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Abstract of research paper on Economics and business, author of scientific article — Debra J. Barksdale, Robin Newhouse, Julie Ann Miller

Abstract As part of the Patient Protection and Affordable Care Act of 2010, the U.S. Congress created the Patient-Centered Outcomes Research Institute (PCORI). Its goal is to fund research that will assist patients, caregivers, clinicians, and others in making informed health decisions. Because nurses play a critical role in engaging patients in health care, they are valued participants in setting the institute's agenda and carrying out its programs. In this article, we provide an overview of PCORI and describe how nurses can participate in institute activities and apply for research grants.

Academic research paper on topic "The Patient-Centered Outcomes Research Institute (PCORI): Information for academic nursing"

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NüRS OUTLOOK 62 (2014) 192-200

Nursing Outlook

www.nursingoutlook.org

The Patient-Centered Outcomes Research Institute (PCORI): Information for academic nursing

Debra J. Barksdale, PhD, FNP-BC, FAANP, FAANa'b'*, Robin Newhouse, PhD, RN, NEA-BC, FAANb'c, Julie Ann Miller, PhDb

a University of North Carolina at Chapel Hi!!, Schoo! of Nursing, Chapel Hill, NC b Patient-Centered Outcomes Research Institute, Washington, DC c University of Maryland School of Nursing, Baltimore, MD

ARTICLE INFO

Article history: Received 7 December 2013 Revised 23 February 2014 Accepted 2 March 2014

Keywords:

Patient-Centered Outcomes Research Institute Patient centered outcomes research

Comparative effectiveness research

ABSTRACT

As part of the Patient Protection and Affordable Care Act of 2010, the U.S. Congress created the Patient-Centered Outcomes Research Institute (PCORI). Its goal is to fund research that will assist patients, caregivers, clinicians, and others in making informed health decisions. Because nurses play a critical role in engaging patients in health care, they are valued participants in setting the institute's agenda and carrying out its programs. In this article, we provide an overview of PCORI and describe how nurses can participate in institute activities and apply for research grants.

Cite this article: Barksdale, D. J., Newhouse, R., & Miller, J. A. (2014, JUNE). The Patient-Centered Outcomes Research Institute (PCORI): Information for academic nursing. Nursing Outlook, 62(3), 192-200. http:// dx.doi.org/10.1016/j.outlook.2014.03.001.

Introduction

Nurses help patients navigate the evermore complicated health care delivery system. The number and type of preventive and treatment options are increasing as is the complexity of patient health problems. Informed health decisions require an appraisal of potential benefits and risks for the individual patient. Yet, it is often difficult to find relevant information in the medical literature. Past clinical studies in which topics were selected by researchers have generally not addressed patients' most pressing questions or concerns.

The goal of the new institute, the Patient-Centered Outcomes Research Institute (PCORI), is to fund research providing the information that patients, caregivers, health professionals, and others need to make choices aligned with patients' desired health outcomes (Washington & Lipstein, 2011). PCORI seeks input from the broad range of stakeholders in the selection of topics, project design, and dissemination of findings (Fleurence et al., 2013). The research that PCORI funds considers patients' different life circumstances, inherent characteristics, behaviors, and other factors affecting health status. It will apply rigorous methodologic standards to help ensure that the information produced is valid and can be generalized to

* Corresponding author: Debra J. Barksdale, University of North Carolina at Chapel Hill, School of Nursing, Carrington CB7460, Chapel Hill, NC 27599-7460.

E-mail address: Djbarksdale@unc.edu (D.J. Barksdale). 0029-6554/$ - see front matter © 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.outlook.2014.03.001

THE MISSION OF PCORI

TREATMENT OPTIONS FOR AFRICAN AMERICANS AND HISPANICS/LATINOS WITH UNCONTROLLED ASTHMA

PCORI helps people make informed health care decisions and improves health care delivery and outcomes by producing and promoting high-integrity, evidence-based information that comes from research guided by patients, caregivers, and the broader health care community.

