PCORI Dissemination and Implementation Funding …...– Application Guidelines • Programmatic...

July 11, 2017

2pm – 3pm EDT

PCORI Dissemination and Implementation

Funding Opportunities

Welcome and Introductions

Lia Hotchkiss, MPHEugene Washington

PCORI Engagement Awards Program Director

Alicia Thomas, MHSEugene Washington

PCORI Engagement AwardsProgram Officer

Rachel MosbacherEngagement

Program Officer

Arielle Gorstein, MPHDissemination &Implementation

Program Associate

I. Welcome

II. Background Information

III. Overview of Dissemination & Implementation (D&I) Program

IV. Funding Opportunities for D&I

I. Engagement Awards

II. Limited Competition Awards for D&I

V. Applicant Resources

VI. Questions

Agenda

Submitting Questions:

Submit questions via the

Q&A function in

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The Need for PCORI’s Work

• For all the advances it produces,

traditional healthcare research has not

answered many questions patients face.

• People want to know which preventive,

diagnostic, or treatment option is best for

them.

• Patients and their clinicians need

information they can understand and use.

PCORI helps people make informed healthcare decisions, and improves healthcare delivery and outcomes, by producing and promoting evidence from research guided by patients, caregivers, and the broader healthcare community.

Our Mission

Our Broad and Complex Mandate

“The purpose of the Institute is to assist patients, clinicians, purchasers, and policy-makers in making informed health decisionsby advancing the quality and relevance of evidence concerning the manner in which diseases, disorders, and other health conditions can effectively and appropriately be prevented, diagnosed, treated, monitored, and managed through research and evidence synthesis...

--from PCORI’s authorizing legislation

… and the dissemination of research findings with respect to the relative health outcomes, clinical effectiveness, and appropriateness of the medical treatments, services...”

Snapshot of Funded CER & Methods Projects

Number of projects: 458

Amount awarded: $1.32 billion

Number of states where we are funding research: 41 (plus the District of Columbia)

As of July 2017

As of July 2017, 113 CER and Methods projects have produced results

PCORI Dissemination & Implementation Program

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• The D&I program is charged with heightening awareness of the results of PCORI-funded research, and with advancing efforts to put these findings into practice to improve healthcare delivery and health outcomes.

• Dissemination is the intentional, active process of identifying target audiences and tailoring communication strategies to increase awareness and understanding of evidence and to motivate its use in policy, practice, and individual choices.

• Implementation is the deliberate, iterative process of integrating evidence into policy and practice by adapting evidence to different contexts and facilitating behavior change and decision making based on evidence across individuals, communities, and healthcare systems.

What PCORI Means by D&I

The Eugene Washington PCORIEngagement Awards Program

Engagement Award Program Objectives

• Fund projects to equip patients and other stakeholders to engage as meaningful partners in PCOR/CER, from topic selection to design and conduct of research and on to dissemination and implementation of results

• Support organizations with constituents who view them as trusted sources of health information to conduct projects to lay the groundwork for disseminating and implementing research results or products derived from PCORI or related studies

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Engagement Awards Overview

Key Information

Full Announcement: Eugene Washington

PCORI Engagement Award Program

Purpose: Support projects that will build a

community better able to participate in

PCOR and CER as well as serve as channels

to disseminate study results; and projects to

lay the groundwork for disseminating and

implementing PCORI findings

Eligibility: Any private or public-sector

organization, including any nonprofit or

for-profit organization or any unit of local,

state, or federal government.

