Health reform's tortuous route to the patient-centered outcomes research institute.

The Patient Protection and Affordable Care Act established a new public-private entity for comparative effectiveness research: the Patient-Centered Outcomes Research Institute. The institute is charged with identifying priorities, establishing an agenda, and carrying out comparative effectiveness research. The political process through which the institute was formalized greatly influenced its scope and charge, including the organization's goals, its unique private-public composition, and its funding. In this paper I highlight key moments and offer background and insights into what did and did not end up in the final legislation.