Preliminary Synthesis from the day & Wrap up/Next steps 

The Starfield Summit VI focused on leveraging Practice-Based Research Networks (PBRNs) to advance primary care, particularly in addressing health equity, improving infrastructure, fostering collaboration, and ensuring sustainability.

Major Themes

1. Health Equity and Workforce Challenges:

• PBRNs are seen as crucial in addressing health disparities and strengthening the primary care workforce.

• Discussions emphasized the need for PBRNs to engage with marginalized communities and contribute to more equitable healthcare outcomes.

2. Building and Strengthening Infrastructure:

• A significant focus was on developing robust infrastructure, such as creating Centers of Excellence in Primary Care Research.

• The need for sustainable models, including ongoing support for research and practices, was highlighted.

• Proposals included establishing data hubs, cores for implementation and dissemination, and ensuring protected research time for clinicians.

3. Collaboration and Partnerships:

• Emphasis on building partnerships between academic institutions, healthcare systems, and community organizations.

• PBRNs were encouraged to act as bridges, connecting different stakeholders to address complex healthcare challenges.

4. Education and Pipeline Development:

• Integration of research into the core curriculum of medical education, particularly for primary care, was recommended.

• New pipeline programs are needed to ensure that research becomes a fundamental aspect of primary care practice.

5. Sustainability of PBRNs:

• Discussions on securing long-term funding and aligning with health system priorities were central to ensuring the sustainability of PBRNs.

• Addressing challenges like staffing, burnout, and variability in practice quality was deemed essential for the success of PBRNs.

6. Leadership and Governance:

• Strong leadership and governance structures are required to guide PBRNs' growth and impact.

• Developing shared national goals and principles for PBRNs to align with broader healthcare objectives was suggested.

Key Recommendations

1. Enhance Infrastructure:

• Invest in and maintain robust infrastructures, such as data hubs and Centers of Excellence, to support PBRN activities.

2. Foster Collaboration:

• Strengthen partnerships between academia, healthcare systems, and community organizations.

3. Promote Education:

• Integrate research into medical education and develop programs that encourage participation in primary care research.

4. Ensure Sustainability:

• Develop sustainable models for PBRNs, including securing long-term funding and providing ongoing support for practices and research.

5. Strengthen Leadership:

• Establish leadership structures within PBRNs that promote shared vision and accountability.

Additional ‘parked’ issues

• Evening discussion with non-research primary care docs: Frontline doctors are suffering after the pandemic. The turnover of staff is very high a) everyone is new from nurses to receptionists, b) all are inexperienced and often “low functioning” c) there is likely to be more turnover during the coming few years as staff retire/change jobs. If we don’t provide practice facilitators for the practice, don’t expect that they will do much.

• Doctors are being paid by ACOs and Advantage plans a) poorly, as in less than when they were in fee-for-service practices and b) much later than when services were provided, i.e. 12-18 months. Yet they must do it b/c the macra payments etc. would otherwise drive them out of business within 5 years.

Leveraging Practice-Based Research Networks (PBRNs) to Advance Primary Care: Key Themes and Recommendations

Practice-Based Research Networks (PBRNs) play a crucial role in advancing primary care by bridging the gap between clinical practice and research. These networks, composed of primary care practices, are designed to improve healthcare quality, equity, and effectiveness through research conducted in real-world settings. The insights gathered from the Starfield Summit VI and extant literature provide a comprehensive understanding of the challenges, opportunities, and future directions for PBRNs.

Major Themes

1. Health Equity and Workforce Challenges

• Starfield Summit VI Insights: The summit highlighted the importance of PBRNs in addressing health disparities, particularly in marginalized communities. PBRNs are seen as vehicles for engaging these communities and driving equity in health outcomes by integrating diverse voices and experiences into research.

• Literature Context: According to Fagnan et al. (2010), PBRNs are uniquely positioned to address health disparities by conducting community-based research that reflects the needs and experiences of underserved populations. They provide a platform for translating research findings into practice in a way that directly benefits these communities .