Funding Level:. Award total costs may not

exceed $250,000

Letters of Inquiry: Competitive Project Period: Maximum of 2 years

LOI Deadline: September 29, 2017 (by 5

p.m. ET)

Funding Cycles Per Year: 3

• Project activities may include developing, demonstrating, and evaluating the processes/pathways/tools necessary to incorporate PCOR/CER results into decision-making settings

• Applicants must:

– Identify existing or emerging PCOR/CER findings highly relevant to their target population

• Research results should be placed within the context of the existing body of evidence in the topic area identified

– Clearly explain how the infrastructure and relationships developed to disseminate and implement PCOR/CER could be sustained over time

– Indicate whether the project may have the potential to be scaled to reach an even greater audience or if it could be a vehicle for disseminating and implementing additional PCOR/CER findings

Engagement Award Dissemination Projects

• Funding support for meetings/conferences that align with PCORI’s mission and strategic plan, and facilitate expansion of PCOR/CER in areas such as:

– Research Design and Methodology

– Research Development

– Dissemination and Implementation—Communicates findings—or emerging findings—from PCORI or related studies to a targeted, essential end-user audience. Conference organizers must address the proposed conference activities as part of an essential strategy for increasing the uptake of findings that have important potential impact on clinical practice, including the important role of the proposed target end-user audience.

• Meeting and conference support awards are for a maximum total cost of $50,000, and can be up to one year in duration.

Engagement Award (EAIN): Research Meeting

and Conference Support

• Projects intended to improve patient engagement in non-research activities, such as healthcare service delivery, patient self-care, or patient-centeredness of care (e.g., shared decision making)

• Research studies• Development of research proposals• Development of interventions• Validation of tools or instruments• Delivery of health care• Development of registries and increasing registry participants• Projects intended to increase the number of patients who participate

in research studies or registries• Development of decision aids or clinical practice guidelines• Meetings that don’t focus on PCOR or CER

Activities We Do Not Fund

• Review projects already awarded by PCORI first – summaries and work products available at http://www.pcori.org/research-results

• Review Available Resources

– Program Guidelines

• Program summary, award types, and list of what we don’t fund

– Application Guidelines

• Programmatic overview and application requirements

• Details on how to submit an LOI and application

• Application checklist

• Includes a glossary of key terms

• Allowable and unallowable costs

– Applicant FAQs

– Online User Manual

• Step-by-step guides to walk through the online application portal

• Schedule a call with the program team to discuss your ideas by emailing [email protected]

• Use Application Guidelines Checklist

– Ensure all required and optional components are included before hitting submit

Tips for Prospective Applicants

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http://www.pcori.org/research-results

Examples of Funded Engagement Awards Projects

Fostering Physician Behavior Change to Improve Health Outcomes and Enhance Patient Engagement

Objectives

• Identify best dissemination practices that have been effectively used by nearly two dozen health plans in changing clinical behavior and improving patient outcomes

• Develop a report of dissemination practices that will cover both the content of information and the process for dissemination and adoption that others – health plans, health systems, policy makers, government purchasers – can draw on when disseminating research findings

George Isham, MD, MSAlliance of Community Health Plans Foundation

Project Collaborators:ACHP member plans, including Kaiser Foundation Health Plan, Inc., and The

Permanente Federation; Group Health Cooperative; Geisinger Health Plan; HealthPartners; UPMC Health Plan;

SelectHealth; AvMed; Martin’s Point Health Care; Capital District Physicians’

Health Plan; and Independent Health

Engagement Award Project,awarded March 2017

PCOR/CER Roadmap for Essential Hospitals

Objectives

• Understand how essential hospitals view the utility of PCOR/CER in their work, current implementation activities, and future needs

• Develop a landscape review of current use of PCOR/CER by essential hospitals

• Identify barriers to the widespread adoption of PCOR/CER initiatives in member hospitals

• Build a roadmap for essential hospitals to overcome these barriers and to facilitate mass adoption of PCOR/CER

• Disseminate the roadmap to promote PCOR/CER integration

Bruce Siegel, MDAmerica’s Essential Hospitals

Project Collaborators:The American Hospital

Association/Health Resource and Education Trust, Premier, Association of

American Medical Colleges, Joint Commission Resources, and all major

hospital associations

Engagement Award Project, awarded December 2016

The National Alliance Disseminates PCOR/CER Findings Thru Purchaser-led Coalitions to Improve Patient-Centered Outcomes

