Three new research awards - totaling up to $19.4 million over five years - will address the growing proportion of the U.S. population that has multiple chronic medical conditions. The grants are funded through the National Institutes of Health's Health Care Systems (HCS) Research Collaboratory, which engages health care systems as research partners in conducting large-scale clinical studies.
The HCS Research Collaboratory, created by NIH in 2012, currently supports five large-scale clinical trials with partnering health care systems across the United States, and a Collaboratory Coordinating Center at Duke University, Durham, North Carolina. The funds are managed through the NIH Common Fund, which encourages collaboration and supports a series of exceptionally high-impact, trans-NIH programs.
It is estimated that 3 in 4 adults over age 65 and 1 in 15 children suffer from two or more chronic medical conditions - such as diabetes mellitus, chronic kidney disease, hypertension, and chronic pain. As patients develop more chronic conditions, they are likely to use more health care services and suffer negative outcomes such as unnecessary hospitalizations, adverse drug reactions, declining functional status, and mortality. These growing problems emphasize the need for more research to improve health outcomes of patients with multiple chronic conditions.
"These awards are timely in that they align with efforts throughout the U.S. Department of Health and Human Services to achieve optimum health and quality of life for people who suffer from multiple chronic conditions," said James M. Anderson, M.D., Ph.D., director of NIH's Division of Program Coordination, Planning, and Strategic Initiatives. "The research funded through these awards will fill gaps in our knowledge about the inventions and systems that can benefit individuals with multiple chronic conditions."
Health care systems, which include health maintenance organizations and other large integrated care settings, serve large populations of patients. Through these new collaborative research projects, NIH is better able to conduct large-scale and cost-effective clinical research on multiple chronic conditions within the settings where patients are already receiving their care.
"These projects represent transformative and high-quality clinical research," said Josephine Briggs, M.D., director of the National Center for Complementary and Alternative Medicine and co-leader of the collaboratory. "An important feature of these studies is that they are randomized trials occurring in real-world clinical settings. These represent crucial public-private partnerships to address questions important to patients and health care providers."
The projects are:
• PROVEN: Pragmatic Trial of Video Education in Nursing Homes, Brown University, Providence, Rhode Island; Dr. Vincent Mor. This trial will evaluate video education as a tool for decision-making for the patient, family, and health care team about advanced care planning in nursing homes, where residents typically have multiple chronic conditions. The videos will be tested to see how they help patients and staff address difficult decisions about resuscitation, use of ventilators in the last stages of illness, and similar important care issues. The study will be conducted in partnership with two large nursing home systems - Genesis and UHS-Pruitt. This project will be primarily overseen by the National Institute on Aging and secondarily by the National Institute of Nursing Research.
• Improving Chronic Disease Management with PIECES (ICD-PIECES), University of Texas Southwestern Medical Center, Dallas; Dr. Miguel Vazquez. This trial will implement a collaborative model between primary and subspecialty care, enhanced with a medical information tool called PIECES, in patients with multiple chronic conditions (diabetes mellitus, chronic kidney disease, and hypertension). The study will be conducted in partnership with four health care systems - Parkland Health and Hospital System, Texas Health and Resources System, VA North Texas Health Care System, and ProHealth Physicians, Inc. This project will be primarily overseen by the National Institute of Diabetes and Digestive and Kidney Diseases and secondarily by the National Heart, Lung, and Blood Institute.
• A Policy Relevant U.S. Trauma Care System Pragmatic Trial for PTSD and Comorbidity, University of Washington, Seattle; Dr. Douglas Zatzick. This trial focuses on patients who are being treated for acute physical injuries and who also have conditions such post-traumatic stress disorder, alcohol and drug use problems, depression, chronic pain, and other medical conditions. The trial will be conducted in partnership with 20 Level I trauma centers across the United States. This project will be primarily overseen by the National Institute of Mental Health and secondarily by the National Institute on Alcohol Abuse and Alcoholism.
The overall goal of the HCS Research Collaboratory is to strengthen the national capacity to implement cost-effective, large-scale research studies that engage health care delivery organizations as research partners. The aim of the program is to provide a framework of implementation methods and best practices that will enable the participation of many health care systems in clinical research, not to support a defined health care research network. Research conducted in partnership with health care systems is essential to strengthen the relevance of research results to health practice.