Road map to a patient-centered research agenda at the intersection of hospital medicine and geriatric medicine

Abstract

As the United States ages, the patient population in acute care hospitals is increasingly older and more medically complex. Despite evidence of a high burden of disease, high costs, and often poor outcomes of care, there is limited understanding of the presentation, diagnostic strategies, and management of acute illness in older adults. In this paper, we present a strategy for the development of a research agenda at the intersection of hospital and geriatric medicine. This approach is informed by the Patient-Centered Outcomes Research Institute (PCORI) framework for identification and prioritization of research areas, emphasizing input from patients and caregivers. The framework's four components are: 1) Topic generation, 2) Gap Analysis in Systematic Review, 3) Value of information (VOI) analysis, and 4) Peer Review. An inclusive process for topic generation requiring the systematic engagement of multiple stakeholders, especially patients, is emphasized. In subsequent steps, researchers and stakeholders prioritize research topics in order to identify areas that optimize patient-centeredness, population impact, impact on clinical decision making, ease of implementation, and durability. Finally, next steps for dissemination of the research agenda and evaluation of the impact of the patient-centered research prioritization process are described.

Figure 1

Schematic of the steps involved in research prioritization (adapted from the PCORI Methodology Report). The proposed methodology begins with a systematic and inclusive process for topic generation. The systematic engagement of multiple stakeholders, especially patients, is a critical component of topic generation. This is followed by a multistep prioritization beginning with systematic reviews and gap analysis to identify what is known, and what desirable knowledge is not known. The VOI analysis is a methodology used to identify the research questions with the greatest potential to improve population health. Finally, proposals addressing the high value research questions are subjected to peer and stakeholder review to ensure methodological rigor. Although these steps are depicted as linear, in practice, prioritization and reprioritization occur at all stages of the process. The integration of patient viewpoints is included at all stages of research prioritization.