Former ACR president Sherine E. Gabriel, MD, MSc, has long been at the forefront of patient-centered clinical research designed to enhance the effectiveness of treatment of rheumatoid arthritis and other rheumatic conditions. Now, Dr. Gabriel, who is professor of medicine and epidemiology and the William J. and Charles H. Mayo Professor at the Mayo Clinic in Rochester, Minn., has been asked to apply her expertise and leadership to improving outcomes across the full gamut of healthcare in the United States.
The researcher and clinician was selected on February 15, 2011, to chair the Methodology Committee of the Patient-Centered Outcomes Research Institute (PCORI). On January 21, U.S. Comptroller General Gene L. Dodaro appointed her as a member of the committee, along with 14 other physicians and scientists.
PCORI, a nonprofit corporation, was established last year in accordance with the Patient Protection and Affordable Care Act, the centerpiece of the healthcare reform enacted in March 2010. The institute’s purpose, Dodaro stated, is “to assist patients, clinicians, purchasers, and policy makers in making informed health decisions by providing quality, relevant evidence on how best to prevent, diagnose, treat, and monitor diseases and other health conditions.”
Hours after her selection as chair, Dr. Gabriel told The Rheumatologist, “I believe PCORI and its Methodology Committee provide an unprecedented opportunity for health and medical science to play a leadership role in America’s transformation toward a high-value healthcare system. The PCORI Board of Governors will identify national research priorities and carry out a corresponding research agenda, while the Methodology Committee will develop and improve the methodological standards needed for patient-centered outcomes research, which includes methods to improve dissemination of research results.”
She adds, “This is a cause about which I am passionate. That is why I am excited and honored to be named chair of the Methodology Committee.”
Strong Support from Colleagues
The ACR and Mayo Clinic both championed Dr. Gabriel’s nomination to serve with PCORI, either on its Board of Governors—she made it to the short list of candidates—or on the Methodology Committee.
In a letter to Comptroller General Dodaro, Stanley B. Cohen, MD, also a former ACR president, wrote, “Dr. Gabriel’s expertise in both clinical practice and epidemiology has contributed to her firm understanding of population health research issues, particularly those regarding the transfer of research findings into effective methods of chronic disease prevention and treatment.” He adds that her “knowledge and expertise are impressive, but her spirit of service and her passion for patient-centered research are even more impressive.”
Aiken Hackett, ACR’s government affairs director, says that, at the ACR’s request, patient-related groups in rheumatology had also written in support of Dr. Gabriel. “It is certainly beneficial for rheumatology to have a voice on the committee,” Hackett says. However, she adds, “I don’t think she was chosen because she was in rheumatology. It was more because of her work. She has a very impressive résumé that speaks for itself.”
Passion for Patient-Oriented Research
Her list of accomplishments confirms Dr. Gabriel’s description of herself as “a passionate advocate and a driving force for patient-oriented clinical research.”
During her many years of service to the ACR, she was the first chair of its Quality Measures Committee, charged with developing nationally endorsed methodological standards for research. She also co-led an initiative to build the first national registry for rheumatoid arthritis.
In 2009, during her term as ACR president, Dr. Gabriel built a transatlantic alliance to develop common methodological research standards endorsed by both the U.S. and European rheumatology communities.
Similarly, as a clinician and clinical epidemiology researcher at Mayo Clinic, she has constantly sought ways to raise the level of patient care. She founded its Center for Patient Oriented Research and, as chair of the Department of Health Sciences Research, led the development of a strategic plan uniting the several disciplines in the department (including epidemiology and healthcare policy research) to improve patient care and reduce the burden of human illness.
As a member of Mayo Clinic’s Executive Board, Dr. Gabriel focused on the importance of patient-centered research to the clinic’s overall research and institutional strategies.
Her research program has generated nearly 250 peer-reviewed scientific publications addressing the risks, determinants, costs, and outcomes of rheumatic diseases.
Sharing Mayo Clinic’s Expertise
Joshua A. Derr, manager of governmental relations at Mayo Clinic, discussed the clinic’s involvement with the PCORI initiative. “Research on healthcare delivery, comparative effectiveness, and patient outcomes are areas where we feel we have a lot to offer the rest of the country,” he says. Mayo Clinic wants to encourage the institute to fund research that will develop new delivery models “that really advance the field of medicine,” Derr notes.