PCORI is supporting comparative effectiveness research to address the following:

• Communication/behavior: enhancing communication between providers and patients, facilitating patient and provider engagement, and tailoring education methods to patients with different characteristics

• Systems: using data integration to identify and target high-risk communities and conducting comprehensive interventions in communities that link support care to health care systems, home, school, and workplace

• Environment: mitigating the effects of stress, violence, and psychosocial dysfunction; providing effective and sustainable environmental interventions; and adding novel environmental interventions for patients who have not responded to current medical therapy

• Response to therapy: adapting evidence-based guidelines for specific groups and examining modifiable mechanisms that underlie differential responses to therapy, factors that may contribute to increased morbidity and mortality, and characteristics that could identify patients who would benefit from aggressive intervention

• Integration of care: integrating care to improve health outcomes and patient and provider experience and improving transitions in care

address the preferences, decision-making needs, and characteristics of a broad range of patients.

In its first 3 years, PCORI has laid an innovative foundation for producing and disseminating clinical research, engaging multiple stakeholders in the process, and embedding clinical research within health care systems and patient communities (Selby & Lipstein, 2014). PCORI expects the results of that research to strongly influence the future education and practice of nurses at all levels.

The Patient Protection and Affordable Care Act of 2010 created PCORI to assist patients, clinicians, and others in making informed decisions by improving the quality and relevance of evidence related to preventing, diagnosing, treating, monitoring, and managing health problems. The institute is to promote innovative research, synthesizing evidence that considers variations in patient subpopulations (Box 1). To guide and carry out its work, PCORI is committed to continuously seek input from a broad range of stakeholders. These include patients; caregivers; clinicians; researchers; policy makers; and representatives of health systems, health care payers, purchasers, industry (e.g., pharmaceutical and biotechnology), training institutions, and organizations that represent stakeholders.

What Is PCORI?

PCORI, although authorized by Congress, is an independent, private, nonprofit institute rather than an entity of the government. This gives us more flexibility to represent the perspectives of the broad health care community and establish the institute as a trusted source of information. PCORI's funding is well established and comes from the general fund of the U.S. Treasury, Medicare, and a small fee assessed on specified private health insurers and self-insured employers. Congress put in place many assurances that PCORI's work would be conducted separately from

politics and partisanship in a credible, open, and transparent manner.

PCORI funds comparative clinical effectiveness research (CER). Such research evaluates and compares the health outcomes and clinical effectiveness, risks, and benefits of two or more treatments, services, and other aspects of health and health care. The subjects of this research can include health care interventions; treatment protocols; procedures; care management and delivery; devices; diagnostic tools; pharmaceuticals; integrative health practices; and any other

PCORI'S FIRST CHALLENGE INITIATIVE

IMPROVING HEALTHCARE OUTCOMES IN RURAL SETTINGS

In June 2013, PCORI announced the winners of a competition to find innovative ways to connect patients, other stakeholders, and researchers as partners to advance patient-centered comparative effectiveness research. A panel of 10 judges, including patients, selected the challenge winners from 29 entries submitted by academic institutions, patient advocacy and community organizations, industry groups, and others. The winner in the prototype category was the University of Michigan's WellSpringboard, a web-based crowdsourcing platform that will let users propose and pledge funds for research topics and researchers to apply for the resulting funding. The prize for the best concept went to ACTONNECT of the Marshfield Clinic Research Foundation. This web-based search engine and interface aims to enable people to conduct searches of health information gleaned from dozens of patient forums and sites and to share their results graphically.

This 2-day Wichita workshop was designed to help build a patient-centered research community in the Lower Plains states. Held in March 2013, it was attended by more than 80 participants representing each of PCORI's stakeholder groups, and 18 additional people joined via webcast. The concerns most frequently expressed at the workshop included the following:

• Lack of home and community-based services to support independent living for rural seniors

• Shortages and uneven distribution of health workers

• Geographic barriers to accessing health care

• Geographic restrictions in insurance coverage that limit access to care

• Difficulties identifying and spreading good health information

The workshop accelerated the growth of PCORI's stakeholder community and built partnerships that may lead to patient-centered research projects. The webcast of the workshop can be viewed at http:// www.pcori.org/events/the-power-of-part-nership-in-research-improving-healthcare-outcomes-in-rural-settings/?type=past.

strategies or items being used in the prevention, treatment, diagnosis, and management of illness or injury in individuals. PCORI also funds work to improve relevant research methods and to build databases to support CER.