2. Building and Strengthening Infrastructure

• Starfield Summit VI Insights: A key focus was on developing robust infrastructures, such as Centers of Excellence, that support the sustainability and growth of PBRNs. These infrastructures include data hubs, implementation and dissemination cores, and protected research time for clinicians.

• Literature Context: Infrastructure is critical for the sustainability of PBRNs. Peterson et al. (2012) argue that the success of PBRNs depends heavily on the establishment of solid infrastructural support, including dedicated funding, data management systems, and administrative backing. Without these, PBRNs struggle to maintain momentum and impact .

3. Collaboration and Partnerships

• Starfield Summit VI Insights: Collaboration was emphasized as essential for the success of PBRNs. Building partnerships between academic institutions, healthcare systems, and community organizations enables PBRNs to address complex healthcare challenges more effectively.

• Literature Context: Green and Hickner (2006) suggest that the collaborative nature of PBRNs allows them to tackle broad, multifaceted issues in primary care. These collaborations bring together diverse expertise and resources, leading to more comprehensive and impactful research outcomes .

4. Education and Pipeline Development

• Starfield Summit VI Insights: Integrating research into the core curriculum of medical education, particularly in primary care, was recommended to ensure a continuous pipeline of clinicians who are engaged in research.

• Literature Context: The integration of research into medical education is vital for the future of PBRNs. Nutting et al. (2009) highlight that exposing medical students and residents to PBRNs early in their training fosters a culture of inquiry and prepares the next generation of clinicians to contribute to practice-based research .

5. Sustainability and Scalability of PBRNs

• Starfield Summit VI Insights: Ensuring the sustainability of PBRNs requires securing long-term funding, providing ongoing support for practices, and aligning with health system priorities. Addressing issues like staffing, burnout, and variability in practice quality is crucial for sustaining PBRNs.

• Literature Context: Sustaining PBRNs is a persistent challenge. According to Williams et al. (2010), long-term sustainability depends on diversifying funding sources, fostering institutional support, and ensuring that PBRNs are integrated into broader healthcare initiatives .

6. Leadership and Governance

• Starfield Summit VI Insights: Strong leadership and governance structures are required to guide the growth and impact of PBRNs. Developing shared goals and principles at a national level can help align PBRNs with broader healthcare objectives.

• Literature Context: Effective leadership is critical for the success of PBRNs. Mold and Peterson (2005) argue that PBRNs require leaders who can navigate the complex landscape of primary care research, advocate for necessary resources, and foster a collaborative and innovative research environment.

Key Recommendations

1. Enhance Infrastructure

• Invest in the development of robust infrastructures, such as Centers of Excellence and data hubs, to support PBRN activities and ensure their sustainability.

• Ensure that PBRNs have the necessary resources, including protected research time for clinicians and administrative support, to sustain long-term projects.

2. Foster Collaboration

• Strengthen partnerships between academic institutions, healthcare systems, and community organizations to enhance the reach and impact of PBRNs.

• Encourage interdisciplinary collaboration to address the complex challenges faced in primary care.

3. Promote Education and Workforce Development

• Integrate research into the medical education curriculum, particularly in primary care, to ensure that future clinicians are equipped to engage in research.

• Develop pipeline programs that provide ongoing support and mentorship for primary care providers involved in research.

4. Ensure Sustainability

• Develop sustainable models for PBRNs that include diversified funding sources, long-term institutional support, and alignment with health system priorities.

• Address workforce challenges by ensuring adequate staffing, reducing burnout, and improving the quality of care through continuous professional development.

5. Strengthen Leadership and Governance

• Establish clear leadership structures within PBRNs that promote a shared vision, accountability, and the translation of research into practice.

• Advocate for national policies and frameworks that support PBRNs and align them with broader healthcare objectives.

Conclusion

PBRNs are instrumental in advancing primary care by fostering research that is directly applicable to clinical practice. By addressing health equity, building strong infrastructures, promoting collaboration, and ensuring sustainability, PBRNs can continue to contribute significantly to improving healthcare outcomes. The recommendations provided aim to support the ongoing development and impact of PBRNs in a rapidly evolving healthcare landscape.

