Practice-based research networks (PBRNs) are a part of many National Institutes of Health (NIH)-funded Clinical and Translational Science Award (CTSA) sites. PBRNs, groups of primary care practices committed to collaborating on practice-relevant research, are unfamiliar to many CTSA leaders. Conversely, the CTSAs, as new research structures designed to transform clinical research, are unfamiliar to many PBRN directors. This study examined the extent to which these programs have congruent goals and expectations, and whether their engagement is likely to be mutually beneficial.
The authors sent a Web-based survey to 38 CTSA community engagement directors and a similar survey to 114 PBRN directors during the fall of 2008.
A total of 66% (25/38) CTSA community engagement directors and 61% (69/114) PBRN directors responded. Two thirds of responding CTSAs reported working with PBRNs, and over half of responding PBRNs reported a CTSA affiliation. Both groups indicated this relationship was important. CTSAs looked to PBRNs for access to patients and expertise in engaging communities and clinical practices. PBRNs reported seeking stable infrastructure support and greater collaboration and visibility in the academic research community. PBRN infrastructure support from CTSAs was highly variable. Both groups perceived considerable promise for building sustainable relationships and a bidirectional flow of information and research opportunities.
With fewer than three years of experience, the PBRN/CTSA relationship remains in the discovery phase; the participants are still negotiating expectations. If these collaborations prove mutually beneficial, they may advance the community engagement goals of many academic health centers.
"By increasing community-based provider participation in research (CBPPR) through Clinical and Translation Science Awards, federally funded provider-based research networks, and other mechanisms, the NIH has sought to advance the science of discovery by conducting research in clinical settings where most people get their care, and accelerate the translation of research results into everyday clinical practice
[1-6]. The Roadmap has spurred discussion of the potential benefits of CBPPR
[6-8], infrastructure and workforce training needs for CBPPR
[4,9], common barriers to increasing CBPPR
[7,10,11], and strategies for overcoming those barriers
[Show abstract][Hide abstract] ABSTRACT: Background
Since 2003, the United States National Institutes of Health (NIH) has sought to restructure the clinical research enterprise in the United States by promoting collaborative research partnerships between academically-based investigators and community-based physicians. By increasing community-based provider participation in research (CBPPR), the NIH seeks to advance the science of discovery by conducting research in clinical settings where most people get their care, and accelerate the translation of research results into everyday clinical practice. Although CBPPR is seen as a promising strategy for promoting the use of evidence-based clinical services in community practice settings, few empirical studies have examined the organizational factors that facilitate or hinder the implementation of CBPPR. The purpose of this study is to explore the organizational start-up and early implementation of CBPPR in community-based practice.
We used longitudinal, case study research methods and an organizational model of innovation implementation to theoretically guide our study. Our sample consisted of three community practice settings that recently joined the National Cancer Institute’s (NCI) Community Clinical Oncology Program (CCOP) in the United States. Data were gathered through site visits, telephone interviews, and archival documents from January 2008 to May 2011.
The organizational model for innovation implementation was useful in identifying and investigating the organizational factors influencing start-up and early implementation of CBPPR in CCOP organizations. In general, the three CCOP organizations varied in the extent to which they achieved consistency in CBPPR over time and across physicians. All three CCOP organizations demonstrated mixed levels of organizational readiness for change. Hospital management support and resource availability were limited across CCOP organizations early on, although they improved in one CCOP organization. As a result of weak IPPs, all three CCOPs created a weak implementation climate. Patient accrual became concentrated over time among those groups of physicians for whom CBPPR exhibited a strong innovation-values fit. Several external factors influenced innovation use, complicating and enriching our intra-organizational model of innovation implementation.
Our results contribute to the limited body of research on the implementation of CBPPR. They inform policy discussions about increasing and sustaining community clinician involvement in clinical research and expand on theory about organizational determinants of implementation effectiveness.
"Practice-based research networks (PBRNs) are interesting relationships of healthcare stakeholders for the purposes of training and research that may or may not conform to the ideals of CBPR [11,26], but are an ideal organizational structure to pursue participatory research. It has been estimated that there are over 100 PBRNs in the US [27,29], and the intent of the majority is to foster fully cooperative research relationships between communities and academic institutions. Clinics in the networks are ideally intimately involved with the generation of research as researchers, rather than only serving as locations where research can be conducted. "
[Show abstract][Hide abstract] ABSTRACT: Bottom-up, clinician-conceived and directed clinical intervention research, coupled with collaboration from researcher experts, is conceptually endorsed by the participatory research movement. This report presents the findings of an evaluation of a program in the Veterans Health Administration meant to encourage clinician-driven research by providing resources believed to be critical. The evaluation focused on the extent to which funded projects: maintained integrity to their original proposals; were methodologically rigorous; were characterized by collaboration between partners; and resulted in sustained clinical impact.
Researchers used quantitative (survey and archival) and qualitative (focus group) data to evaluate the implementation, evaluation, and sustainability of four clinical demonstration projects at four sites. Fourteen research center mentors and seventeen clinician researchers evaluated the level of collaboration using a six-dimensional model of participatory research.
Results yielded mixed findings. Qualitative and quantitative data suggested that although the process was collaborative, clinicians' prior research experience was critical to the quality of the projects. Several challenges were common across sites, including subject recruitment, administrative support and logistics, and subsequent dissemination. Only one intervention achieved lasting clinical effect beyond the active project period. Qualitative analyses identified barriers and facilitators and suggested areas to improve sustainability.
Evaluation results suggest that this participatory research venture was successful in achieving clinician-directed collaboration, but did not produce sustainable interventions due to such implementation problems as lack of resources and administrative support.
[Show abstract][Hide abstract] ABSTRACT: Practice-based research networks (PBRNs) provide an important approach to implementing primary care research at the community level, thus increasing the relevance and utility of research findings for routine primary care practices. PBRNs expend considerable time and energy in the recruitment, engagement, and retention of network clinicians and practices to establish this community-based primary care research laboratory. This study assessed factors motivating PBRN clinicians to participate and stay involved in practice-based research in their primary care office setting.
We invited practicing clinicians across the United States who are affiliated with a PBRN to share their stories regarding motivations to participate in practice-based research. Using qualitative methods, we categorized the stories into the main motivation for participation and the perceived impact of participation.
We collected 37 stories from clinicians affiliated with 12 PBRNS located in 14 states. Motivations for participation in practice-based research included themes associated with personal satisfaction, improving local clinic-based care, and contributing to community- and system-level improvements. Sources of personal satisfaction corresponded to the 3 psychological needs postulated by Deci's and Ryan's Self-Determination Theory: competence, autonomy, and relatedness.
These stories from PBRN clinicians describe the values, motivations, and unique paths that clinicians took as they chose to participate and stay active in a PBRN. Their voices have the potential to influence others to participate in practice-based research.
The Journal of the American Board of Family Medicine 07/2010; 23(4):442-51. DOI:10.3122/jabfm.2010.04.090189 · 1.98 Impact Factor
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