Patient-centered outcomes research (PCOR) is CER that helps answer the following questions that a patient is likely to pose:

• "Given my personal characteristics, conditions, and preferences, what should I expect will happen to me?"

• "What are my options, and what are the benefits and harms of those options?"

• "What can I do to improve the outcomes that are most important to me?"

• "How can the health care system improve my chances of achieving the outcomes I prefer?"

To answer those questions, PCORI will do the following:

• Assess the benefits and harms of preventive, diagnostic, therapeutic, palliative, or health delivery system interventions to inform decision making, highlighting comparisons and outcomes that matter to people.

• Be inclusive of an individual's preferences, autonomy, and needs, focusing on outcomes that people

notice and care about such as survival, function, symptoms, and health-related quality of life.

• Incorporate a wide variety of settings and diversity of participants to address individual differences and barriers to implementation and dissemination.

• Investigate optimizing outcomes while addressing burden to individuals, resource availability, and other stakeholder perspectives.

To succeed in its mission, PCORI is charged with establishing national research priorities, carrying out a research agenda, developing and updating methodo-logic standards, and disseminating its research findings so that they may be put into routine clinical practice in a timely manner. Topics for PCORI-funded research must meet a variety of criteria outlined in the founding legislation. Topics must be patient centered and address current gaps in knowledge or variation in care while also addressing a challenge that

can be improved through research. The research must be comparative, include different populations, follow rigorous research methods, and use research resources effectively. The expected findings must have the potential to influence decision making and have an impact on the health of individuals and populations or on the performance of the health care system.

What Is PCORI Doing.?

PCORI began simultaneously building its structure and carrying out its mission. The U.S. Government Accountability Office appointed the PCORI Board of Governors in September 2010 based on specific member attributes. That board includes patients and health care consumers, physicians, a nurse, health services researchers, and representatives of hospitals, integra-tive health care, and health systems; self-insured employers; the pharmaceutical, device, and diagnostics industries; and federal and state governments. The directors of the National Institutes of Health (NIH) and the Agency for Healthcare Research and Quality (AHRQ) serve on that board.

PCORI has reorganized its work around three strategic goals with a dedicated committee for each goal that includes members from the Board of Governors and the Methodology Committee. The goals are: (1) to substantially increase the quantity, quality, and timeliness of useful, trustworthy information available to support health decisions; (2) to speed the implementation and use of patient-centered outcomes research; and (3) to influence clinical and health care research funded by others to be more patient centered. Debra Barksdale, PhD, RN (member of the Board of Governors), chairs the Engagement, Dissemination, and Implementation Committee. The PCORI Methodology Committee members, including Robin New-house, PhD, RN, who is the chair, were also appointed by the U.S. Government Accountability Office. The Methodology Committee is charged to develop and improve the science and methods of CER. External experts and stakeholders (e.g., patients, clinicians, and researchers) are also engaged to inform PCORI's work through advisory panels. In addition to the Board of Governors and Methodology Committee, nurses are represented on PCORI's advisory panels and ambassadors program and as merit reviewers and recipients of funding.

The PCORI Board of Governors approved five national research priorities in May 2012 (Table 1). It continues to collect input from patients, caregivers, clinicians, and policy makers about what health questions are the most important and what outcomes should be considered.