Objectives

• Identify existing and emerging PCOR/CER findings highly relevant to the purchaser community, prioritize dissemination, and determine implications for purchasers and related stakeholders

• Educate and inform healthcare benefits professionals to help shift their current practices and those of their vendors toward a stronger evidence-based approach in their healthcare decision making

Mike Thompson, BS, FSA, MAAANational Alliance of Healthcare Purchaser Coalitions

Project Collaborators:National Alliance member coalitions,

Consumer Reports

Engagement Award Project,awarded March 2017

PCOR Dissemination at Work: How Employers Use Evidence to Make Employee Health Investment Decisions

Kimberly Jinnett, PhDThe Center for Workforce Health and Performance

Project Collaborators: Integrated Benefits Institute; Center for Value-Based Investment Design;

RAND; employers

Objectives

• Identify existing PCOR/CER evidence of high relevance to a working population

• Understand how employers use such evidence

• Improve the uptake and implementation of this PCOR-based evidence in employee health investment decision making

Engagement Award Project,awarded May 2016

Methods

• Employer case studies, expert panel, employer interviews, stakeholder-specific communications materials, and dissemination events

Reducing Cancer Disparities by Engaging Stakeholders

Ron Myers, PhDThomas Jefferson University

Project Collaborators: Two regional health systems (Lehigh

Valley Health Network and Delaware Valley Accountable Care Organization);

a patient and stakeholder advisory committee from each health system;

insurers; a state and a local health department; regional employer groups;

a national advocacy organization; a regional advocacy organization; and

Children’s Hospital of Philadelphia

Objectives

• Develop a learning community with a common agenda related to reducing cancer screening-related disparities;

• Determine disparities in screening rates;

• Identify evidence-based approaches that increase screening and reduce screening disparities;

• Adapt effective intervention approaches for use in primary care practices;

• Disseminate a model approach to intervention adaptation in health systems;

• Evaluate learning community engagement and related outcomes.

Engagement Award Project,awarded October 2015

The D&I Limited Competition Program

Limited Competition D&I Awards are designed to give PCORI awardee teams

an opportunity to:

– Propose investigator-initiated strategies for disseminating and

implementing findings from their PCORI-funded studies

– Undertake the next step(s) for making their research results more

useful, actionable, and accessible to targeted end-users

– Promote and facilitate the effective and timely use of research

evidence in the real world

Purpose and Objectives of the Award Program


Awards (Limited Competition)

Key Information

Full Announcement: Dissemination and

Implementation of PCORI-funded Patient-

Centered Outcomes Research Results

Purpose: Offer PCORI awardee teams an

opportunity to propose investigator-

initiated strategies for disseminating and

implementing their research results.

Eligibility: Current awardee; draft final

research report submitted

Funding Level: $350,000 total direct costs.

Greater budget levels may be considered

with appropriate justification.

Letters of Intent: Competitive Project Period: 2 years. Longer projects may

be considered with appropriate justification.

First Awards Announced: Dec 2016 Funding Cycles Per Year: 3

• We fund projects that:

– Disseminate/implement PCORI findings that have real potential to affect healthcare and health outcomes in the short or long term

– Disseminate/implement PCORI findings through active approaches to appropriate target populations

– Draw upon principles of effective implementation, as described in established dissemination and implementation models and frameworks

– Actively engage those required to accomplish the project successfully (patients, providers, representatives of the host delivery system, or others who are critical to the success of the proposed project)

– Evaluate the success of the dissemination and implementation strategy

Important Considerations for D&I Projects

– Develop and demonstrate approaches for incorporating PCORI research

results in specific decision-making settings

– Adapt the content, format, or vehicle for delivering PCORI findings for

different populations and/or across different settings

– Take programs and products found effective to scale in diverse settings

and populations

– De-implement or reduce the use of interventions that are not evidence-

based, have been prematurely adopted, or are harmful or wasteful

Supported D&I Project Objectives

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We do not fund projects that propose to:

• Develop or validate a new tool or system for patients or clinicians unless it has the primary purpose of disseminating or implementing evidence in the proposed project

• Translate or adapt a finding without actively disseminating or implementing it

• Focus on a passive dissemination plan (publications or presentations to heterogeneous audiences)

• Focus on conducting new research. (Activities to evaluate the success of D&I efforts are not considered “new research” and are acceptable/required.)

