Partnership to Improve Patient Care

Dr. Harold Sox, co-chair of the Institute of Medicine Committee that developed CER priority recommendations for HHS last year, has a new article providing a CER progress report in this week's Annals of Internal Medicine.

Reflecting the impressive and intensive effort of the IOM Committee, Dr. Sox notes that it delivered its report on CER priorities just four months after enactment of the Recovery Act, as required by the law. Unfortunately, his next sentence suggests that HHS, the National Institutes of Health and the Agency for Healthcare Research and Quality already had made their own decisions about priorities by that time. "The NIH and AHRQ were well advanced in their plans for disbursing Reinvestment Act funds by that time," according to Dr. Sox, though the agencies and HHS all cross-checked their predetermined priorities with IOM's list. So if I'm understanding the sequence correctly, the input offered to IOM by dozens of stakeholders at public meetings and in hundreds of written comments (including input from many PIPC members), and the hours the IOM Committee spent deliberating, all was a waste of time?   

Dr. Sox says that stakeholders "will play a similar role in the newly created" Patient-Centered Outcomes Research Institute to the role they play at AHRQ and NIH. I must respectfully disagree, or at a minimum, hope that he is wrong. If PCORI is implemented right, patients, providers and other stakeholders won't have to offer their input in to decision-makers not knowing whether it will even be considered. They will know it will be considered because they will be part of the decision-making process, and that process will be open, transparent and accountable. At a speech to the National Minority Quality Forum earlier this year, I highlighted these differences. A chart that I presented in the speech is available here.  

I do agree with Dr. Sox that CER "embraces the concept of individual decision-making." To translate this concept into practice, patients and providers need a meaningful role in the process. Public trust and buy-in are vital prerequisites to the CER success that Dr. Sox and all of us seek. That is why successful launch and implementation of PCORI over the next 12 months is so critically important.