Research Funding

PCORI funds projects fitting within its national research priorities. PCORI selects projects through a competitive review process in which scientists, patients, caregivers, and other stakeholders evaluate

Table 1 — National Priorities for Research and Research Agenda

National Priority

Research Agenda

Assessment of prevention, diagnosis, and treatment options

Improving health care systems

Communication and dissemination research

Addressing disparities

Accelerating Patient-Centered Outcomes Research (PCOR) and methodologic research

Comparisons of alternative clinical options to support personalized decision making and self-care Identifying patient differences in response to therapy

Studies of patient preferences for various outcomes

Improving support of patient self-management Focusing on coordination of care for complex conditions and improving access to care

Comparing alternative strategies for workforce deployment

Understanding and enhancing shared decision making

Alternative strategies for dissemination of evidence Exploring opportunities to improve patient health literacy

Understanding differences in effectiveness across groups

Understanding differences in preferences across groups

Reducing disparities through the use of findings from PCOR

Improving study designs and analytic methods of PCOR

Building and improving clinical data networks Methods for training researchers and patients to participate in PCOR Establishing methodology for the study of rare diseases

proposals on the basis of scientific merit, methodologic rigor, and how well they engage patients and other stakeholders. PCORI funded 50 pilot research projects, each lasting 2 years, and 192 primary research projects, typically lasting 3 years. These awards totaled approximately $350 million.

PCORI has also funded studies focused on specific high-impact topics. These topics are chosen and refined through a process that includes recommendations from the public and organizations; review by staff; development and ranking by workgroups, advisory boards (see below), and the board's Program

Development Committee; and approval by the board. One targeted funding announcement, focusing on uncontrolled asthma among African Americans and His-panics/Latinos, resulted in about $23 million funding for eight asthma projects (Box 2).

In other targeted funding, PCORI is working with AHRQ to support research on uterine-sparing options for the treatment of fibroids. PCORI is also partnering with the National Institute on Aging to develop and fund a large clinical trial aimed at preventing injuries from falls in the elderly. The funding announcement invited proposals for CER on medication management strategies; tailored treatments to address balance defects; information technology to assess and reduce risk of falls and injuries; diagnostic checklists linked to therapeutic interventions; and scalable, sustainable, multicomponent, ongoing prevention programs.

Each project that PCORI funds addresses questions that are critically important to patients and clinicians making health care decisions or seeks information to improve health care delivery (Krumholz & Selby, 2012). A list of the funded projects is available on the website (www.pcori.org/pilot-projects/ and www.pcori.org/fun ding-opportunities/pfa-awards/).

PCORI has also invested $93.5 million in supporting the development and integration of 29 networks operated by either patient communities or health systems. The result will be PCORnet, the National Patient-Centered Clinical Research Network, which will make patient-centered research faster and more efficient.

Research Methodology

The PCORI Methodology Committee is charged with defining rigorous, high-integrity standards and methods to strengthen the science supporting PCOR (Gabriel & Normand, 2012; Methodology Committee of the Patient-Centered Outcomes Research Institute, 2012). The committee held workshops, commissioned contractor reports, and then drafted the PCORI Methodology Report, which the PCORI Board of Governors approved in November 2013 (http://www.pcori.org/ research-we-support/the-pcori-methodology-report/). That report sets forth rigorous standards for research activities and makes recommendations for new research related to methodology. The first methodology projects were funded in summer 2013.

Engagement Awards

PCORI has begun facilitating opportunities for patients to become more engaged in the research process. The goals of these initiatives are to accelerate research proposal submission and the dissemination of findings and also to develop a nationwide community of patients, stakeholders, and researchers equipped and eager to participate in PCOR. The Eugene Washington PCORI Engagement Awards Program recently began calling for proposals in three categories: (1) Knowledge Awards, which will build knowledge around how consumers of health care information receive and make use of PCOR/CER findings; (2) Training and

Development Awards, which will promote the training and development of members of the patient and stakeholder community to increase capacity for engaging in PCOR/CER; and (3) Dissemination Awards, which will support activities dissemination of information and encourage the adoption of PCORI-funded research results as well as support best practices for engaging patients and other health care stakeholders in research.

Within the Training and Development Award Program, there is the Pipeline to Proposal Awards. This three-tier initiative seeks to shift the research-funding paradigm, allowing patients and other health care stakeholders to engage and partner with researchers to study the issues that are most critical to them. In December 2013, 30 projects received awards under this initiative's first funding opportunity available in the Western Region of the United States to individuals, consumer/patient organizations, health professionals and entities, researchers, and combinations of these individuals and groups.

