Large federal program aimed at providing better health care underfunds primary care

Despite a mandate to help patients make better-informed health care decisions, a ten-year research program established under the Affordable Care Act has funded a relatively small number of studies that examine primary care, the setting where the majority of patients in the U.S. receive treatment.

The finding, reported in the Journal of General Internal Medicine, found that only about a quarter of the 250 trials funded between 2015-2018 by the Patient-Centered Outcomes Research Institute (PCORI) had any relation to the primary care setting. The rest were devoted to specialty care.

Furthermore, only about 30 percent of the $1.17 billion spent on the research had any applicability to primary patient care, says the study's senior investigator, Dan Merenstein, MD, professor of medicine and director of research programs in the department of family medicine at Georgetown University School of Medicine.

"If the mission is to help guide patients through issues that have the greatest impact upon them, then PCORI is funneling substantial grant money where it shouldn't be," says Merenstein. "The program, which is up for renewal and may be dissolved in 2020 with grants exceeding $3.5 billion, is very disappointing to physicians who are devoted to, and strongly believe in, primary care. We should be at the forefront of such research."

Merenstein and his collaborators, all at Georgetown when the study began, pointed out in their first study, published in 2016, that an examination of 300 grants, worth $400 million, awarded between 2011-2014 found between 19 percent and 32 percent included any focus on primary care.

This latest study looks at grants given between 2015-2018, and has found no change.

This new study is "stronger in the sense that if there was any chance the study impacted primary care patients we counted it as primary care," says Merenstein.

PCORI is an independent nonprofit, nongovernmental organization authorized by Congress in 2010.

"It is in a unique position to impact patient health, particularly in the primary care setting. Most health care is accessed within primary care, making it an ideal setting to do research that will make an impact on the patient health care experience," says the first author, Andrew Blaster, a Georgetown medical student. co-author