Practice-Based Research Networks
Professional Development Core
Practice-Based Research Networks
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Overview of PBRNs
What are PBRNs?
PBRNs are groups of primary care clinicians and practices working together to answer community-based health care questions and translate research findings into practice. PBRNs engage clinicians in quality improvement activities and an evidence-based culture in primary care practice to improve the health of all Americans (AHRQ).
Overview of PBRNs
Look at the timeline below to see the history of PBRNs
Overview of PBRNs: 1970s and earlier
The first PBRNs as we know them today were established in Europe, and they were known as Sentinel Networks. One of the oldest Sentinel Networks in the UK is the Royal College of General Practitioners Research and Surveillance Centre, which was established in 1957. The Dutch Sentinel General Practice Network was established in 1970 for disease surveillance in primary care (Schewikardt et al., 2016).
Archer, 2017
United Kingdom
Netherlands
Overview of PBRNs: 1970s and earlier
The first PBRN established in the United States was the Dartmouth Cooperative Information Project (CO-OP). CO-OP was founded in 1972 and still exists today, serving Vermont, New Hampshire, and Maine.
Overview of PBRNs: 1970s and earlier
The most known PBRN in the United States of the early PBRN era was the Ambulatory Sentinel Practice Network (ASPN), which formed in 1978 and existed until 1999 before being absorbed by American Academy of Family Physicians’ National Research Network (AAFP NRN). At ASPN’s height, it included 700 family physicians in 125 practices in the United States and Canada (AAFP, 1999).
Overview of PBRNs: 1980s
In the 1980s, the number of PBRNs began to expand in the United States. Some of these 1980s-era PBRNs include the following:
These PBRNs still exist today. The 1980s also saw the publication of peer-reviewed articles written by PBRN members. The first of these was “Functional Health Status Levels of Primary Care Patients” by Nelson et al. of Dartmouth CO-OP in 1983 (Mold & Peterson, 2005).
Overview of PBRNs: 1990s
The 1990s led to increased publication of PBRN peer-reviewed literature. In 1994, issue 38 of the Journal of Family Practice was devoted entirely to PBRN findings. Issue 46 of the Journal of Family Practice in 1998 was devoted to the Direct Observation of Primary Care study conducted by the then-Research Association of Practicing Physicians, which is now known as the Research Association of Practices of the PBRN Shared Resource.
Overview of PBRNs: 1990s
In 1994, 28 PBRNs were established in the United States (Green & Hickner, 2006), but in the year 2000, there were only 24 PBRNs operating, according to AHRQ (2018). The 2000s will see unprecedented proliferation of PBRNs, as well as financial support and membership.
Overview and Functions of PBRN: 2000s
In the year 2000, there were 24 PBRNs. In the year 2012, there were over 150 primary care PBRNs operating across the United States with more than 55,000 clinicians in over 17,000 locations serving approximately 46 million patients. There is at least one member of a primary care PBRN in every state (AHRQ, 2018). We must look at the reasons for this rapid expansion.
Overview of PBRNs: 2000s
Between 2000 and 2005, AHRQ funded four major competitive grant programs for PBRNs:
The awarding of the above grants led to rapid development of PBRNs across the country. But there were additional resources that led to this growth.
Overview of PBRNs: 2000s
In 2001, AHRQ awarded over $8 million to over 45 PBRNs (Werner & Stange, 2008). In the same year, AHRQ also opened the PBRN Resource Center, which still exists today to support PBRNs through providing informational resources, group learning experiences, and research tools to support all steps of research from research question development to publication.
Overview of PBRNs: 2000s
PBRNs continued to be highlighted in peer-reviewed literature. The Journal of the American Board of Family Medicine has been highlighting PBRNs in theme issues every year since 2006. NIH also started funding PBRNs through existing Clinical and Translational Science Awards (CTSA) grants in 2006 (Werner & Stange, 2008).
Overview of PBRNs: 2010s
A survey conducted by AHRQ in 2015 found that 174 PBRNs across nearly 30,000 practices contained over 150,000 clinicians who served over 86 million patients. A visual of this can be shown on the next slide.
