funded project compared the effectiveness of team-based outpatient palliative care to current standards of care for people living with Parkinson’s disease. The palliative care intervention included quarterly visits with a team that included a neurologist, social worker, chaplain, and nurse who used checklists to assess and manage palliative care.
The project team reported in JAMA Neurology that, compared to usual care that used a neurologist and primary care practitioner, patients receiving palliative care at six months had improvements in their quality of life, symptom control, grief, and advance care planning. Caregivers had improved anxiety and spiritual well-being at six months and reduced caregiving burden at 12 months. A related editorial calls palliative care "the next frontier" in treating Parkinson's disease.
Through a Dissemination and Implementation award, the program is now being rolled out as part of standard care at 34 medical centers designated as Centers of Excellence by the Parkinson’s Foundation. The centers vary in size, type, staffing, and resources to support staff, and serve diverse patient populations.
According to the U.S. Department of Health and Human Services, American Indian/Alaska Native adults are almost three times more likely than non-Hispanic white adults to be diagnosed with diabetes.
In response, this PCORI-funded study trained laypeople known as community health representatives to coach and help coordinate care for people in their own Navajo communities. Because many of the communities are rural, there are geographical challenges with access to health clinics.
As reported in International Journal for Equity in Health, compared to those not in the program, people in it lowered blood sugar and cholesterol levels at a greater level, and they also were more likely to make and keep appointments with doctors and other health providers. This PCORI Blog post provides additional insight into the study and others like it that are focused on the health of people living in the Navajo Nation.
Lung cancer is one of the most common and deadly cancers, causing more deaths than colon, breast, and prostate cancers combined, according to the American Cancer Society. Treatment requires an array of specialists. One promising approach is multidisciplinary care, in which all of the specialists involved in a patient’s care work together to develop a coordinated treatment plan. Leading cancer organizations recommend this approach, but questions remain about its effectiveness and how to best implement it.
Results from a PCORI-funded study suggest patients receiving multidisciplinary care—in which pulmonologists, oncologists, radiologists, and surgeons meet to design a care plan with patients and their families—get more-thorough procedures to pinpoint the stage of their cancer than those who see specialists through a sequence of referrals. As a result, the multidisciplinary treatment that patients receive is more appropriate for their stage of cancer. Finally, patients who received multidisciplinary care and their caregivers also were more satisfied with their overall care.
In this PCORI Story, read about how the research team found that with up-front treatment planning among the different specialists, patients get treatment that is more appropriate for their cancer’s severity
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