• Disseminate and/or implement findings that are not associated with a PCORI-funded comparative effectiveness or methods study

Note: Applicants must submit the draft final research report from their original PCORI study before the D&I award application deadline.

Activities We Do Not Fund

Tips for Prospective Applicants

• Clearly describe the PCORI study findings to be disseminated/implemented

• Make sure your proposed D&I activity is consistent with the strength of the evidence to be disseminated/implemented

• Be mindful of the time/budget constraints of this PFA

• Have a fully developed D&I plan in mind before submitting your application

• Include key personnel with D&I experience on your team

• Look at the projects we’ve already funded on our website

• Schedule a call with the program team to discuss your ideas by emailing [email protected]

Funded awards

• 2 Projects Awarded December 2016

• 3 Projects Awarded March 2017

Next awards

• Fall 2017


Awards (Limited Competition)

Examples of Funded D&I Limited Competition Projects

Preventing Venous Thromboembolism (VTE) in Hospitalized Patients

Elliott Haut, MD, Johns Hopkins University

Baltimore, MD

Original PCORI study tested a patient education intervention to prevent VTE in hospitalized patients.

• Real-time EMR alert notified a health educator immediately when a patient missed or refused a dose of VTE prophylaxis

• Health educator provided one-on-one, face-to-face education about risks of VTE and potential benefit from prophylaxis

PCORI Study Findings

• The intervention led to a 42% reduction in non-administration (missed doses and refusals) of VTE prophylaxis across intervention floors (p < .001)

• AHRQ has called VTE prevention the number one strategy to improve patient safety in hospitals

• Proper administration of VTE prophylaxis is associated with reduction in VTE risk

• Omitting even a single dose of VTE prophylaxis is associated with an event

Dissemination & Implementation of PCORI Funded Patient-Centered Outcomes Research Results and

Products, awarded December 2016

Preventing Venous Thromboembolism in Hospitalized Patients

Dissemination & Implementation Project: Preventing VTE: Engaging Patients to Reduce Preventable Harm from Missed/Refused Doses of VTE Prophylaxis

Aims• Implement intervention in

• all floors of a large teaching hospital (Johns Hopkins)• a medium-sized, community, non-teaching hospital (Howard County General)

• Examine effect of VTE prophylaxis for inpatients at both hospitals

If successful, this D&I project will result in• Improved quality of patient-nurse communication about VTE and VTE prophylaxis • More informed patient decisions regarding the choice to take VTE prophylaxis• Decreased VTE events; decreased mortality associated with VTE events

Evaluation Plan• Measuring rates of missed doses, patient refusal, and VTE events• Will capture VTE rates in hospital and 30 days post-discharge through diagnosed VTE

in 2 hospital EDs, readmissions, 38 outpatient clinics, and other sources

Targeting Interventions to Prevent Diabetes to Patients at Higher Risk

David Kent, MDTufts Medical Center Inc.

Boston, MA

Original PCORI study assessed heterogeneity of treatment effect in clinical trials. Researchers analyzed individual patient data from 32 studies including the 2002 Diabetes Prevention Program Study.


• Baseline risk for developing diabetes varies dramatically. Some patients had a 1-2% risk of developing diabetes within 3 years; the risk was 90% for others.

• Low-risk patients showed little benefit from interventions (metformin; lifestyle modification) in the Diabetes Prevention Program Study

• High-risk patients showed significant benefit from these interventions

• Prediabetes affects approximately 86 million people in the United States.