Overview of PBRNs: 2020s
As of August 2020, there are 186 PBRNs registered with the AHRQ PBRN Resource Center. These networks represent practices from all 50 states and over 25 countries. For more information on AHRQ-registered PBRNs, visit the PBRN Registry.
Functions of PBRNs
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Functions of PBRNs
PBRNs exist to address a disparity in research between medical research centers, where most medical research occurs, and primary care, where most people go to receive healthcare. The next slide will best illustrate this disparity by the numbers.
Functions of PBRNs
Results of a reanalysis of the monthly prevalence of illness in the community and the roles of various sources of health care. Green LA et al., N Engl J Med 2001, 344:2021-2024
Functions of PBRN
As seen in the highlighted boxes on the previous slide, <1 person out of 1,000 people will be admitted to an academic medical center, but over 200 people out of 1,000 people will visit a physician’s office. It’s apparent that research should be conducted where most people receive healthcare when they need it in regard to obtaining generalizable outcomes from research. On the next slide, we’ll take a look at the characteristics of both biomedical and PBRN research to compare them.
Functions of PBRN
Characteristics of Biomedical and PBRN Research | |
Biomedical Research | PBRN Research |
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Nutting, P A. (1996). Practice-based research networks: building the infrastructure of primary care research. The Journal of Family Practice, 42(2), 199–203.
Functions of PBRN
The greatest strength of PBRN lies in the fact that research occurs in the community. Instead of gathering data from less-than-generalizable patients in the study of isolated diseases (i.e. no comorbidities) as in biomedical research, PBRN research enables us to be pragmatic in our findings and research where most people get most of their care most of the time (Werner & Stange, 2008; Nutting 1996). On the next slides, we’ll take a look at how the research process differs between clinical research and PBRN research.
Functions of PBRN
(Werner and Stange, 2008)
Functions of PBRN
Practice-based research isn’t simply clinical research conducted in practice settings. The practice-based research process employs the same systematic approach of clinical research. Practice-based research is based on the challenges faced by clinicians on a daily basis, which helps to identify the right knowledge gaps and ask the right research questions (Werner and Stange, 2008).
Functions of PBRN
The types of research that can be performed within a PBRN mirror the same types found in clinical trials. For example, observational, survey, RCT, qualitative, and mixed method research have all been conducted within a PBRN (Werner & Stange, 2008). To take a look at examples of PBRN research, feel free to take a look at the this recent issue of Journal of the American Board of Family Medicine which featured PBRNs as the theme of the issue.
Organization of PBRNs
A PBRN is a group of 15 to several hundred primary care practices devoted principally to the care of patients. These practices are united by a shared commitment to expand the science base of clinical care through systematic inquiry to better understand the health and health care events that unfold daily in their community practice settings.
Organization of PBRNs
Often affiliated with academic or professional organizations, these practices investigate questions of importance to clinical practice. Typically, PBRNs draw on the experience and insight of practicing clinicians to identify and frame research questions whose answers can improve the practice of primary care. By linking these questions with rigorous research methods, PBRNs produce research findings that are immediately relevant to the primary care clinician and more easily translated into everyday practice (AHRQ).
Organization of PBRNs
In order for an organization to register as a PBRN on AHRQ’s PBRN Registry, the following conditions must be satisfied to register as a Primary Care PBRN:
PBRNs that are still in the process of organizing can also be registered. PBRNs that have a membership of <50% primary care clinicians are registered as Affiliate PBRNs e.g. pharmacy and dental PBRNs.
Organization of PBRNs
PBRNs need an infrastructure of leadership, administration, communication, and quality improvement in order to be effective in the present and the future. The components of this infrastructure can be seen on the following slide.