Challenge Initiative

In another activity, PCORI introduced a challenge initiative, asking for ideas about how researchers might connect with potential patient or caregiver partners and how patients or caregivers who have research ideas or are interested in working with researchers might connect with the appropriate investigators. This open-innovation approach tapped into the expertise of patient and other stakeholder communities to explore possibilities for creating a matching system to link patients, other stakeholders, and scientists as partners in conducting research (Box 3).

Advisory Panels

PCORI's advisory panels have helped to identify research priorities and refine the research project agenda. Each panel has about 20 members, including representatives of practicing and research clinicians, patients, and experts in scientific and health services research, health services delivery, and evidence-based medicine who have experience in the relevant topic and, as appropriate, experts in integrative health and primary prevention strategies. Appropriate experts from industry are represented as well. Current advisory panels focus on disparities in health and health care; assess prevention, diagnosis, and treatment options; improve health care systems; engage patients; and evaluate clinical trials and rare diseases.

Workgroups

PCORI has hosted workgroups to obtain input on a set of targeted research topics for funding. PCORI follows a three-step process to narrow broad research ideas into a concise list of high-priority research questions: (1) identification of broad range research areas, (2) refinement of research areas into questions, and (3) identification of a concise list of high-priority questions for research funding.

Workgroups have considered the following: (1) bipolar disorder and antipsychotic use in adolescents and young adults, (2) clinical interventions to reduce hypertension disparities, (3) ductal carcinoma in situ,

(4) integration of mental health care and primary care,

(5) obesity treatment options in diverse populations, (6) patient-empowering care management for people with ongoing complex health care needs, (7) perinatal care and outcomes, (8) preventing injuries from falls in the elderly, (9) transitional care (from hospital to home), (10) treatment options for back pain, (11) treatment options for severe asthma in African Americans and Hispanics/Latinos, and (12) treatment options for uterine fibroids. More information about and archived recordings of these workgroups are available online (http://www.pcori.org/events/?type=past).

Workshops and Roundtables

PCORI has held regional workshops to listen to and learn from participants about their health care questions, concerns, and research priorities. Another goal of the workshops is to educate patients and stakeholders on CER, PCOR, and PCORI. PCORI hosts workshops in regions that have not had high levels of participation in the institute's activities. In 2013, PCORI held regional workshops in Wichita, KS; Memphis, TN; and Albuquerque, NM (Box 4).

PCORI also targets roundtables to specific groups of stakeholders. In January 2014, PCORI hosted representatives from more than 40 nursing organizations. The roundtable provided an opportunity for PCORI staff and leadership, including the authors, to engage nurses in PCORI work, learn from leaders of the nursing community, and encourage them to activate their respective organizations' research capacity for PCOR. PCORI recognizes that its long-term goal of including patients as research partners will require it to build and interact with the community of patients, caregivers, and health care professionals and also evaluate research addressing patient engagement.

Dissemination and Implementation PCORI has established a program that will fund research aimed at developing a blueprint for dissemination and implementation of research results. The goal is to speed implementation of findings by determining how they can be used by health care decision makers and whether dissemination of the findings reduces practice variation and disparities in health care. The blueprint will guide PCORI in communicating and disseminating the findings of the research it funds. PCORI held a roundtable on research dissemination and implementation and released a request for proposals for the development of an action plan.

Ambassador Program

The PCORI Ambassador Program serves as a multidirectional information-exchange platform to build a PCOR community with special focus on underserved populations and those that experience below-average

health and health care. PCORI has appointed its first group of ambassadors, who will provide an informed, boots-on-the-ground complement to PCORI's research outreach and as a valuable resource and conduit for evaluations, surveys, feedback, and dissemination. Ambassadors will also help recruit panelists, presenters, co-authors, and patient/stakeholder spokespeople.

