PCOR Trust Fund Investments At-A-Glance
Patient-centered outcomes research (PCOR) provides decision-makers with objective, scientific evidence on the comparative effectiveness of treatments, services, and other interventions used in healthcare. The Patient-Centered Outcomes Research Trust Fund (PCORTF) is funded by a tax on insurers. AHRQ's portion of the PCORTF is approximately $100 million/year which, by statute, is allocated to training PCOR researchers and dissemination and implementation of evidence into practice to make sure the best available evidence is understood and used to achieve outcomes that patients care about.
Training PCOR Researchers
AHRQ uses the PCORTF training authority and approximately 15% of PCORTF funds to support career development training in the full range of PCOR research design, data analysis, and comparative effectiveness research. AHRQ's training investments aim to produce the next generation of researchers to conduct PCOR that represents national healthcare priorities and needs and implements the results to improve the quality of care and patient outcomes. Examples include:
- AHRQ invests in traditional early, mid-career, and senior investigator development grants (K01, K08, K18).
- Since 2018, AHRQ has partnered with the Patient-Centered Outcomes Research Institute (PCORI) to develop the new Learning Health System Centers of Excellence. Newly trained clinician and research scientists used LHS Training Competencies within health systems to collaborate with systems' leaders and conduct studies to address how healthcare organizations can improve patient outcomes.
- Most recently, AHRQ and PCORI co-funded Learning Health System Embedded Scientist Training and Research (LHS E-STaR) Centers. Grantees will create new models of learning health system infrastructure that will use evidence generated by these scientists' research to optimize care as quickly, broadly, and equitably as possible and ultimately improve health outcomes.
- AHRQ uses learning collaboratives among grantees to share valuable lessons, resources, curriculum, and training materials.
- AHRQ evaluates its training programs to assess the outputs and early outcomes of AHRQ's PCOR training and infrastructure capacity building programs.
Disseminating PCOR Evidence
In its dissemination efforts and investments, AHRQ aims to ensure evidence is understood and used. Therefore, AHRQ invests more than 80% of its PCORTF dollars across the dissemination and implementation (D&I) continuum by synthesizing the best available evidence, translating it into actionable knowledge, and supporting and evaluating implementation tools and strategies across various healthcare settings.
AHRQ's PCORTF D&I investments include:
- AHRQ's Healthcare Extension Service: State-based Solutions to Healthcare Improvement, launched in Fall 2024, is one of AHRQ's most prominent investments to date, accounting for nearly half of AHRQ's PCORTF investments. This 5-year program includes up to 15 state-based Healthcare Extension Cooperatives, a National Coordinating Center, and a National Evaluation Center. The goal of the Healthcare Extension Service is to accelerate the dissemination and implementation of patient-centered outcomes research evidence into healthcare delivery in order to reduce the time from evidence generation and its use in healthcare delivery. The program is designed to enhance healthcare delivery through improvements in healthcare policy, payment systems, and clinical practice, and to reduce healthcare disparities especially among people who receive Medicaid, are uninsured, or are medically underserved.
- AHRQ's Evidence-based Practice Centers (EPC) that synthesize the best available evidence on the outcomes, benefits and harms, and appropriateness of drugs, devices, and healthcare services and by helping healthcare professionals, patients, policymakers, and healthcare systems make informed healthcare decisions. They also create evidence tools and continually advance and produce guidance on evidence synthesis methods.
- Advancing the science of Clinical Decision Support by supporting implementers, clinicians, and technology vendors in developing clinical decision support tools that are shareable, standards-based, publicly available, and patient-centered.
- Developing and implementing other types of tools to support dissemination of "actionable knowledge" derived from evidence-based research findings and practices from PCORI and other government-funded and non-government-funded entities that sponsor relevant research. Examples include:
- The Comparative Health System Performance Initiative, which is currently updating the Compendium of U.S. Healthcare Systems to study how healthcare systems promote evidence-based practices in delivering care.
- The SHARE Approach curriculum and toolkit for clinicians to learn the skills for shared decision making with their patients.
- Working with HHS Agencies in developing behavioral health integration measures.
- Supporting and evaluating implementation strategies to help local, State, and Federal decision-makers use PCOR to inform needed improvements in healthcare. Examples include:
- EvidenceNOW, which focused on providing external support to small and medium primary care practices to advance cardiovascular health. The EvidenceNOW project resulted in a multitude of learnings and tools for change that were further adapted for additional EvidenceNOW projects to implement PCOR evidence for Managing Unhealthy Alcohol Use, Managing Urinary Incontinence, and Building State Capacity.
- TAKEheart, an initiative to help hospitals increase participation in cardiac rehabilitation.
- Improving Implementation Strategies for Implementation of Evidence-based Care to Reduce High Burden Racial and Ethnic Disparities.
Infrastructure and Program Support
AHRQ also makes operational investments to support its PCORTF Training and D&I programs. These investments include staff, strategic planning and evaluation, information technology, communication support, and stakeholder engagement, including technical advisory panels, the PCORTF Sub-committee of AHRQ's National Advisory Council, and expenditures for grants and contracts.
AHRQ's Strategic Plan for PCORTF Training and D&I Investments
Following reauthorization of the PCORTF in FY2020, AHRQ engaged in an extensive strategic planning process including a Federal Register Notice for public input, four virtual workshops through the National Academy of Science Engineering and Medicine: Accelerating the Use of Findings from Patient-Centered Outcomes Research in Clinical Practice to Improve Health and Health Care: A Workshop Series, and a subcommittee of AHRQ's National Advisory Council (NAC) to provide input on building, implementing, and evaluating a connected portfolio of investments to achieve our goals. Robust input informed AHRQ's final PCORTF Strategic Framework, which guides all of AHRQ's PCORTF investments.
AHRQ recently established an internal Steering Committee to operationalize the Strategic Framework within a Learning Portfolio Model. This means that AHRQ will aim for continuous improvement in internal operations to support investment decisions informed by data- and stakeholder-driven insights, applying an equity framework to all projects. A learning culture requires careful analysis of the portfolio, from the mix of project types, targets, and strategies, to project outputs and outcomes. The goal is a connected portfolio of projects aligned with national priorities to achieve the mission, vision, and goals of the strategic framework. Becoming a learning portfolio will enhance the Agency's adaptability to change; increase capacity for impact and innovation; engage and empower portfolio, program, and project-level stakeholders; and improve long-term success and sustainability.