Organization of PBRNs
Westfall, J. M., Roper, R., Gaglioti, A., & Nease, D. E., Jr (2019). Practice-Based Research Networks: Strategic Opportunities to Advance Implementation Research for Health Equity. Ethnicity & disease, 29(Suppl 1), 113–118. https://doi.org/10.18865/ed.29.S1.113
Organization of PBRNs
One of the greatest problems for PBRNs, especially in the beginning, is that of funding. More often than not, PBRNs initially operate on a “shoestring” budget, but can secure greater forms of funding (Werner, 2008). Today, organizations such as NIH and PCORI offer grants to PBRNs. But let’s get an estimate of what all a PBRN needs will cost.
Organization of PBRNs
On the following slide, we’ll view hypothetical annual infrastructure costs for PBRNs based on their respective complexity levels. All annual costs have been adjusted for inflation (2023) from Green et al., 2005. All items defined with N/A as cost are because these items aren’t a part of a basic PBRN network, and these infrastructure items don’t reflect the infrastructures of all PBRNs.
A basic network, for this chart’s purposes, is a PBRN of 15-20 practices conducting observational studies whereas a moderate-complexity network would be a regional network of 20-60 practices engaged in intervention studies (Werner, 2008).
Expense | Basic Network | Moderate-Complexity Network |
Director (0.2, 0.5 FTE) | $50,648 | $123,546 |
Coordinator (0.5, 1.0 FTE) | $50,648 | $101,297 |
Research assistants (2.0 FTE) | N/A | $131,370 |
Secretarial support (0.5 FTE) | N/A | $33,871 |
Computers and software | $1,582 | $3,482 |
Technical support | $791 | $17,410 |
Printing and mailing | $633 | $2,849 |
Telephone and fax | $474 | $1,899 |
Travel | N/A | $12,662 |
Meeting Costs | $5,539 | $26,907 |
Total | $110,315 | $455,203 |
Organization of PBRN
Once the PBRN is established, we need an idea of how the infrastructure works to perform the mission of the PBRN. On the next slide, we’ll take a look at how all of the various roles work together.
Organization of PBRN
Cancer | Diabetes | Mental Health |
Click on any title to learn more about its role in the PBRN.
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Organization of PBRN
A community advisory board (CAB) is a collective group of community members who provide community information and assistance to the PBRN. They also identify issues in the community, voice thoughts and perspectives to the research group, and provide context to aid research (WVCTSI).
Organization of PBRN
A network director is the individual who leads the PBRN. At times, this role can be shared between two individuals, such as an academic researcher and a clinician. A network director initiates activity within the PBRN (Werner, 2008).
Organization of PBRN
A steering committee governs and oversees the PBRN, which involves deciding which studies to fund and which actions to take. They guide the network director on how to operate the PBRN (Werner, 2008).
Organization of PBRN
A PBRN staff can have numerous roles to fill. A network coordinator conducts communications and administrative roles on behalf of the steering committee. Research assistants work alongside project research teams to conduct research. Support staff fulfill the administrative needs of the PBRN (Werner, 2008).
Organization of PBRN
Academic and professional partners exist to help the PBRN conduct research. These partnerships can provide a PBRN with resources and expertise (Dolor et al., 2014).
Organization of PBRN
A project-specific principal investigator works alongside the PBRN staff and research teams to form research questions and draft study protocol to best address those research questions based on issues observed by the community advisory board (CAB).
Organization of PBRN
Project research teams are primarily composed of clinicians who are engaging in research to produce findings that are generalizable and readily translatable into practice. Under the guidance of the project-specific principal investigator, project research teams collect data for the project-specific principal investigator to analyze and publish.
Interacting with PBRNs
There are many ways to engage with a PBRN regardless of whether you’re a clinician, outside researcher, community member, or a patient. If you have interest in improving public health, the PBRN will be interested in meeting with you.
Interacting with PBRNs
Opportunities | ||
Clinicians | Investigators | Community Members |
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Source: Great Plains Primary Care PBRN
Interacting with PBRNs
To get started, first visit the PBRN Registry to look for PBRNs in your region. Click here to get started.
Interacting with PBRNs
After finding a PBRN, you’ll be presented with a contact page of information about the PBRN which includes the following:
All that’s left to do is to reach out via email to the contact listed
on the card and you will be properly directed based on your interest.