The first PCORI Ambassadors are patients or other stakeholders who had participated in PCORI engagement activities, such as workshops, merit reviews, or advisory panels. Others had served as a partner in a PCORI-funded project or hosted a PCORI activity. PCORI is providing the ambassadors with communication tools and training to help them become more knowledgeable about PCORI and PCOR.

How is PCORI Different/rom Other Research Funders.?

Several federal agencies, including the NIH, AHRQ and the Food and Drug Administration, include patients and other stakeholders in creating and reviewing research questions. However, PCORI differs in its overriding focus on meaningful involvement of patients and caregivers to guide its work and participate in all aspects of the research process. PCORI also considers the perspectives of healthy people; although they are not currently patients, they have health care needs.

A major theme of PCORI is "research done differently." PCORI has reached out to patients and other stakeholders in many ways to consider their perspectives. The board, committees, and staff bring people into the institute's headquarters in Washington, DC, and also go out to the community to listen to what different constituencies have to say about health and health care. In recent workshops, patients voiced their opinions to attendees including scientists, clinicians, and other stakeholders.

PCORI hopes to fund investigators representing an unusually broad cross-section of Americans. To this end, PCORI is releasing funding announcements that can be easily understood by the large audience of potential applicants. PCORI encourages patients and those who care for them to join with researchers on new teams. Funding applicants must include patients and other stakeholders in formulating research questions, defining essential characteristics of the research design, monitoring the study's conduct and performance, and disseminating research results. There are also patients on the PCORI panels that review the applications.

Research plans that receive funding must be easily understood by a broad audience and meet the institute's methodology standards. Applicants must provide plans for disseminating the results of their investigations and assessing their impact on health care.

PCORI's goal is to support rigorous research that addresses practical, everyday questions and considers the outcomes that matter to patients. A related challenge is to make findings have an impact on health care more rapidly than is common today. Research results

from the studies PCORI funds will have a high likelihood of changing current practice because patients, caregivers, and other decision makers were involved in the funding, research, and dissemination choices.

What's on the Horizon?

Research Funding

PCORI will continue to fund patient-centered CER based on its National Priorities for Research and Research Agenda. PCORI also plans to put greater emphasis on targeted funding awards, which address key research questions developed by workgroups including patients, nurses, and other stakeholders. PCORI is planning additional workshops to aid in the identification of topics for future targeted funding announcements.

In 2014, PCORI is introducing a new initiative that will fund larger, longer studies of high-impact topics. These studies, performed in typical clinical and community settings, will directly compare outcomes between two or more approaches to an important clinical challenge. PCORI plans to seek applications in twice-yearly cycles and, in each cycle, award up to $10 million for each of six to nine projects.

Research Methodology

The legislation establishing PCORI directs that the methodology standards be periodically updated. The PCORI Methodology Committee expects to reconsider, refine, and widen the scope of the standards and to refine the methods used to develop the standards. It will also review the empirical evidence supporting the standards and evaluate their usefulness in specifying research designs and methods.

The committee plans to expand the inventory of patient-centered CER methods for which standards are needed. The committee will also specify and support new research to strengthen methods relevant to CER and PCOR. The committee will refine its processes to use its members, PCORI scientific staff, professional societies and other external groups, and other stakeholders in locating, assessing, and synthesizing existing standards and developing new standards.

Engagement

PCORI will continue a number of engagement activities. PCORI will expand ambassador training to individuals and organizations that have not had the opportunity to participate in PCORI activities. PCORI's current advisory panels will continue their work. There are plans for an additional panel to address the communication and dissemination of research. PCORI will continue to hold regional workshops to learn about health care concerns and research priorities. In 2014, it plans to host a workshop in Minneapolis—Saint Paul, MN.

During 2014, tier I Pipeline to Proposals Engagement Awards will be expanded to include all regions of the United States, and tier II awards will be initiated to

invest in the development and maturation of research partnerships with the goal of creating a PCORI research proposal. PCORI will also begin funding other projects under the Eugene Washington PCORI Engagement Awards Program.

Implications of PCORI for Nursing Research, Education, and Practice

PCORI can have important effects on nursing education, practice, and research. Nurses and nursing faculty will have many opportunities to learn from the institute's activities as well as participate in meaningful ways.

