LDI/Penn Medicine's Neuman, Bekelman and Guevara Win $25 Million in PCORI Grants

LDI/Penn Medicine's Neuman, Bekelman and Guevara Win $25 Million in PCORI Grants

Projects Focus on Anesthesia and Surgical Outcomes, Proton vs. Photon Therapy, and ADHD Patient Family Dynamics

LDI Senior Fellows Mark Neuman, Justin Bekelman and James Guevara, all of Penn's Perelman School of Medicine, have tentatively won more than $25 million in Patient-Centered Outcomes Research Institute (PCORI) funding for comparative clinical effectiveness studies.

The grants were announced by the PCORI Board of Governors who point out that the projects are still subject to a programmatic and budget review by the PCORI staff and the negotiation of a formal
Mark Neuman
Mark Neuman, MD, will receive $11.9 million in PCORI funding for a five-year comparative effectiveness study of anesthesia methods for hip fracture surgery.
Justin Bekelman
Justin Bekelman, MD, will receive $11.9 million in PCORI funding for a five-year comparative effectiveness study of Proton vs. Photon radiation therapy.
James Guevara
James Guevara, MD, MPH, will receive $2.1 million in PCORI funding for a three-year comparative effectiveness study of communications related to the treatment of childhood ADHD.

award contract. The three projects were among 34 clinical effectiveness studies selected for a total of $120 million in funding from PCORI.

Broad impact
The emphasis of PCORI's chosen research proposals is on studies conducted in typical clinical settings during routine care with the goal of producing results applicable to a broad range of patients and care situations.

Neuman, MD, an Assistant Professor of Anesthesiology and Critical Care at Penn's medical school, is slated to receive $11.9 million for a five-year study of how the two most commonly used anesthesia methods effect the ultimate outcomes of hip-fracture surgeries among adults older than 49. Neuman's earlier observational studies of this issue set the stage for his PCORI proposal.

His REGAIN (Regional vs. General Anesthesia) study proposal notes that that one year after fracture surgery with anesthesia, 50% of previously independent patients have died or require nursing home placement and 40% of survivors who previously walked independently need help to walk 10 feet. The REGAIN trials will compare short- and long-term outcomes of surgeries using spinal versus general anesthesia among a cohort of 1,600 patients from 18 academic and community hospitals.

Patient decisions
"By comparing two universally available, basic anesthesia approaches," Neuman wrote, "the REGAIN trial will directly and immediately affect patient decision making, care and outcomes for more than 300,000 U.S. patients who need surgery to treat hip fracture each year."

Bekelman, MD, Assistant Professor of Radiation Oncology at the medical school, will receive $11.9 million for a five-year study comparing the short and long-term effects of Proton versus Photon radiation therapy for patients with stage II or III breast cancer.

A consortium of 20 academic and community practice radiation therapy centers and related professional groups will conduct a randomized clinical trial in which 1,716 patients with stage II and II breast cancer involving lymph nodes under the arm or above the collarbone will receive after-surgery Proton or Photon therapy. Patients will be followed to determine differences in subsequent heart problems, cancer control and health-related quality of life measures.

"Our study results," Bekelman wrote, "will be directly relevant to many thousands of patients and doctors who confront difficult treatment decisions about breast cancer therapies every day."

Childhood ADHD patients
Guevara, MD, MPH, an Associate Professor of Epidemiology and Biostatistics at the medical school and Associate Professor of Pediatrics at the Children's Hospital of Philadelphia (CHOP), is to receive $2.1 million for a 3-year comparative study of communications integration among all parties involved in the treatment of children with Attention-Deficit/Hyperactivity Disorder (ADHD).

His proposal notes that currently, and despite previous federal calls for improvement, the health communications related to the care of young ADHD patients remains fragmented among patients, family members, teachers and clinicians. This results is poorly coordinated services, lack of coherent information sharing across clinical systems, and ultimately, suboptimal outcomes for the patients.

The comparative investigation will be conducted at 15 pediatric primary care clinics in the CHOP Care Network and will enroll 300 children with ADHD, ages 5-12 years. They will be randomized to the electronic patient portal alone, or to the electronic portal combined with a care manager. The patients' clinicians, teachers and parents will participate.

"Findings of this study," Guevara wrote, "will inform the use of communication strategies to share family preferences and goals among parents, teachers, and clinicians of children with ADHD."

Created as part of the Affordable Care Act, PCORI is an independent, non-profit organization whose mission is to fund research that provides patients, caregivers and clinicians with evidence-based information that supports better-informed healthcare decisions.