Abstract
Despite widespread agreement that stakeholder engagement is needed in patient-centered outcomes research (PCOR), no taxonomy exists to guide researchers and policy makers on how to address this need. We followed an iterative process, including several stages of stakeholder review, to address three questions: (1) Who are the stakeholders in PCOR? (2) What roles and responsibilities can stakeholders have in PCOR? (3) How can researchers start engaging stakeholders? We introduce a flexible taxonomy called the 7Ps of Stakeholder Engagement and Six Stages of Research for identifying stakeholders and developing engagement strategies across the full spectrum of research activities. The path toward engagement will not be uniform across every research program, but this taxonomy offers a common starting point and a flexible approach.
Similar content being viewed by others
References
Bastian H, Glasziou P, Chalmers I. Seventy-five trials and eleven systematic reviews a day: how will we ever keep up? PLoS Med. 2010;7:e1000326.
Zilberberg MD. The clinical research enterprise. JAMA. 2011;305:604–5.
Grol R. Improving the quality of medical care. JAMA. 2001;286:2578–85.
Rothwell PM. Treating individuals 2. Subgroup analysis in randomised controlled trials: importance, indications, and interpretation. Lancet. 2005;365:176–86.
Rothwell PM, Mehta Z, Howard SC, Gutnikov SA, Warlow CP. Treating individuals 3: from subgroups to individuals: General principles and the example of carotid endarterectomy. Lancet. 2005;365:256–65.
Kent DM, Hayward RA. Limitations of applying summary results of clinical trials to individual patients: the need for risk stratification. JAMA. 2007;298:1209–12.
Killien M, Bigby JA, Champion V, et al. Involving minority and underrepresented women in clinical trials: the National Centers of Excellence in Women's Health. J Womens Health Gend Based Med. 2000;9:1061–70.
Yancey AK, Ortega AN, Kumanyika SK. Effective recruitment and retention of minority participants. Annu Rev Public Health. 2006;27:1–28.
Caldwell PH, Murphy SB, Butow PN, Craig JC. Clinical trials in children. Lancet. 2004;364:803–811.
Institute of Medicine. Initial Priorities for Comparative Effectiveness Research. Washington: National Academies Press; 2009.
Federal Coordinating Council for Comparative Effectiveness Research. Report to the President and Congress. Washington: US Department of Health and Human Services; 2009. http://www.hhs.gov/recovery/programs/cer/cerannualrpt.pdf. Accessed June 18, 2011.
Patient Centered Outcomes Research Institute. Available at: http://www.pcori.org. Accessed June 18, 2011.
McClellan M, Benner J, Garber AM, Meltzer DO, Tunis SR, Pearson S. Comparative Effectiveness Research: Will It Bend the Health Care Cost Curve and Improve Quality? Washington: The Brookings Institute; 2009.
Roehr B. More stakeholder engagement is needed to improve quality of research, say US experts. Br Med J. 2010;341:c4193.
Conway PH, Clancy C. Charting a path from comparative effectiveness funding to improved patient-centered health care. JAMA. 2010;303:985–6.
Institute of Medicine. Conflict of Interest in Medical Research, Education, and Practice. Washington: National Academies Press; 2009.
Harvard Business School Press. The Essentials of Negotiation. Boston: Harvard Business School Publishing; 2005.
Malhotra D, Bazerman MH. Negotiation Genius. New York: Bantam Books; 2008.
Institute of Medicine. Clinical Practice Guidelines We Can Trust. Washington: The National Academies Press; 2011.
Selker HP, Leslie LK, Wasser JS, Plaut AG, Wilson IB, Griffith JL, Tufts CTSI. Tufts CTSI. Clin Transl Sci. 2010;3:56–8.
Minkler ME, Wallerstein NE. Community Based Participatory Research for Health. San Francisco: Jossey-Bass; 2003.
CTSA Community Engagement Key Function Committee. Principles of Community Engagement. 2nd ed. Washington: U.S. Department of Health and Human Services; 2011.
Israel BA, Schulz AJ, Parker EA, Becker AB. Review of community-based research: assessing partnership approaches to improve public health. Annu Rev Public Health. 1998;19:173–202.
O’Haire C, McPheeters M, Nakamoto EK, et al. Methods for Engaging Stakeholders To Identify and Prioritize Future Research Needs. Rockville: Agency for Healthcare Research and Quality; 2011. AHRQ Publication No. 11-EHC044-EF.
Hoffman A, Montgomery R, Aubry W, Tunis SR. How best to engage patients, doctors, and other stakeholders in designing comparative effectiveness studies. Health Aff. 2010;29:1834–41.
Medicare prescription drug, improvement, and modernization act of 2003, H.R.1, 108th Congress.
Patient-Centered Outcomes Research Institute. Draft National priorities for research and research agenda, version 1. Washington; 2012.
Luce BR, Kramer JM, Goodman SN, et al. Rethinking randomized clinical trials for comparative effectiveness research: the need for transformational change. Ann Intern Med. 2009;151:206–9.