The type of research that PCORI funds will strengthen evidence-based practice, providing more effective health care. Future nurses will need a firm understanding of research findings and quality as they provide care and guide patients through the health care system. Nurses help with patient choices on preventive measures, treatments, and continuing care. They must understand and communicate the strength and uncertainties of research findings and their relevance to the patient's decisions, which will depend on what outcomes the patient regards as most important, whether it be survival, quality of life, or level of activity.

PCOR will provide information that will help patients make better-informed decisions. This type of research includes CER, which compares the benefits and harms of health care choices such as tests, drugs, medical devices, surgeries, or ways to deliver health care for different groups of people. These studies can be clinical trials or other forms of research that generate new findings, or they can be systematic reviews of available evidence from previous studies.

PCOR can also include investigations using patient-reported outcomes. In such studies, patients answer questions to indicate how they feel and what they are able to do. Information gathered through those questions supplement traditional clinical measures to document how various treatments affect patient symptoms and activity. NIH has developed the Patient Reported Outcomes Measurement Information System to collect information on physical, mental, and social well-being (http://www.nihpromis.org/default#2), particularly on those aspects of health that are most important to patients and their caregivers. PCORI is funding research projects focused on Patient Reported Outcomes Measurement Information System with the intent of advancing the use of the tool in CER.

How Can PCORI Help in Teaching?

Nurse educators will want to introduce the concepts of patient centeredness as a model of care and PCOR as a type of research or framework for research. This understanding is especially important for masters and doctoral degree students but should also be of interest

to students in undergraduate nursing programs. Educators can give the students links to material on the PCORI website.

Reports from PCORI's Methodology Committee can keep nurses current on good research practices and provide a teaching instrument for faculty members who educate nurses in research methods. The methodology standards describe good practices in such activities as formulating research questions, designing trials, and handling data.

Nurses in practice can play an important role in the dissemination of research findings and the speed with which results affect practice. AHRQ has observed that, on average, more than a decade passes before scientific findings are translated into applications that reach patients (http://www.ahrq.gov/research/findings/facts heets/translating/tripfac/index.html). For research to have an impact sooner, there must be new ways to translate findings into practice. Nurses can speed the adoption of evidence-based methods by staying current on PCOR and CER findings, applying new practices that result, and encouraging others to do so. The engagement of patients and other stakeholders in PCOR increases the chance that the findings will be relevant to improved health care.

How Nurses Can Become Active in PCORI?

PCORI provides many opportunities for nurses and nursing students to become involved in its activities. They can suggest research questions for PCORI to

consider in its funding. They can also attend workshops in person or via webcasts. Nurses can become stakeholder reviewers to evaluate research proposals or apply for places on advisory boards. In those capacities, nurses can provide their clinical expertise to make recommendations about patient and stakeholder engagement efforts and help prioritize research questions. More information on stakeholder involvement is available (http://www.pcori.org/get-involved/).

Nursing as a profession is inherently patient/people centered, guided in provision of care by principles of holistic care, ethical standards, and consideration of the total human condition. Nursing research has also historically exposed many of the same principles that are exposed in PCOR. Thus, nurse scientists should apply for PCORI funding and be leaders of research teams. Nurses can also join with other investigators as well as patients and caregivers to form research teams.

PCORI issues funding announcements to support a portfolio of CER representing needs of patients and other health care system stakeholders in making personalized decisions across a wide range of conditions and treatments. The institute is currently funding research in the areas it identified as national priorities (listed previously).

Some examples of PCORI-funded research led by nurse scientists are given in Table 2. Lists of all awards are available online (http://www.pcori.org/funding-opportunities-3/pilot-projects/funded/ and http:// www.pcori.org/pfaawards/).

