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Comparatively Ineffective? PCORI and the Uphill Battle to Make Evidence Count in US Medicine

September 14, 2020

In September 2020, Eric Patashnik wrote, "Comparitively Ineffective? PCORI and the Uphill Battle to Make Evidence Count in US Medicine," a piece analyzing the trials and tribulations of the Patient-Centered Outcomes Research Institute (PCORI). The Institute was created to promote research on the comparative effectiveness of treatment options, and has struggled to have an impact on the decisions of physicians and payers. 


There is too little rigorous scientific research on what medical therapies work best for patients. To address this problem, the Affordable Care Act established the Patient-Centered Outcomes Research Institute (PCORI) to promote research on the comparative effectiveness of treatment options. PCORI's creation sparked heated political controversy as many conservatives and industry groups feared PCORI would ration care and threaten physicians' autonomy. PCORI faced three challenges during its first decade of operation: escaping early termination, shaping medical practice, and building a public reputation for relevance. While PCORI has won bipartisan reauthorization, it has not yet had a major impact on the decisions of clinicians or payers. PCORI's modest footprint reflects not only the challenges of getting a new organization off the ground but also the larger political, financial, and cultural barriers to the uptake of medical evidence in the US health care system.