Interacting with PBRNs
The means by which research occurs within the infrastructure of a PBRN is a simple process:
Interacting with PBRNs
Community Advisory Board (CAB) identifies a problem
Academic/Professional Partners or PBRN will issue a grant.
P.I. will develop research questions and protocol.
Project research teams collect data to find a solution.
Project research teams return data to P.I.
Project research teams return data to P.I. Papers and new grants result.
References
About Us. (2021). In Dartmouth CO-OP PBRN. Retrieved from https://geiselmed.dartmouth.edu/dcpbrn/about_us/
American Academy of Family Physicians. (2021). Practice-Based Research networks in the 21st Century: The Pearls of Research (pp. 29-30). Leawood, KS: Author. Retrieved from https://www.aafp.org/dam/AAFP/documents/patient_care/nrn/pearlsofresearch.pdf
Dolor, R. J., Patterson, V. B., Daly, J., Levy, B., Campbell-Voytal, K., Neale, A. V., ... Smith, P. (2014). PBRN Research Good Practices (PRGP) (pp. 22-23). Leawood, KS: North American Primary Care Research Group. Retrieved from https://www.napcrg.org/media/1196/prgp-2014-09-29.pdf
Green, L. A., White, L. L., Barry, H. C., Nease, D. E., Jr, & Hudson, B. L. (2005). Infrastructure requirements for practice-based research networks. Annals of family medicine, 3 Suppl 1(Suppl 1), S5–S11. https://doi.org/10.1370/afm.299
Green, L. A., & Hickner, J. (2006, January). A Short History of Primary Care Practice-based Research Networks: From Concept to Essential Research Laboratories. The Journal of the American Board of Family Medicine, 19(1), 1-10. doi:https://doi.org/10.3122/jabfm.19.1.1
Home. (n.d.). In Practice-Based Research Networks: Research in Everyday Practice. Retrieved from https://pbrn.ahrq.gov/
Interactive Map of Europe (2017, January 23). In Phil Archer. Retrieved from https://philarcher.org/diary/2013/euromap/
References
Mold, J. W., & Peterson, K. A. (2005). Primary care practice-based research networks: working at the interface between research and quality � improvement. Annals of family medicine, 3 Suppl 1(Suppl 1), S12–S20. https://doi.org/10.1370/afm.303
Nutting, P A. (1996). Practice-based research networks: building the infrastructure of primary care research. The Journal of Family Practice, 42(2), � 199–203.
Primary Care Practice-Based Research Networks: An AHRQ Initiative. (2018, October). In Agency for Healthcare Research and Quality. Retrieved from https://www.ahrq.gov/research/findings/factsheets/primary/pbrn/index.html
Results of a reanalysis of the monthly prevalence of illness in the community and the roles of various sources of health care. Green LA et al., � N Engl J Med 2001, 344:2021-2024
Schweikardt, C., Verheij, R.A., Donker, G.A. et al. The historical development of the Dutch Sentinel General Practice Network from a paper-based into a digital primary care monitoring system. J Public Health 24, 545–562 (2016). https://doi.org/10.1007/s10389-016-0753-4
References
Werner, J. (Narrator). (2008). Development of Practice-Based Research N [Online video]. Retrieved from https://www.youtube.com/watch?v=4Ugefr8NHk8
Werner, J., & Stange, K. (Narrator). (2008). Week 1: Introduction to Practice Based Research [Online video]. PBRN Shared Resource. Retrieved from https://www.youtube.com/watch?v=NRu31UgzmAc
Western Virginia Clinical and Translational Science Institute. (n.d.). Community Advisory Boards. In PowerPoint Presentation. Retrieved from https://wvctsi.org/media/1491/community-advisory-boards-community.pdf
Westfall, J. M., Roper, R., Gaglioti, A., & Nease, D. E., Jr (2019). Practice-Based Research Networks: Strategic Opportunities to Advance Implementation Research for Health Equity. Ethnicity & disease, 29(Suppl 1), 113–118. https://doi.org/10.18865/ed.29.S1.113