Table 2 — Examples of PCORI-funded Research Led by Nurse Scientists

Name of Project

Primary Investigator

Organization

Type of Award

Involving Nursing Home Residents and Families in Acute Care Transfer Decisions CAPE: Patient-Centered Quality Assessment of Psychiatric Inpatient Environments Decision Support for Symptom and Quality of Life Management A Community Partnership Approach For Advancing Burden Measurement in Rare Genetic Conditions Reducing Health Disparities in Appalachians with Multiple Cardiovascular Disease Risk Factors Bringing Care to Patients: A Patient Centered Medical Home for Kidney Disease Patient Outcomes of a Self-Care Management Approach to Cancer Symptoms: A Clinical Trial

Ruth M. Tappen, EdD, RN, FAAN

Kathleen Delaney, PhD, RN, NP

Mary E. Cooley, PhD, CRNP, MSN

Pamela Holtzclaw Williams, JD, PhD, RN

Florida Atlantic University

Rush University Medical Center/Rush College of Nursing

Dana-Farber Cancer Institute

Medical University of South Carolina

Debra Kay Moser, DNSc, RN University of Kentucky

Pilot Project

Pilot Project

Pilot Project Pilot Project

Primary Research

Denise Hynes, PhD, MPH, RN University of Illinois at Chicago Primary Research

Susan McMillan, PhD, NP

University of South Florida Primary Research

PCORI also seeks applications for targeted funding in areas identified by patients, clinicians, and other stakeholders through its website, workshops, round-tables, and other channels. The topics selected for the first group of targeted funding announcements were based in part on input from the American Nurses Association.

To apply for funding, applicants prepare a letter of intent, design their research plans, describe the people and organizations that will participate, and develop a budget. In creating the research plan, applicants must consider the PCORI methodology standards. They must also be sure to include patients in each step of the research process, beginning with the conception of the idea.

Applicants should remember when preparing their submissions that the review panels include members of the public as well as researchers. PCORI conducts rigorous merit reviews of all applications to promote quality scientific research while ensuring patient centeredness. More information is available online (http://www.pcori.org/funding-opportunities/funding-announcements/application-center/).

Finally, nurses and other professionals as well as members of the public can stay abreast of PCORI activities by signing up for the mailing list (www.pcori. org/subscribe). They will receive periodic reports on research, engagement, and funding activities and stay informed about opportunities to participate in PCORI's work.

Conclusions

PCORI is promoting research that will help people make informed health care decisions. PCORI accesses a broad-based stakeholder community, including

patients, caregivers, and clinicians, to help generate and prioritize topics for research, select projects for funding, participate in the design and conduct of investigations, and disseminate findings. PCORI's research will help nurses guide patients in making decisions regarding prevention, diagnosis, and treatment of illnesses. PCORI also provides resources useful in the education of nurses. Nurses are invited to participate in suggesting topics for future research and serving in advisory groups as well as submitting grant applications as primary investigators or participating as members of research teams.

REFERENCES

Fleurence, R., Selby, J. V., Odom-Walker, K., Hunt, G., Meltzer, D., Slutsky, J. R., ..., & Yancy, C. (2013). How the Patient-Centered Outcomes Research Institute is engaging patients and others in shaping its research agenda. Health Affairs (Millwood), 32(2), 393—400.

Gabriel, S. E., & Normand, S. L. (2012). Getting methods right—The foundation of patient-centered outcomes research. New England Journal of Medicine, 367(9), 787—790.

Krumholz, H. M., & Selby, J. V. (2012). Seeing through the eyes of patients: The Patient-Centered Outcomes Research Institute funding announcements. Annals of Internal Medicine, 157(6), 446—447.

Methodology Committee of the Patient-Centered Outcomes Research Institute (PCORI). (2012). Methodological standards and patient-centeredness in comparative effectiveness research: The PCORI perspective. Journal ofthe American Medical Association, 301(15), 1636—1640.

Selby, J. V., & Lipstein, S. H. (2014). PCORI at 3 years—Progress, lessons, and plans. New England Journal of Medicine, 370(7), 592—595.

Washington, A. E., & Lipstein, S. H. (2011). The Patient-Centered Outcomes Research Institute—Promoting better information, decisions, and health. New England Journal of Medicine, 365, e31.