• For every patient screened for diabetes who’s identified as being diabetic, screening also identifies 3 patients with prediabetes.

• The main interventions for prediabetes are pharmacotherapy with metformin and an intensive lifestyle program.


Products, awarded March 2017

Dissemination & Implementation Project: Improving Diabetes Prevention with Benefit-Based Tailored Treatment: Disseminating Patient-Centered Estimates of Benefit

Aims

• Adapt and incorporate the prediction model based on the Diabetes Prevention Program Study into an EHR-based risk-prediction tool that clinicians can access at the point of care

• Partner with American Medical Group Association (AMGA) to launch the EHR tool in 50 clinic sites within two AMGA-member healthcare provider organizations

If successful, this D&I project will

• Help clinicians triage costly and potentially burdensome preventive interventions to patients with prediabetes based on their risk for developing diabetes, improving the appropriateness of care at all levels

Evaluation Plan

• Will assess use of the EHR-based tool, the rate clinicians preferentially refer prediabetic patients at high risk to Diabetes Prevention Program interventions, and patients’ acceptance/adherence to their prescribed interventions

Targeting Interventions to Prevent Diabetes to Patients at Higher Risk

Using Causal Inference Methods to Compare Treatment Strategies

Yi Zhang, PhD, Medical Tech. and Practice Patterns Institute

Bethesda, MD

Original PCORI study tested use of advanced causal inference methods (G-methods) to compare dynamic treatment strategies over time using observational data sets.

• To see if these methods can be used when RCT data are not available

• Investigators validated these methods by comparing results from analysis using Medicare claims data versus RCTs


• Using causal inference methods, investigators were able to approximate RCT results both in terms of magnitude and direction of risk estimates

To compare changing treatments using the plethora of existing data, new analytic approaches are necessary.

Conventional (traditional) statistical approaches are not well equipped to deal with changing treatments and can provide inaccurate or spurious results.


Products, awarded December 2016

Dissemination & Implementation Project: Enhancing Dissemination and Implementation of Causal Inference Methods through Partnerships with a Large Health System

Aims• Demonstrate use of advanced causal inference methods in 11 funded studies

currently conducting CER using observational data. Studies funded by AHRQ, PCORI, NIH, VA, industry.

• Provide hands-on training in appropriate applications of these methods

• Communicate experience to trialists, methodologists, others in partnership with study teams

If successful, this D&I project will result in• Improved ability to use observational data to compare changing treatment

strategies – particularly important when clinical trials are not feasible

Evaluation Plan:• Adoption and effective use of the methods within each partner site

Using Causal Inference Methods to Compare Treatment Strategies

Advance Planning for Home Services for Seniors

Lee Lindquist, MD, MPH, MBA, Northwestern University at Chicago

Chicago, IL

Original PCORI study developed and tested a web-based tool (PlanYourLifespan) to educate seniors on health crises that often occur with age and connect them to home-based resources that can provide support.


Use of PlanYourLifespan led to improvements in

• Planning behavior scores (primary outcome; p < 0.01)

• Home services knowledge (p < 0.01)

Satisfaction scores were significantly higher for PlanYourLifespan users than for the control group.

• People with unmet health and home-based needs face increased rates of hospitalizations, re-hospitalizations, morbidities, and institutionalization.



Advance Planning Support to Keep Seniors in the Home

Dissemination & Implementation Project: Leveraging Patient Partner/Stakeholder Engagement to Implement PCOR – PlanYourLifespan.org

Aims• Implement PlanYourLifespan through diverse community organizations:

FirstVitals (Hawaii) and Pastors4PCOR (Chicago) using train-the-trainer approach

• Training to be led by original study patient partners. New trainees will train 3-5 additional community members who will promote access in their communities.

