This week, NIH awarded three new research grants that will address the growing proportion of Americans with multiple chronic medical conditions. The grants are funded through the NIH Health Care Systems (HCS) Research Collaboratory, the Common Fund program intended to improve the way clinical trials are conducted by creating a new model for collaborative research.
The ultimate goal of the HCS Research Collaboratory, which I co-lead with Dr. Thomas Insel, Director of the National Institute of Mental Health, is to ensure that health care providers and patients can make decisions based on the best available clinical evidence. The Collaboratory was created by NIH in 2012 and currently supports five large-scale clinical trials with partnering health care systems across the United States, and a Collaboratory Coordinating Center at Duke University. Results of this research will help us learn more about the interventions and health care systems that can provide benefits to people suffering from multiple chronic conditions, such as diabetes, chronic kidney disease, hypertension, and chronic pain. Patients with chronic conditions are likely to use more health care services and have negative outcomes such as unnecessary hospitalizations, adverse effects to drugs, declining functional status, and death.
One notable feature of these studies is that they occur in real-world settings, representing crucial partnerships to address questions that are important to patients and their care providers. This is of special interest to NCCAM as many complementary health approaches are readily available in the marketplace. As a consequence, NCCAM’s research has to bridge the research process and real-world consumer use. Another important feature of this work is that all of the studies are randomized controlled trials. Randomization is important because it is the best way to make sure that the comparison groups do not differ in other ways except in the intervention being tested. Finally, these studies all represent important cooperative activities with health care delivery organizations—they are true public-private partnerships. The projects awarded are:
- Pragmatic Trial of Video Education in Nursing Homes (PROVEN), Brown University, Providence, Rhode Island, Dr. Vincent Mor; Hebrew SeniorLife, Boston, Dr. Susan Mitchell; and Massachusetts General Hospital, Boston, Dr. Angelo Volandes. This trial will evaluate decision-making for the patient, family, and health care team about advanced care planning in nursing homes, where residents typically have multiple chronic conditions. It uses a set of video education tools developed specially for this purpose. 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 overseen by the National Institute on Aging and 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 overseen by the National Institute of Diabetes and Digestive and Kidney Diseases and 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 overseen by the National Institute of Mental Health and the National Institute on Alcohol Abuse and Alcoholism.
We at NCCAM are very excited about these projects, which represent transformative and high-quality clinical research that addresses the need for improvement of health outcomes of patients with these conditions.
NIH Collaboratory Steering Committee leadership
Seated left to right: Michael Lauer (NHLBI), Catherine Meyers (NCCAM), Josephine Briggs (NCCAM), Barry Coller (The Rockefeller University), Rob Califf (Duke University Medical Center), Eric Larson (Group Health Research Institute), Wendy Weber (NCCAM), Rich Platt (Harvard Pilgrim Health Care Institute)