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MTPPI’s Population Health Management Practice Wins PCORI Contract

PHM Strategy Project Will Focus On Deploying Research Dissemination Model Nationally

Bethesda, MD – The Population Health Management Practice of the Medical Technology and Practice Patterns Institute (MTPPI) has been awarded a two-year dissemination contract from the Patient-Centered Outcomes Institute (PCORI Contract # EADI-12149). MTPPI’s Director of Research, Dr. Mae Thamer, will lead the multi-disciplinary research team tasked with disseminating four select research projects from PCORI’s kidney disease research portfolio. “PCORI has awarded over 600 research contracts since its inception in 2010. These projects represent over $2.4 Billion in research funding dedicated to improving medical outcomes for patients across the United States,” said Nicholas Hamilton-Cotter, Director of Development and Strategic Alliances for MTPPI. “This project is a great opportunity to pair MTPPI’s Population Health Management strategies and methods with research findings from four of the nation’s most respected healthcare organizations represented by the University of Washington1, Penn State Health’s Hershey Medical Center2, the Arbor Research Collaborative for Health3, and Baystate Health4.”

MTPPI will be partnering with Quality Insights Renal Network 5, one of eighteen geographic End-Stage Renal Disease networks in the United States. “The QI Network 5 team, led by Executive Director Brandy Vinson, are experts at ensuring that quality improvement initiatives are sustainable and incorporated into daily clinical practice,” stated Dr. Thamer. “By leveraging the existing dissemination infrastructure at Network 5, we will be able to rapidly deploy research findings into the field while also collecting feedback data from a variety of ESRD stakeholders. This engagement ‘flywheel’ will be used to iterate the dissemination tools and systems and expand the reach of the new dialysis-related research findings nationally into the eighteen ESRD networks by the end of the two-year project.”

Below are summaries of the four research projects that will be disseminated:

Treatment Options for Depression in Patients Undergoing Hemodialysis – The Principal Investigator (PI) for this project is Dr. Rajnish Mehrotra, Professor of Medicine at the University of Washington’s Kidney Research Institute. This project involved a randomized controlled clinical trial of 400 patients that tested whether an engagement interview would result in a higher proportion of dialysis patients accepting treatment for depression. A second randomized controlled clinical trial of 180 patients was conducted to determine whether there was any difference in the likelihood of improvement of depressive symptoms with psychotherapy or drug therapy among dialysis patients with depression. Patients in these studies were enrolled from 50 dialysis facilities in three metropolitan areas—Seattle, Dallas, and Albuquerque.

Improving Patient Quality of Life and Caregiver Burden by a Peer-Led Mentoring Program for Patients with Chronic Kidney Disease and Their Caregivers – This project was led by Dr. Nasrollah Ghahramani, Professor and Vice Chair for Educational Affairs in Penn State’s Department of Medicine. Investigators enrolled patients with advanced chronic kidney disease and caregivers of such patients into randomly assigned groups. On group received face-to-face Patient and Family Partner Program (PFPP) sessions—individuals received six months of PFPP peer-mentoring along with an informational text. Another group received online PFPP—individuals received six months of online peer-mentoring modeled after the PFPP program, along with an informational text; and a third group composed the information-only control group—individuals received the text of the material provided to the other two groups.

Does an Online Decision Aid Help People with Advanced Chronic Kidney Disease Choose between Two Treatment Options? – Dr. Lalita Subramanian served as the PI for this five- year research project. Investigators created and tested an online decision aid that helped people choose between two or more treatments based on what is most important to them. The decision aid in this study gave patients information on CKD and compared the two treatment options. The research team wanted to learn if the decision aid increased patients’ knowledge about CKD and helped them with their decision on choosing treatments. The study included 140 patients with advanced CKD who had not started dialysis. The average patient age was 59. About 77 percent of patients in the study were white, and 16 percent were African American. Almost all patients had at least a high school degree, and 94 percent spoke English as their native language. The research team randomly assigned patients to one of two groups. One group used the decision aid, and the other group didn’t. Patients in the first group took a survey before and after using the decision aid. The survey asked patients what they knew about CKD and asked them about how they make decisions about treatment. Patients in the second group took the survey only once. A panel of patients, caregivers, social workers, and doctors provided input on the study. Research findings showed that the decision aid increased what patients knew about CKD and treatment options, how sure patients were about what was most important to them in choosing between treatments and how sure patients felt about which treatment they would choose. The decision aid did not change patients’ self-confidence in their ability to decide which treatment would be best for them.

Shared Decision Making and Renal Supportive Care – Dr. Lewis Cohen of the Psychiatric Consultation Service at Baystate Medical Center served as the PI for this research project. Investigators designed a multi-center study that deployed an intervention to improve end-of-life communication for hemodialysis patients who are at high risk of death in the ensuing six months. The intervention was carried out as a prospective cohort with a retrospective cohort serving as the comparison group. Patients were recruited from 16 dialysis units associated with two large academic centers in Springfield, Massachusetts and Albuquerque, New Mexico. Critical input from patient advisory boards, a stakeholder panel, and initial qualitative analysis of patient and caretaker experiences with advance care planning informed the communication intervention. Rigorous communication training for hemodialysis social workers and providers ensured that standardized study procedures were performed at each dialysis unit. Nephrologists and social workers communicated about the prognosis and provided advance care planning in face-to-face encounters with patients and families using a social work-centered algorithm. Study outcomes including frequency and timing of hospice referrals, patient and caretaker satisfaction, quality of end-of-life discussions, and quality of death were assessed over an eighteen month period. The Shared Decision-Making Renal Supportive Care Communication intervention intended to improve discussions about prognosis and end-of-life care with end-stage renal disease patients and help guide hemodialysis staff and providers to effectively participate in advance care planning for patients and caretakers to establish preferences and goals at the end of life.

About MTPPI: MTPPI is a nonprofit organization established in 1986 to conduct research on the clinical and economic implications of health care technologies. MTPPI’s research is directed toward the formulation and implementation of local and national health care policies. With extensive investigator experience in both the public and private sectors, MTPPI’s staff designs, implements, and conducts a full range of healthcare research and technology development activities. Our staff includes statisticians, epidemiologists, economists, programmers, biomedical engineers, and policy analysts. We specialize in using big data to conduct real-time, real-world studies that are both affordable and useful for healthcare stakeholders.

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