Public Release: 

Should PCORI fund more primary care research?

Georgetown University Medical Center

WASHINGTON -- The Patient-Centered Outcomes Research Institute (PCORI), established under the Affordable Care Act, is charged with funding research that ultimately helps patients make better-informed health care decisions. But some at the forefront of such research -- primary care physicians -- say the grant money is not supporting the PCORI mission.

An examination of PCORI funding conducted by Georgetown University Medical Center researchers and published online in Academic Medicine, examined where PCORI funding has been distributed. The review included the first six rounds of PCORI funding. The researchers looked at whether PCORI and NIH funding patterns differed by investigator, department and institution, and whether PCORI funded research in the primary care setting.

"Primary care is the cornerstone of where patients seek care, accounting for fully 50 percent of all doctor's visits," explains the study's senior investigator, Daniel Merenstein, MD, director of research programs in the department of family medicine at GUMC. "We've reported data that at times showed PCORI funding is clearly supporting its mission of impacting the patient care experience, while other data pointed towards funding not supportive of that mission."

An examination of about 300 PCORI grants awarded in 2013 and 2014 and totaling about $400 million found that less than a third of the awards, depending on how they were counted, were implemented in primary care settings, "lower than the 50 percent that we anticipated based on where care is occurring," Merenstein says. "Less than a third of PCORI studies are relevant to the primary care settings."

However, researchers say, PCORI is meeting another of its goals, diversifying research with 25 percent of PCORI-funded principal investigators holding a PhD, compared with 67 percent of PhDs those funded by NIH. Additionally, ten biomedical departments receive over 70 percent of NIH's funding, while only 42 percent of PCORI's funding goes to these same departments.

"Overall the record we are seeing from PCORI is a mixed bag, and while we're not shocked that primary care is not better represented, it's still very disappointing," says Merenstein.

PCORI is an independent nonprofit, nongovernmental organization authorized by Congress in 2010. By the time the organization is dissolved in 2020, it's expected to grant $3.5 billion in research funding.

Given PCORI's goal, the organization "is in a unique position to impact patient health, particularly in the primary care setting. Most health care is accessed within primary care, making it an ideal setting to do research that will make an impact on the patient health care experience," says the study's lead investigator, Stephany Mazur, a medical student at Georgetown University School of Medicine.

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In addition to Mazur and Merenstein, Andrew Bazemore, MD, MPH, a Georgetown family medicine physician who also directs the Robert Graham Center for Policy Studies in Family Medicine and Primary Care in Washington, participated in the study.

The study was funded by the Georgetown University School of Medicine Office of Student Research.

About Georgetown University Medical Center

Georgetown University Medical Center (GUMC) is an internationally recognized academic medical center with a three-part mission of research, teaching and patient care (through MedStar Health). GUMC's mission is carried out with a strong emphasis on public service and a dedication to the Catholic, Jesuit principle of cura personalis -- or "care of the whole person." The Medical Center includes the School of Medicine and the School of Nursing & Health Studies, both nationally ranked; Georgetown Lombardi Comprehensive Cancer Center, designated as a comprehensive cancer center by the National Cancer Institute; and the Biomedical Graduate Research Organization, which accounts for the majority of externally funded research at GUMC including a Clinical and Translational Science Award from the National Institutes of Health.

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