- The Patient-Centered Outcomes Research Institute (PCORI) is putting more than $31 million into programs that will use telehealth and telemedicine to improve access to treatment.
The Washington, D.C.-based non-profit created by Congress in 2010 has approved a $13.3 million grant to West Virginia University for a project that will examine how physicians can use a connected health platform to treat patients with major depressive orders. In addition, the New York-based Feinstein Institute for Medical Research is getting a $3 million grant to study how telehealth can help improve care management for Hispanic and Latino patients living with type 2 diabetes.
Also, the PCORI has approved a $15.7 million grant to Vanderbilt University Medical Center to test an stroke care delivery Integrated Practice Unit (IPU) that includes telemedicine.
In all, the PCORI’s Board of Governors approved $85 million in grants for 16 projects that “(compare) two or more approaches to improve care and outcomes for a range of conditions and problems that impose high burdens on patients, caregivers and the healthcare system, including unsafe opioid use, cancer, depression and stroke.”
“These new awards will help answer significant questions about treatment and care delivery that are important to patients and those who care for them,” PCORI Executive Director Joe Selby, MD, MPH, said in a press release. “They reflect the best ideas for urgently needed research on topics prioritized based on input from patients, caregivers, clinicians and other stakeholders. The results will give healthcare decision makers evidence they need to make better-informed health and healthcare decisions.”
At the Feinstein Institute, the principal research facility for the Northwell Health System, Renee Pekmezaris, PhD, will use the $3 million grant to compare a telehealth program in which patients have weekly “televisits” with their care provider to outpatient management, “the most common treatment approach for Hispanic patients from lower-income and health access communities.”
More than half of all Hispanics and Latinos will develop type 2 diabetes in their lifetimes, Pekmazaris says.
The two-part project will first adapt the telehealth platform for Hispanic and Latino patients, using a community advisory board that includes the American Diabetes Association, community leaders, caregivers and patients. Pekmezaris will then equip half of the program’s participants with telehealth tablets enabling collaboration with their care team, and compare results against a control group receiving traditional in-person care.
“The idea is that patients who are more engaged in their care through DTM (diabetes telemanagement programs) will experience less illness and hospitalization, have a better quality of life, and be more self-confident in their ability to manage their diabetes,” Pekmezaris says in her project summary. “We also want to see if involving caregivers improves the care and quality of life of patients.”
“While this kind of intervention has been studied in the general population and has found that sugar management improves, no one has studied whether this will be better for Hispanic disparity patients with type 2 diabetes, so this will be the first study of its kind,” she added.
At West Virginia University’s Robert C. Byrd Health Sciences Center, meanwhile, principal investigator Robert Bossarte, PhD, will use the PCORI’s $13.3 million grant to study whether providers using remote internet-based cognitive behavior therapy (eCBT) can improve care management and outcomes in patients with Major Depressive Disorder (MDD).
Bossarte is targeting “one of the most burdensome illnesses in the world,” affecting as much as 16 percent of the population, and he’s doing it in a state that ranks near the bottom in availability of mental health treatment resources and near the top in opioid abuse and suicide rates.
Patients with MDD are typically treated with antidepressant medication or psychotherapy, though the latter often involves waiting lists of three or four months.
“The most realistic prospect to improve this situation is through remote eCBT, which can be delivered much more efficiently and inexpensively than live (i.e., either face-to-face or telephone) psychotherapy,” Bossarte says in his project summary. “CBT is the type of psychotherapy that has the most evidence for effectiveness in treating MDD.”
Through eCBT, caregivers called eCoaches, working under the supervision of a psychiatrist or clinical psychologist, can guide patients through a computerized series of psychotherapy sessions via e-mail, text or phone. The platform can be used to reach remote patients, as well as allowing care teams to treat larger populations.
“Controlled treatment trials show that guided eCBT is as effective in treating MDD as live CBT,” Bossarte says. “Furthermore, eCoaches delivering centralized remote eCBT in integrated healthcare networks like the one we will study can also provide elements of remote collaborative care case management, such as encouraging ADM adherence, monitoring ADM side effects and treatment response, coordinating with the primary care treatment provider, and facilitating specialty referral, all of which increase MDD recovery rates.”
The Depression and Bipolar Support Alliance of West Virginia (DBSAWV) will collaborate on the project with the Practice-Based Research Network (PBRN) of the West Virginia University Clinical and Translational Science Institute (WVCTSI). The PBRN’s network of 56 federally qualified health centers (FQHCs) in rural parts of the state will participate in the program.
At Vanderbilt, principal researcher Kenneth Gaines, MD, MBA, says the IPU program was designed with a three-year, $3.8 million grant from the Centers for Medicare & Medicaid Services’ Medicaid Innovations Award program. The IPU “(embraces) team-based care in-hospital and enhanced collaboration with rehabilitation/skilled nursing facilities using telemedicine technology via a redesign component, called Stroke Central.”
“The IPU encompassed a one-year continuum of stroke care from onset through 12-month follow-up in a home or skilled nursing/rehabilitation facility–based program, called Stroke Mobile, with a registered nurse and lay health educator team that visited the patient and the caregiver’s/family’s home or facility to assess recovery, medication compliance, and risk factor control with telemedicine that facilitated access to multiple layers of care providers and was associated with decreased hospital length of stay and readmissions, decreased recurrence rates, and lower cost,” Gaines wrote in his project summary.
With the PCORI grant, Gaines plans on expanding the program to 18 sites and comparing the IPU model against traditional stroke care.
“Results will be key for patients, caregivers, organizations, payers, and policy makers to apply high-quality scientific evidence to the decision, currently in equipoise, on how to best direct resources toward implementing the most effective and efficient stroke care delivery systems that enhance health outcomes for patients and caregivers,” he wrote.