Pipeline to Proposal (P2P) project is cause for excitement: An Interview with Judi Foley

Public health professionals who are involved with the Pipeline to Proposal (P2P) project have reason for excitement. They can be pleased -- awed even -- by the projects that are coming through their own pipelines. There's also the knowledge that they are working on something big: something that has the potential to change health research and improve lives. At the same time, though, there are concerns about the future.

P2P is part of the vision of the Patient-Centered Outcomes Research Institute (PCORI), an independent nonprofit authorized by the Affordable Care Act. PCORI seeks to engage stakeholders and reduce the time it takes to translate research into evidence-based practice.

Judi Foley is among those working for change through P2P. She says, “There are many people working towards solutions of all types and the more we include those most impacted, the better we will come to getting to the most effective response.” Foley heads the P2P program at Massachusetts-based Health Resources in Action, a public health institute with a diverse portfolio of projects. HRiA is one of five Pipeline Award Program Offices; it serves the Eastern part of the nation.

The Status of Medical Research

Medical research in the United States is not as effective as it could be. U.S. PhDs and MDs are held to rigorous research standards, but their best ideas spend too long ensconced in ivory towers. A significant translational gap has been noted. Some experts have figured the time between scientific discovery and practical application at 17 years. There are delays as scientists replicate results, translate them to real world conditions, and put the information in the hands of practitioners. Of course, some good ideas get lost along the way.

One area of concern: Research questions and designs have often failed to adequately incorporate the opinions of important populations, those that do not have expertise in research but nonetheless have a stake in the results.

Working for Change at P2P Program Offices

PCORI seeks to engage those not traditionally involved with research. This group includes not just practitioners who work on the frontlines but people with serious health concerns -- the patients themselves. It also includes many people who interact with patients on a regular basis, among them, caregivers and members of advocacy groups.

PCORI supports research into both rare and common diseases. P2P supports development at the very early stages of the research process -- hence the term ‘pipeline’. Among the necessary steps for engaging lay people: making the terminology accessible to the average person. Foley notes that some patients involved with P2P come from populations where there is a tremendous amount of inequity health-wise.

Foley speaks of a P2P project where the original goal was to shorten the amount of time cardio and lung patients spent in the intensive care unit. It seemed a worthy goal. But what did the patients say when their input was sought? It just wasn't that important to them whether they were in the ICU or another hospital room; they wanted to shorten the time until they went home. And so it was time to re-envision this particular project.

When patients are engaged, there is a greater chance that the intervention is something they will buy into. Ultimately, there is a greater chance of success.

PCORI is thinking about another component of success -- the translational gap -- from the start. It is not enough, Foley notes, to put research in peer-reviewed journals. It is also important to utilize newer forms of communication like blogs and to present at conferences. The form must suit the audience, and patients represent one important audience.

PCORI is particularly interested in comparative effectiveness studies: those that compare the relative effectiveness of multiple interventions. The organization does not fund projects that focus on cost effectiveness; this is one of many ways it is different from the Center for Medicare and Medicaid Innovation, an ACA-authorized governmental entity that invests heavily in healthcare innovations.

Challenges Moving Forward

Currently funded P2P projects are working through a three tier process. Those in the first tier bring stakeholders together and create a governing document and a plan for engagement. The literature review is among the various projects undertaken at the Tier 2 level. (Literature review is a step also carried out by academic researchers). By the end of Tier 3, successful projects will have a finely honed research proposal for which they can seek PCORI (or other) funding. They won’t yet have a body of clinical research. However, they will be ready to go through the same type of rigorous process that those in academia do.

The PCORI team recently announced a new model, one where organizations that enter at the beginning stage will go through just two tiers before ‘graduating’ from P2P.

PCORI seeks to shorten the pipeline, but some gap is inevitable. One can’t take a good idea and produce measurable results the same year. This is one of the challenges from a policy standpoint. It will take time before researchers have evidence for the value of particular interventions over others or know what their most successful models are. It will take time before researchers can say, “Look, people's health is better.” It may take time before those doing the inevitable tallying can say this adds value and is cost-effective – as improved health often is, even when cost is not the thing being measured.

PCORI projects extend beyond P2P. In fact, P2P is a more recent component. The PCORI organization recently sought an independent contractor to model the financial impacts of some of their projects.

PCORI relies on the ACA for its funding. This funding goes through 2019. If re-authorized, the work may be ongoing. If not, there will be losses. One of the hopes, though, in all cases, is that P2P will have a role in changing how research is done and that other funders will take note. PCORI – and P2P – are investments in the future.