Giving broad-spectrum antibiotics to children with acute respiratory tract infections did not achieve better outcomes than using narrow-spectrum antibiotics, but did increase the rate of harmful effects, a PCORI-funded study found. Earaches, strep throat, and other respiratory tract infections commonly occur in children. Broad-spectrum antibiotics target a wider range of bacteria than narrow-spectrum drugs that target only certain ones, but broad-spectrum carry a somewhat greater risk for creating drug-resistance among bacteria.
PCORI began funding research in 2012. A growing number of our funded studies are now producing important results that are being summarized in leading medical journals and presented at major scientific meetings. Here are examples of those projects and their findings.
As people age, they face an elevated risk of losing their independence through increasing difficulty in getting around. Exercise may help preserve mobility, but programs offered to older adults typically involve exercises that they do while sitting down. This PCORI-funded study compared the effectiveness of a standing exercise program called On the Move with a seated exercise program. It found that On the Move, with its focus on enhancing motor skills and muscle control necessary for walking, was more effective than the seated exercise program at improving older adults’ function and walking ability in the short term.
Although the On the Move group reported a few minor injuries and a somewhat greater discontinuation rate, those in it reported feeling equally safe and satisfied with the more challenging program. The results appear in JAMA Internal Medicine.
Although chest pain sends many people to the ER, a significant percentage are not having a heart attack or other serious heart problems. Using a questionnaire called Chest Pain Choice proved effective in helping such individuals decide whether to forgo unnecessary hospital stays and intensive medical tests.
People who used the questionnaire were more knowledgeable about their risk and care options and more involved in their care decisions than people who didn't use it, this study found. There were no differences in rates of heart-related problems in the following weeks between the two groups. Results appear in The BMJ. A Medscape commentary describes the tool as a “win-win-win” for patients, providers, and payers. Learn more about how these results can help patients and clinicians make decisions about chest pain in a PCORI feature article.
The finger pricks that many people with type 2 diabetes do daily to check their blood sugar levels confer little value compared with forgoing this self-monitoring, this study concluded. There has been debate about how much this self-monitoring enhances the health of people with non-insulin-dependent type 2 diabetes, and whether the benefits exceed the inconvenience and discomfort of daily finger pricking, anxiety it can induce, and financial burdens of out-of-pocket costs for the testing equipment. In results that augment findings of previous research, the study found that self-monitoring achieves no significant differences in disease control, hospitalization rates, need to start using insulin, or quality of life.
Long-term use of opioids, particularly in high diseases, for treating chronic pain increases the risks for addiction and overdose. Healthcare providers need guidance about what works to help patients manage their pain and to avoid or minimize the risks associated with opioids. This study in Washington State compared clinics that implemented an initiative focused on more-cautious opioid prescribing to clinics that did not.
Physicians following the initiative prescribed fewer high doses of opioids. The results appear in the Journal of Pain. Learn more about how these results can help advance safer opioid prescribing in a PCORI feature article.
Two studies in Tennessee and in North Carolina provide men with robust new evidence about the rates of side effects associated with contemporary treatment options for prostate cancer. These options include robot-assisted surgery and newer forms of radiation therapy, as well as active monitoring instead of immediate treatment. The study’s findings can help men better weigh the benefits and risks of their options in consultation with their clinicians.
Two papers (first paper, second paper), one on each study, appeared in the March 21, 2017 issue of JAMA. A related JAMA editorial states, "To date, men with clinically localized prostate cancer have never been better informed about the trade-off they have to make between oncological outcomes and now clearly defined potential adverse effects of available treatments." Find out how men with prostate cancer helped shape one of these studies in a PCORI feature article and a PCORI video.
More PCORI-Funded Research with Results
If clinicians routinely collected data about sexual orientation from patients, it would significantly boost our ability to identify and address health disparities among lesbian, gay, and bisexual populations. However, health systems are not regularly collecting this information. This study determined that while 80 percent of healthcare professionals believe patients would refuse to provide sexual orientation information if asked, only 10 percent of patients say they would refuse. The results appear in JAMA Internal Medicine and LGBT Health. The New York Times also has a feature on the study.
Children taking antibiotics to prevent recurrence of serious infections could remain infection-free, and their families could face fewer costly complications and daily hassles with medical equipment, if the children took the drugs by mouth rather than receiving them through an intravenous line, according to this study. The results appear in JAMA Pediatrics, Pediatrics, and Annals of Surgery. A JAMA Pediatrics commentary says, "the investigators have provided very necessary information about how we can best organize and deliver care to children with a relatively common pediatric diagnosis while improving outcomes, reducing costs and untoward effects, and improving patient satisfaction." Learn more about how these results can inform decisions about treating these infections in a PCORI feature article and a PCORI video.
Using the blood-thinning medicine warfarin enabled stroke survivors, even those over 80, to continue living in their homes longer compared with those who didn’t take the drug, the PROSPER study found. Those taking warfarin stayed in their homes on average 46 more days during the two years after being hospitalized for stroke. Patients advising the researchers said that staying in their homes, rather than being institutionalized in a nursing home or hospital, is the outcome that mattered most. The findings appear in The BMJ. A related editorial calls the study “a solid example of how to refocus research on questions, outcomes, and approaches that could help patients and clinicians to make better healthcare decisions." Learn more about how these results can help stroke survivors gain time at home in a PCORI feature article and a PCORI video.
Using a benefit prediction model, researchers in this study could identify those patients with prediabetes who are most likely to benefit from taking the diabetes drug metformin—and those likely to suffer more harm than good. Although usually safe, metformin causes a potentially serious side effect called lactic acidosis in some people. Knowing which patients won’t benefit from the drug could reduce the number of people who experience this side effect. The paper appears in The BMJ. The incorporation of this benefit prediction model into an electronic health record is now being tested in 50 clinics via this dissemination project. Learn more about how these results can help identify who benefits from medicine in a PCORI feature article.
Medical mistakes can be frightening, harmful, and costly. This study found that involving family members of hospitalized children in the effort to identify and report medical errors boosted error reporting by 16 percent. Family members reported incidents that were otherwise neither detected nor documented, including preventable errors. Such family engagement may be a fruitful way to gather information for both hospital safety improvement and research. Results appear in JAMA Pediatrics.
Two approaches to obesity care helped to reduce body mass index (BMI) scores in overweight or obese children. Both approaches also improved other key health measures and family satisfaction with the children’s care. This study's two approaches both enhanced the usual primary care for childhood obesity by linking families to community resources and sending supportive text messages. Some of the families also received bimonthly coaching on healthy behaviors, which resulted in slightly but not significantly greater reductions in their children’s BMI scores. Results appear in JAMA Pediatrics. Learn more about this study in a PCORI feature article.
Other Journal Articles about PCORI and the Research We Fund
View a collection of papers, articles, and commentaries that provide insights into PCORI-funded work to advance patient-centered comparative clinical effectiveness research.
Posted: August 3, 2017; Updated: January 11, 2018