Tunis SR, Stryer DB, Clancy CM. Practical clinical trials: increasing the value of clinical research for decision making in clinical and health policy. JAMA. 2003;290:1624–32.
Ware JH, Hamel MB. Pragmatic trials: guides to better patient care? N Eng J Med. 2011;364:1685–7.
Lindenauer PK, Pekow PS, Lahti MC, Lee Y, Benjamin EM, Rothberg MB. Association of corticosteroid dose and route of administration with risk of treatment failure in acute exacerbation of chronic obstructive pulmonary disease. JAMA. 2010;303:2359–67.
Krishnan JA, Mularski RA. Acting on comparative effectiveness research in COPD. JAMA. 2010;303:2409–10.
Institute of Medicine. Finding What Works in Health Care: standards for Systematic Reviews. Washington: National Academies Press; 2011.
Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0. The Cochrane Collaboration; 2008.
Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6(7):e1000100.
Facey K, Boivin A, Gracia J, et al. Patients' perspectives in health technology assessment: a route to robust evidence and fair deliberation. Int J Tech Assess Health Care. 2010;26:334–40.
Krahn M, Naglie G. The next step in guideline development: incorporating patient preferences. JAMA. 2008;300:436–8.
Agency for Healthcare Research and Quality. About the Eisenberg Center. Available at: http://www.effectivehealthcare.ahrq.gov/index.cfm/who-is-involved-in-the-effective-health-care-program1/about-the-eisenberg-center. Accessed June 18, 2011.
Benner JS, Morrison MR, Karnes EK, Kocot SL, McClellan M. An evaluation of recent federal spending on comparative effectiveness research: priorities, gaps, and next steps. Health Aff. 2010;29:1768–76.
Lauer MS, Collins FS. Using science to improve the nation's health system: NIH's commitment to comparative effectiveness research. JAMA. 2010;303:2182–3.
Selker HP, Strom BL, Ford DE, et al. White paper on CTSA consortium role in facilitating comparative effectiveness research. Clin Transl Sci. 2010;3:29–37.
Veterans Administration. Quality Enhancement Research Initiative (QUERI). Available at: http://www.queri.research.va.gov/about/default.cfm. Accessed June 18, 2011.
Wells K, Miranda J, Bruce ML, Alegria M, Wallerstein N. Bridging community intervention and mental health services research. Am J Psychiatry. 2004;161:955–63.
Leung MW, Yen IH, Minkler M. Community based participatory research: a promising approach for increasing epidemiology's relevance in the 21st century. Int J Epid. 2004;33:499–506.
Seifer S. Building and sustaining community-institutional partnerships for prevention research: findings from a national collaborative. J Urban Health. 2006;83:989–1003.
Clancy CM. Getting to 'smart' health care. Heal Aff. 2006;25:589–92.
Rosengren K, Trinity M. Roundtable on expanding capacity for comparative effectiveness research in the United States. Heal Serv Res. 2009;44:327–42.
Acknowledgements
The authors wish to thank Harry P. Selker, MD, MSPH, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Donna Jo McCloskey, PhD, National Center or Research Resources, National Institutes for Health, and Sean Cahill, PhD, The Fenway Institute, for reviewing early versions of the manuscript.
The authors wish to acknowledge Joseph Lau, MD, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, for creating an earlier version of the six-stage model of CER.
The authors wish to acknowledge Tully Saunders, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, for help in preparing the manuscript.
Conflict of Interest
The authors declare that they do not have a conflict of interest.
Financial Disclosures
This project was funded in whole or in part with federal funds from the National Center for Research Resources (NCRR), National Institutes of Health (NIH), through the Clinical and Translational Science Awards Program (CTSA), part of the Roadmap Initiative, Re-Engineering the Clinical Research Enterprise. This publication was supported by grant no. UL1 RR025752 from the National Center for Research Resources (NCRR), National Institutes of Health (NIH). Dr. Concannon was supported by grant no. K01 HS017726 from the Agency for Healthcare Research and Quality. Dr. Morrato’s effort was supported by grant no. K12HS019464 from the Agency for Healthcare Research and Quality.
Other Disclosures
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the National Center for Research Resources, National Institutes of Health, the Centers for Medicare & Medicaid Services, the Agency for Healthcare Research and Quality, or the Centers for Disease Control & Prevention.
Author Contributions
Dr. Concannon took primary responsibility for conceiving and writing the manuscript, obtaining contributions from co-authors, and managing stakeholder reviews and government clearances. All co-authors made intellectual contributions and contributed original writing to the manuscript. Dr. Leslie contributed substantial editorial review.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Concannon, T.W., Meissner, P., Grunbaum, J.A. et al. A New Taxonomy for Stakeholder Engagement in Patient-Centered Outcomes Research. J GEN INTERN MED 27, 985–991 (2012). https://doi.org/10.1007/s11606-012-2037-1
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11606-012-2037-1