At a community center in San Bernadino, California, there’s a conversation unfolding among patients, caretakers and health care professionals about the factors driving poor appointment attendance among local HIV patients. Is it difficult for people to find transportation, or are they skipping appointments in an effort to save money? Or perhaps patients are reluctant to see health care professionals who they feel lack cultural competency?
The facilitator of the discussion is Daniel Pearce, DO, an associate professor at Loma Linda University Medical Center in Loma Linda, California. He’s the leader of a research team that has received $40,000 so far from the Patient-Centered Outcomes Research Institute to investigate what local HIV patients, their caretakers and community health care professionals consider the biggest barrier to appointment attendance. The funding is part of PCORI’s pipeline to proposal program, which is designed to help investigators ramp up major research projects.
In this edited interview, Dr. Pearce explains how his research has taken shape and offers tips for other DOs who’d like to pursue PCORI funding.
Dr. Pearce’s project is focused on HIV patients in California’s Inland Empire, a vast swath of land east of Los Angeles that includes Riverside and San Bernadino counties. He and his research team began by organizing two forums to brainstorm reasons patients might skip appointments and identify the intervention most likely to help. “Out of the 20 ideas they came up with, the group unanimously identified support as the #1 factor in helping HIV patients get to their medical appointments,” Dr. Pearce explains. “I was expecting transportation to be the biggest concern, so this was eye-opening.”
Designing a research question
Next, Dr. Pearce’s team obtained $25,000 in Tier II PCORI funding to embark on the yearlong process of working with patients and stakeholders to create a comparative research question. The team designed a project that will compare appointment attendance for HIV patients who receive one of two kinds of support through their local clinic. Participants will be newly diagnosed HIV patients and existing patients whose disease hasn’t been controlled well in the past.
One group will get support through a peer navigator system in which a designated clinic staffer offers in-person help with obtaining prescriptions and connecting with social workers. A second set of patients will receive support in the form of frequent contact. Clinic workers will conduct regular check-ins with patients by phone, email or text message to see how they’re managing their disease. After two years, researchers will evaluate the community viral loads of both groups of patients to compare the effectiveness of the two interventions.
For Dr. Pearce, the project has illustrated the importance of incorporating patient input into comparative effectiveness research. “I thought comparing the two HIV support models for one year would be sufficient, but our patient partners strongly recommended two years because it takes people time to get into the groove of treatment,” he says. “That kind of patient and stakeholder expertise is really helpful, because otherwise your study won’t work.”
As a next step, Dr. Pearce and his colleagues have applied for Tier III funding from PCORI, which would provide up to $50,000 while the researchers apply for a multimillion dollar grant. “It’s an amazing opportunity,” he says. “If we are approved for Tier III, not only will we be paid to write a big grant, but PCORI will also advise us on designing the study and putting the grant together.”
Overall, Dr. Pearce says, the process of obtaining PCORI funding is work-intensive, but achievable. “We received funding even though we weren’t a major organization with tons of grants in our area of medicine when we first got started,” he says. “My advice to other DOs is, if you do it right, you can get your project funded.”