At the center of any health care encounter is a patient who confronts the clinician with a question: what is the best treatment for this particular individual, with this particular set of symptoms?
Answering that question is the goal of the Patient Centered Outcomes Research Institute (PCORI), created as part of the Affordable Care Act. In the words of the institute’s mission statement, it aims to “help people make informed health care decisions and improve 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.”
In September, psychiatrist Grayson Norquist, M.D., became chair of the Board of Governors of PCORI. He was appointed to the board three years ago by the Government Accountability Office (GAO), which oversees the institute, and was nominated for the position by APA. He was chosen by the GAO to be chair when Eugene Washington, M.D., M.Sc., vice chancellor for UCLA Health Sciences and dean of the David Geffen School of Medicine at UCLA, stepped down.
“The reason PCORI was created is to develop information that would inform everyday health care decisions, so that if you are the patient or the caregiver, you have the information you need to make a decision about your health care,” Norquist told Psychiatric News. “As clinicians, we struggle with this every day—what is the best medication to use for this patient with schizophrenia, or what is the best form of psychotherapy for the patient sitting in front of me right now?
“The whole idea of PCORI is to develop this kind of information but make it patient-centered, so that at front and center of everything we do are the needs of patients,” Norquist said. “We want to promote through our funding and infrastructure development high-integrity, evidence-based information that can be used to guide patients and caregivers and the broader health care community in improving health care.”
Norquist brings to the task a long history of experience with patient-centered outcomes research. For 15 years he worked at the National Institute of Mental Health (NIMH). There, Norquist was director of the Division of Services and Intervention Research, which was responsible for clinical, prevention, and services research. In that role, Norquist was instrumental in helping to instigate two of the most fruitful—and highly publicized—treatment outcomes trials: the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) and the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE).
After leaving NIMH, Norquist returned to his native Mississippi because he had a passion for disseminating best practices to underserved populations. Currently he is professor and chair of the Department of Psychiatry and Human Behavior at the University of Mississippi Medical Center in Jackson. His research focuses on the use of telemedicine to reduce disparities in mental health treatment for those living in the Delta region in Mississippi and to improve the quality of care they receive at local community health centers.
The 21-member board of governors of PCORI includes two fixed positions for the director of the National Institutes of Health (Francis Collins, M.D.) and the director of the Agency for Health Research and Quality (Richard Kronick, Ph.D.). The rest of the board includes representatives of patients and caregivers; health care providers from academia and private practice; health researchers; developers of pharmaceuticals, devices, and diagnostics; the health insurance industry; and the business and employer community.
As chair, Norquist is responsible for leading this diverse group in developing an agenda to meet the priorities of the institute. In 2012, the PCORI board adopted the report “National Priorities for Research Agenda,” which identified 10 priority areas of interest: prevention, acute care, care coordination, chronic disease, palliative care, patient safety, engagement, overuse, information technology, and the impact of new technology.
Since its inception, PCORI has approved 147 awards, totaling more than $243 million over three years, to fund patient-centered, comparative clinical-effectiveness research projects under the five priorities.
Norquist is dedicated to improving patient-centered outcomes research in all areas of medicine, but he noted that mental health-related research is among the leading award winners at the institute. Currently the institute is funding, among other mental health-related projects, research comparing the effectiveness of treating maternal depression to improve fetal health, improving psychological distress among critical illness survivors and their informal caregivers, and developing “decision algorithms” to help people make decisions about their own mental health care.
Norquist said he hopes psychiatrists with take an interest in PCORI. Even those not actively involved in research are invited to participate in review groups, reviewing the Institute’s grants. And clinicians can partner with a PCORI researcher to help ensure, as Norquist says, that research is grounded in the real-world of clinical care. Finally, he said PCORI would be looking to APA for help in determining what kinds of research would be most useful to psychiatrists and patients.
“Having a psychiatrist as chair of the board of governors of PCORI is a sign, I believe, of how far we have come as a field, and how important we are to the rest of medicine,” he said. “I also think it signals recognition that what PCORI is doing is something we have been trying to do in mental health for a long time, which is really trying to engage with our patients. We in mental health have been a leader in this area and I think we have an opportunity to get more engaged on this topic with the rest of our colleagues in health care.” ■