Dr. Gabriel was an obvious choice to recommend for a position on the PCORI Methodology Committee. “She has devoted her career to this type of research and has served in a variety of roles that positioned her to … [engage] with PCORI,” Derr says.
He says that Dr. Gabriel also brings personal attributes to her new position that are no less important than her professional experience. He recalls, “When we were talking to her about whether she wanted to be involved with the institute, her main concern was to evaluate if she had the time, because when she commits to something, she commits 110%. Her level of commitment was something that impressed me.”
He adds, “In working with her, I found that she is incredibly organized and efficient. She can take complex concepts and turn them around and produce information and give input on the information relatively quickly.”
I believe PCORI and its Methodology Committee provide an unprecedented opportunity for health and medical science to play a leadership role in America’s transformation toward a high-value healthcare system.
—Sherine E. Gabriel, MD, MSc
In an interview, the new chair of PCORI’s Methodology Committee discussed what drew her to epidemiology and patient-centered outcomes research and how she hopes her involvement with the institute will lead to advances in that area.
Dr. Gabriel, who earned her medical degree from the University of Saskatchewan College of Medicine in 1982, observed, “When you’re a medical student you quickly learn that there is so much we don’t know, that so many questions remain. I’m one of those inquisitive people who feel compelled to do what they can to help find answers to some of those questions.”
Dr. Gabriel points out that her professional interests are usually at the patient and population level, rather than the cellular and subcellular level. “Improvements in health are much closer at the human level where, if you make effective changes, you can see improvements fairly quickly,” she says. “If you find something in a molecule or a cell, that’s very exciting, and maybe in 10 or 15 years it could have a huge impact on health. Or maybe not.”
Another attraction of patient-centered research, she says, is that “it seemed to me there was some low-hanging fruit there. There was knowledge that already existed that we were not implementing. If we just implemented it optimally, we could make people healthier.”
An example of low-hanging fruit is smoking cessation. “We’ve known for so long that smoking causes illness and premature death, but we still haven’t figured out how to eliminate smoking from the human race,” she says.
Her desire to concentrate on medicine at the human level led Dr. Gabriel to get an MSc in clinical epidemiology from McMaster University, Hamilton, Ontario, in 1990, after completing an internal medicine residency and rheumatology fellowship at Mayo Graduate School of Medicine.
One reason that Dr. Gabriel has high hopes that PCORI can help build a high-value healthcare system in America is the unusual structure of its board. Although her committee consists entirely of MDs and PhDs, the PCORI governors are a far more diverse group.
“It’s a multi-stakeholder board,” she says. “There are four or five MDs, but there are also representatives of patient groups, leaders from the pharmaceutical and the insurance industries, and people from all corners of medicine and healthcare.”
Instead of having a panel of experts develop purely scientific solutions and then hope everyone accepts them, she says, “the idea is to define priorities across multiple stakeholders so that we have buy-in across the broader community with respect to our strategy moving forward. I really bought into that notion.”
Dr. Gabriel describes herself as “a passionate advocate and a driving force for patient-oriented clinical research.”
As a rheumatologist, Dr. Gabriel believes that her selection to lead the Methodology Committee will have the benefit of bringing added attention to her field. However, she says, the benefits flow both ways.
She suspects that one reason she was named to the committee is that she brings a chronic disease perspective. “We in rheumatology understand disabilities and the impact they have on the quality of life, and we come at it from the perspective of a chronic disease,” she says. “Rheumatoid arthritis is the most prevalent and most disabling of chronic diseases.” Also, rheumatology has done a good job of building consensus around quality measures and translating research into practice improvements, she notes.
Learn as We Go
It will be some time before the impact of PCORI is known. Currently, mounting congressional opposition to the overall healthcare reform program raises the threat of reduced funding for aspects of the Patient Protection and Affordable Care Act. However, PCORI was not on the list of five areas of mandatory spending that the House Energy and Commerce Committee’s Subcommittee on Health was seeking to eliminate from the act at press time, according to a March 7, 2011, majority staff memo.
Even if the institute’s funding is not cut, PCORI and its Methodological Committee have just begun to chart their course. “It’s all pretty uncertain. But I think that’s a good thing. I wouldn’t want to be stepping into a role that is too tightly prescribed. We’ll learn as we go, and that’s the right way to do it,” Dr. Gabriel says.
David H. Kirkwood is a freelance writer and editor based in New York City.