Center for American Progress

RELEASE: CAP Analysis Finds the Patient-Centered Outcomes Research Institute Has Made Progress, But Still Has Shortfalls
Press Release

RELEASE: CAP Analysis Finds the Patient-Centered Outcomes Research Institute Has Made Progress, But Still Has Shortfalls

Washington, D.C. — A new analysis of the Patient-Centered Outcomes Research Institute, or PCORI, by the Center for American Progress finds that the institute has made progress in funding comparative effectiveness research, or CER, since CAP’s previous evaluation two years ago. Despite this improvement, however, CAP finds that PCORI has devoted barely half of its grant funding to CER—creating an urgency for the institute to intensify its focus through 2019. While PCORI’s grant funding for CER did jump from 37 percent to 58 percent between December 2013 and January 2016, the cumulative share now stands at 51 percent. This falls short of CAP’s recommendation of having PCORI dedicate at least 80 percent of grant funding to CER.

“PCORI studies should have the potential to change clinical treatment decisions or insurers’ coverage determinations,” said CAP Senior Fellow and co-author Zeke Emanuel. “With just three years of funding remaining, PCORI must act more urgently to fulfill its role as an important tool under the Affordable Care Act to reduce costs and improve the quality of care across the country.”

CAP’s updated analysis reviewed all of PCORI’s grants to evaluate whether they funded a CER study, which was defined as comparing two or more prevention, diagnosis, or treatment alternatives. The same methodology was used in our 2014 assessment.

With PCORI only authorized through 2019, CAP recommends that it should specifically focus on high-impact research topics to maximize its impact in a short time period. Recent grant announcements on topics such as opioid abuse, depression, and multiple sclerosis are a step in the right direction. However, given its funding choices to date, CAP’s analysis notes that PCORI can no longer reach 80 percent CER or higher cumulatively by 2019.

Going forward, PCORI must dedicate at least 90 percent of its funding awards to CER, with the goal of coming as close as possible to a cumulative 75 percent CER share. This is an aggressive target and will require reducing or eliminating PCORI’s projected spending on methods and engagement awards.

“PCORI made extensive investments in infrastructure, developing large research and data networks to facilitate future comparative effectiveness trials. It now needs to take full advantage of them,” said Topher Spiro, Vice President for Health Policy at CAP and a co-author of the issue brief.

CAP recommendations to PCORI:

  1. Use PCORnet, the massive data network constructed with previous PCORI funding, to track and evaluate certain new drugs as they enter the market.
  2. Rapidly increase investment in CER that compares drugs to a level that accurately reflects their importance to clinical practice, patient treatment, and national health spending.
  3. Invest more in CER for oncology, multiple sclerosis, spine surgery, and other high-cost specialties where evidence gaps exist.
  4. Invest more in systematic reviews synthesizing existing CER studies. These can be done relatively quickly and will make it easier for providers and payers to incorporate CER studies into clinical practice and coverage decisions.
  5. Rank treatment alternatives by their clinical effectiveness in areas where the comparative effectiveness of different interventions has already been evaluated. This will improve the usability of CER results for patients, payers, and providers by providing a simple explanation of whether a treatment option is more or less clinically effective than its alternatives. PCORI could model this rating system after the U.S. Preventive Services Task Force’s rating system.

Read the full brief, “Re-evaluating the Patient-Centered Outcomes Research Institute” by Zeke Emanuel, Topher Spiro, and Thomas Huelskoetter, online here.

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For more information on this topic or to speak with an expert, contact Liz Bartolomeo at or 202.481.8151.