The mission of the Patient‐Centered Outcomes Research Institute (PCORI) is to fund the production of high‐quality evidence that will enable patients and clinicians to make informed, personalized healthcare decisions. Since 2012, the PCORI has invested $177 million in patient‐centered comparative effectiveness research (CER) that specifically targets the health needs of older adults, with additional relevant studies in its broader portfolio. Developing the PCORI's research portfolio has provided us with significant insights into what factors to consider when conducting CER in older adult populations. When comparing the net benefit of two or more interventions for older adults, investigators should consider the following: absolute risk difference, competing risks, life expectancy, the difference between chronologic and physiologic age, the importance of patient preferences, and other potential drivers of variable treatment effects. Investigators should also engage older adults and their caregivers as partners throughout the research process. Their input helps to identify key outcomes of interest and insights about the conduct of the research. As the PCORI continues to support research that addresses the healthcare decisions of the rapidly growing older adult population, it needs to partner with patients and researchers to identify the most important questions to address. J Am Geriatr Soc 67:21–28, 2019.

Background People with advanced, serious illnesses experience a high burden of physical and psychosocial symptoms, limitations in functioning, and declining quality of life (QOL) over the course of their illness. Caring for these patients can take a significant physical and emotional toll on their caregivers as well. Palliative care has been defined as ''patient-and family-centered care that optimizes QOL by anticipating, preventing, and treating suffering. Palliative care throughout the continuum of illness involves addressing physical, intellectual, emotional, social, and spiritual needs and facilitating patient autonomy, access to information, and choice.'' 1,2 Evidence reviews show that receipt of palliative care can provide clinically meaningful relief of a broad range of patient symptoms, reduce caregiver burden, and improve patient and caregiver QOL. 3e5 At the same time, patients and caregivers report significant barriers to receiving comprehensive palliative care services (i.e., care that facilitates advance care planning [ACP] and medical decision-making, systematically assesses and manages patient symptoms, and addresses caregiver burden). Access to comprehensive palliative care is typically limited to either inpatient hospitals or endof-life hospice settings. Thus, patients who are not terminally ill and their caregivers report an unmet need for receiving palliative care where they live (i.e., in their communities). 6 The challenge of accessing effective palliative care services is only expected to exacerbate, due to increasing demand from the aging U.S. population with multiple comorbid health conditions and limited supply from a projected shortage of competent clinicians to provide these services. 5 There is an urgent need for research studies to generate evidence for identifying the optimal mix of providers, settings, and content of palliative care needed at different stages of an advanced illness, from diagnosis until death. In the following section, we discuss the Patient-Centered Outcome Research Institute's (PCORI's) current and future investments in research on palliative care.

The objective of this study was to understand the existing practices and attitudes regarding inpatient sleep at the 2020 US News and World Report (USNWR) Honor Roll pediatric (n = 10) and adult (n = 20) hospitals. Section chiefs of Hospital Medicine from these institutions were surveyed and interviewed between June and August 2021. Among 23 of 30 surveyed physician leaders (response rate = 77%), 96% (n = 22) rated patient sleep as important, but only 43% (n = 10) were satisfied with their institutions' efforts. A total of 96% (n = 22) of institutions lack sleep equity practices. Fewer than half (48%) of top hospitals have sleep-friendly practices, with the most common practices including reducing overnight vital sign monitoring (43%), decreasing ambient light in the wards (43%), adjusting lab and medication schedules (35%), and implementing quiet hours (30%). Major themes from qualitative interviews included: importance of universal sleep-friendly cultures, environmental changes, and external incentives to improve patient sleep.

OBJECTIVES: Hospitalized children experience frequent nighttime awakenings. Oral medications are commonly administered around the clock despite the comparable efficacy of daytime administration schedules, which promote sleep. With this study, we evaluated the effectiveness of a quality improvement initiative to increase the proportion of sleep-friendly antibiotic administration schedules. METHODS: Interprofessional stakeholders modified computerized provider order entry defaults for 4 oral antibiotic medications, from around the clock to administration occurring exclusively during waking hours. Additionally, care-team members received targeted education. Outcome measures included the proportion of sleep-friendly administration schedules and patient caregiver–reported disruptions to sleep. Pre- and posteducation surveys were used to evaluate education effectiveness. Balancing measures were missed antibiotic doses and related escalations of care. RESULTS: Interrupted time series analysis revealed a 72% increase (interceptpre: 18%; interceptpost: 90%; 95% confidence interval: 65%–79%; P < .001) in intercept for percentage of orders with sleep-friendly administration schedules (orders: npre = 1014 and npost = 649). Compared with preeducation surveys, care-team members posteducation were more likely to agree that oral medications scheduled around the clock cause sleep disruption (resident: 71% pre, 90% post [P = .01]; nurse: 63% pre, 79% post [P = .03]). Although sleep-friendly orders increased, patient caregivers reported an increase in sleep disruption due to medications (pre 28%, post 46%; P < .001). CONCLUSIONS: A simple, low-cost intervention of computerized provider order entry default modifications and education can increase the proportion of sleep-friendly oral antibiotic administration schedules for hospitalized children. Patient perception of sleep is impacted by multiple factors and often does not align with objective data. An increased focus on improving sleep during hospitalization may result in heightened awareness of disruptions.