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Large federal program aimed at providing better health care underfunds primary care

April 16, 2019

WASHINGTON -- Despite a mandate to help patients make better-informed health care decisions, a ten-year research program established under the Affordable Care Act has funded a relatively small number of studies that examine primary care, the setting where the majority of patients in the U.S. receive treatment.

The finding, reported in the Journal of General Internal Medicine, found that only about a quarter of the 250 trials funded between 2015-2018 by the Patient-Centered Outcomes Research Institute (PCORI) had any relation to the primary care setting. The rest were devoted to specialty care.

Furthermore, only about 30 percent of the $1.17 billion spent on the research had any applicability to primary patient care, says the study's senior investigator, Dan Merenstein, MD, professor of medicine and director of research programs in the department of family medicine at Georgetown University School of Medicine.

"If the mission is to help guide patients through issues that have the greatest impact upon them, then PCORI is funneling substantial grant money where it shouldn't be," says Merenstein. "The program, which is up for renewal and may be dissolved in 2020 with grants exceeding $3.5 billion, is very disappointing to physicians who are devoted to, and strongly believe in, primary care. We should be at the forefront of such research."

Merenstein and his collaborators, all at Georgetown when the study began, pointed out in their first study, published in 2016, that an examination of 300 grants, worth $400 million, awarded between 2011-2014 found between 19 percent and 32 percent included any focus on primary care.

This latest study looks at grants given between 2015-2018, and has found no change.

This new study is "stronger in the sense that if there was any chance the study impacted primary care patients we counted it as primary care," says Merenstein.

PCORI is an independent nonprofit, nongovernmental organization authorized by Congress in 2010.

"It 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 first author, Andrew Blaster, a Georgetown medical student. co-author
-end-
Other collaborators in the new study are 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, and Stephany Mazur, who was the lead investigator of the 2016 study while attending medical school at Georgetown. A co-author on the new study, Mazur, MD, is now at Northwestern University.

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

Conflicts on Interest: Merenstein discloses that he has previously applied for PCORI grants and has served on PCORI review committees.

About Georgetown University Medical CenterGeorgetown 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. Connect with GUMC on Facebook (Facebook.com/GUMCUpdate), Twitter (@gumedcenter) and Instagram (@gumedcenter).

Georgetown University Medical Center

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