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Published in CenterView on November 25, 2013
Dr. Grayson Norquist
Dr. Grayson Norquist

Psychiatry chair assumes leadership of outcomes research group

By Jack Mazurak

Presiding at his first meeting as Board of Governors chair of the Patient-Centered Outcomes Research Institute, Dr. Grayson Norquist quickly showed his aptitude for outcomes research.

Norquist, professor and chair of psychiatry and human behavior, didn’t assign seats for each board member, in contrast to the previous chair’s method of careful design.

Asked why, Norquist said, “That’s because he’s an obstetrician. I am a psychiatrist. I let them sit where they want, then ask them why later.”

The Patient-centered Outcomes Research Institute, known as PCORI, is a 3-year-old federally created, independent, nonprofit organization charged with shifting medical research in the U.S. toward producing more usable findings for patients and health-care providers.

That can be accomplished by enabling evidence-based research; for example, direct comparisons of two or more drugs, treatment methods or population research that takes into consideration factors from genetics to household income.

More usable information will help patients and caregivers get down the road toward personalized care and help resolve health disparities. It also would benefit health systems and insurance companies by making them more efficient and cost-effective.

Norquist assumed the PCORI board of governors chair position in late September. He acknowledged PCORI’s mission is vast, but the organization has well-defined plans to get to those outcomes.

“In a nutshell, we’re trying to help people get the information they need to make informed decisions about their care and treatment,” Norquist said. “One of the problems is, as a patient, you’re sitting there with a physician and you don’t have the information about whether you should take this medication or not, what’s the best treatment.”

In many cases, no data exist to guide the patient or health-care provider, he said.

So how are Norquist, the board and PCORI going to influence the nation’s biomedical research agenda with a staff of 89 and a fiscal year 2014 budget of approximately $650 million when every year, well more than $100 billion is spent on medical research?

In a way, like a factory production line.

On the raw materials end, PCORI partners with ongoing research projects, co-funding with other agencies, associations and established groups. It also awards grants to start entirely new research projects, and is establishing industry-standard guidelines on how to conduct patient-centered outcomes research.

PCORI started with pilot studies and has already approved nearly 200 research projects totaling almost $275 million.

Topics of studies under way or in planning include falls in the elderly co-funded with the National Institute on Aging, treatment efficacy for asthma in African-Americans, interventions to reduce disparities in the treatment of chronic pain, factors influencing rural patients after hospital discharge, and uterine fibroid treatments.

“These studies range from very specific to very general,” Norquist said. “They can be broad or pin-pointed.

“We’ll look at rare diseases, but mostly public health problems that we think we can have an influence on.”

As those studies progress, the production line will turn out usable findings for patients and health-care workers. Then there’s packaging, marketing and distribution of those products, so to speak. Norquist and PCORI already have plans.

“From the beginning, we’ll work with patients and other stakeholders to find out what information they need to make decisions,” he said. “Then we’ll drive for that in our research.

“Part of it is to have these engaged communities so when you have outcomes and findings, they want them.”

Findings also will be distributed through traditional means – journal articles, niche and mainstream media – and through new media, directly from PCORI and other groups’ websites and social media pages.

“We’ll tap into patient-powered networks, patients who could be involved in clinical research,” Norquist said.

When it comes to tackling the job, the group gathered around PCORI’s table also counts for a lot.

“One thing about this board is that it’s very passionate,” he said. “We started this together, and they all care intensely about making PCORI a success.

“Dr. Francis Collins (National Institutes of Health director) is a member of the board. There are representatives from the pharmaceutical industry, medical device manufacturing, nursing, the Veterans Administration.

“It’s a huge window to tie in other agencies, funders and stakeholders.”

Dr. Joe Selby, PCORI executive director, said members of the Government Accountability Office, which selected Norquist as chair, spoke with every PCORI board member before making a decision.

“The fact that he was selected speaks to the board’s confidence,” Selby said. “Gray has, very fortunately for PCORI, a set of experiences as well as personality for this position.”

Before joining the UMMC faculty in 2004, Norquist served in a number of leadership positions at the National Institute of Mental Health, including as director of the Division of Services and Intervention Research. His work had very similar aspirations as PCORI, Selby said.

“He oversaw practical comparisons, head-to-head trials,” Selby said. “And he also knows a lot about funding, supporting researchers and grant making.”

And Norquist’s specialty brings an added benefit.

“Any board with 21 strong-willed people is improved by having a psychiatrist on it,” Selby said, noting the board actually has two. “He’s calm and thoughtful as many psychiatrists are, and he’s able to say just enough at the right time.”

Norquist’s own research focuses on the use of telemedicine to reduce disparities in mental health treatment for those living in the Mississippi Delta and to improve the quality of care they receive at local community health centers.

Norquist succeeds Dr. A. Eugene Washington, UCLA vice chancellor for health sciences and dean of the David Geffen School of Medicine, who served a three-year term as PCORI board president.

“The rise of the consumer movement and the rise of social media, those are in part what’s driving the need for the kind of effort PCORI is undertaking,” Norquist said. “People have been thinking about this for a long time, but now we have the funding and the organization to do it.”