If successful, this D&I project will result in• Increased use of this popular tool• Validation of this training approach for extending reach of PlanYourLifespan

Evaluation Plan:• Training outcomes including satisfaction with training, knowledge gained,

trainings held, use of PlanYourLifespan

• Patient outcomes: impact on anxiety, stress, self-efficacy, planning behavior

• Investigators are pursuing research funding to test impact on other outcomes

A Virtual Care Model for Parkinson’s Disease Specialty Care

Earl “Ray” Dorsey, MD, MBAUniversity of Rochester

Rochester, NY

Original PCORI study evaluated the feasibility, effectiveness, and satisfaction associated with telehealth care visits for patients with Parkinson’s disease.

PCORI Study Findings• Telehealth visits successfully delivered:

98% of study patients had 1 or more video house calls

• Intervention group spent less time on appointments and more time interacting with a doctor (p<0.01)

• 95% of patients were “satisfied” or “very satisfied” with the care, convenience, comfort, and overall quality of the video house calls

• No significant differences in quality of life, quality of care, or caregiver strain for intervention group versus control

• Telehealth is growing rapidly; has the potential to improve access to care and reduce healthcare costs.

• Over 40% of Medicare beneficiaries with Parkinson Disease do not receive care from a neurologist within four years of diagnosis, increasing their risk for morbidity, loss of independence, and death.



A Virtual Care Model for Parkinson’s Disease Specialty Care

Dissemination & Implementation Project: Dissemination and Implementation of a Virtual Care Model for Parkinson’s Disease and Other Chronic Conditions

Aims

• Refine and expand the telehealth intervention to include multidisciplinary care and address comorbid conditions (anxiety, depression, dementia)

• Implement the revised model into a funded statewide telemedicine program that will provide care to 500+ individuals with Parkinson’s disease

If successful, this D&I project will• Increase access to multidisciplinary care for individuals with Parkinson’s disease• Assess effectiveness of telehealth program as a viable option for providing care for

people with restricted access to in-person health care

Evaluation Plan:

• In addition to patients reached, sites providing the service, and other measures of program implementation, will examine clinical outcomes, quality of life, caregiver burden, and other patient-centered outcomes

Summary of Funding Opportunities

Funding Opportunity Comparisons

D&I Limited Competition Engagement Awards (Projects)Engagement Award (EAIN):

Meeting and Conference Support

Purpose of program

Offer PCORI awardee teams an opportunity to propose “next step” strategies for disseminating and implementing their research results.

Fund projects that will equip patients and other stakeholders to be able to meaningfully engage in PCOR/CER in areas such as D&I of results, or lay the groundwork for D&I of research results or products

Support conferences to communicate findings—or emerging findings—from PCORI or related studies to a targeted, essential end-user audience

Who can apply

PCORI awardees who have submitted their DFRR

Any private-sector research organization; any public-sector research organization; any laboratory or manufacturer; or any unit of local, state, or federal government

Any private-sector research organization; any public-sector research organization; any laboratory or manufacturer; or any unit of local, state, or federal government

Source of findings for D&I

PCORI research project for which PI has submitted DFRR

Research results or products derived from PCORI or related studies

Research results or products derived from PCORI or related studies

FundsAvailable

$350,000 direct costs; option to request more through Greater Than mechanism

$250,000 total costs $50,000 total costs

Project Period

2 years, option to request more time through Greater Than mechanism

Up to 2 years Up to 1 year

Applicant Resources

D&I Limited Competition Engagement Awards (Projects)Engagement Award (EAIN):

Meeting and Conference Support

Next LOI due date

July 25, 2017 October 1, 2017 October 1, 2017

PFA available at

http://bit.ly/2tqy50z http://bit.ly/2ur93yo http://bit.ly/1JztUEg

Link to examples of funded projects

http://bit.ly/2tJL1Ry http://bit.ly/2uL82R1 http://bit.ly/2uL82R1

Email for program fit questions

[email protected]

[email protected] [email protected]

* If you would like direct links instead of the bitlys (shortened links) provided, please email either of our programs.

mailto:[email protected]



Q&A

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PCORI Dissemination and Implementation Funding …...– Application Guidelines • Programmatic...

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