Feds Target Roles of PAs and Nurses for Comparative Research

January 23, 2012

January 23, 2012 — Physicians and hospitals are deploying nurses, physician assistants, and other nonphysicians in new, expanded, and sometimes controversial ways, especially as healthcare reform puts a premium on medical homes and the teams that staff them.

A new research agency created by the Affordable Care Act (ACA) wants to compare such workforce strategies to see which ones benefit patients the most.

That is just one priority among many that appears in a tentative agenda published online today by the Patient-Centered Outcomes Research Institute (PCORI). All in all, the priorities proposed by PCORI are broad, but several issues pertinent to physicians — such as the role of nonphysician clinicians — jump off the page.

The healthcare reform law established PCORI to improve healthcare through comparative effective research (CER) — that is, making head-to-head comparisons of different ways to prevent, diagnose, and treat a clinical condition. Such research, sorely in short supply, can help patients, clinicians, and other healthcare players make better decisions, according to PCORI.

When first unveiled in reform legislation, PCORI sparked fears of healthcare rationing among social conservatives, some going so far as to warn of "death panels." The ACA, however, prohibits the Department of Health and Human Services from relying on PCORI findings to determine "coverage, reimbursement, or incentive programs" under Medicare that discriminate against elderly, disabled, or terminally ill individuals.

The draft version of its agenda, including the CER priorities, is designed to guide PCORI as it decides what research projects to fund. The agency is inviting public comment on its proposed game plan through March 15. The agency expects to issue a final version sometime in April and then begin soliciting research proposals in May, an agency spokesperson told Medscape Medical News.

The ACA provides PCORI with a large budget. The law requires private payers and Medicare to pay a tax on each insuree to fund the agency's work. In 2014, that head tax will bring in $500 million.

Use of EHR Systems to Come Under Research Spotlight

The draft document that PCORI published today sets forth 5 general priorities for CER:

Assessment of options for prevention, diagnosis, and treatment: Research in this category might compare 2 different drugs for treating acid reflux, or 2 different diagnostic imaging methods for assessing mitral valve leakage. PCORI is looking for studies that emphasize patient preference and decision-making. They also should focus on wild-card factors ranging from clinical to economic that can affect patient outcomes. PCORI will devote 40% of its research budget to this category.

Improving healthcare systems: These studies will compare system-level approaches to improving access, coordination of care, self-care, and the like. Electronic health records (EHRs) and the use of physician assistants, nurses, dentists, and pharmacists also fall into this category.

Communication and dissemination research: PCORI's goals in this category include finding the best ways to educate clinicians and patients alike about their options for prevention, diagnosis, and treatment, and getting patients more involved in making healthcare decisions — through EHRs, for example.

Addressing disparities: Health status and healthcare vary by race, sex, geographic location, economic status, and other factors. PCORI will fund research on how to reduce these disparities.

Accelerating patient-centered outcomes research and methodologic research: These studies will delve into the use of registries and clinical data networks, how to improve the quality of clinical data in follow-up studies, and methods of analyzing data that track patients over time.

Wide Evidence Gap

The report issued by PCORI today repeatedly stresses how the new agency is attempting to fill in a gaping evidence gap in the healthcare system.

For example, new therapies and technologies hit the market without adequate comparisons to other approaches, according to the report. Outcomes important to patients go unstudied, as do benefits and risks over years of use. Likewise, comparative studies are lacking for systemwide interventions, such as disease management, telemedicine, and quality improvement.

Clinicians, patients, healthcare organizations, and the general public can weigh in on the proposed agenda and research priorities of PCORI at the agency's Web site or at its National Patient and Stakeholder Dialogue meeting, set for February 27 in Washington, DC. More information about the meeting is available at the PCORI Web site.

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