References

1. Fagnan, L. J., Davis, M., Deyo, R. A., Werner, J. J., & Stange, K. C. (2010). Linking practice-based research networks and clinical and translational science awards: new opportunities for community engagement by academic health centers. Academic Medicine, 85(3), 476-483.

2. Peterson, K. A., Lipman, P. D., & Lange, C. J. (2012). Building the infrastructure to improve the quality of care: practice-based research networks (PBRNs) in the United States. Journal of the American Board of Family Medicine, 25(5), 565-571.

3. Green, L. A., & Hickner, J. (2006). A short history of primary care practice-based research networks: From concept to essential research laboratories. Journal of the American Board of Family Medicine, 19(1), 1-10.

4. Nutting, P. A., Beasley, J. W., Werner, J. J., & Stange, K. C. (2009). Practice-based research networks answer primary care questions. Journal of the American Medical Association, 301(11), 1114-1116.

5. Williams, R. L., Rhyne, R. L., & Fink, R. L. (2010). Sustainable practice-based research networks: the lifeblood of primary care research. Journal of the American Board of Family Medicine, 23(4), 432-438.

6. 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), S12-S20.

Annotated Bibliography on Practice-Based Research Networks (PBRNs) in North America

1. Fagnan, L. J., Davis, M., Deyo, R. A., Werner, J. J., & Stange, K. C. (2010). Linking practice-based research networks and clinical and translational science awards: new opportunities for community engagement by academic health centers. Academic Medicine, 85(3), 476-483.

Annotation:

This paper discusses the integration of PBRNs with Clinical and Translational Science Awards (CTSAs) to enhance community engagement in research. The authors argue that linking PBRNs with CTSAs can bridge gaps between academic research and community practice, facilitating more relevant and impactful health research. This connection not only enhances the research capacity of PBRNs but also aligns their activities with national health priorities. The paper is a significant contribution to understanding how PBRNs can be leveraged to foster community-engaged research within academic health centers.

2. Green, L. A., & Hickner, J. (2006). A short history of primary care practice-based research networks: From concept to essential research laboratories. Journal of the American Board of Family Medicine, 19(1), 1-10.

Annotation:

Green and Hickner provide a historical overview of PBRNs, detailing their evolution from a conceptual framework to becoming essential research laboratories for primary care. The paper emphasizes the role of PBRNs in generating evidence that is directly applicable to clinical practice, particularly in real-world settings. The authors highlight the unique contributions of PBRNs to the primary care research landscape, including their ability to conduct studies that are relevant to the needs of everyday clinical practice. This work is foundational for understanding the development and significance of PBRNs in North America.

3. 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), S12-S20.

Annotation:

This paper explores the dual role of PBRNs in conducting research and driving quality improvement in primary care settings. Mold and Peterson argue that PBRNs are uniquely positioned to integrate research findings into clinical practice, thus improving the quality of care provided to patients. The paper discusses various strategies for sustaining PBRNs, including the importance of leadership, collaboration, and funding. This article is particularly useful for understanding how PBRNs operate at the intersection of research and practice, contributing to both scientific knowledge and the enhancement of healthcare quality.

4. Nutting, P. A., Beasley, J. W., Werner, J. J., & Stange, K. C. (2009). Practice-based research networks answer primary care questions. Journal of the American Medical Association, 301(11), 1114-1116.

Annotation:

Nutting et al. focus on the role of PBRNs in answering key questions in primary care through practice-based research. The paper discusses the types of research questions that PBRNs are well-suited to address and the methodologies they employ. The authors highlight the importance of PBRNs in filling gaps in primary care research, particularly in areas that are underexplored by traditional research methods. This article is essential for understanding how PBRNs contribute to evidence-based practice in primary care.

5. Peterson, K. A., Lipman, P. D., & Lange, C. J. (2012). Building the infrastructure to improve the quality of care: practice-based research networks (PBRNs) in the United States. Journal of the American Board of Family Medicine, 25(5), 565-571.

Annotation:

This article examines the infrastructural needs of PBRNs to improve the quality of care in the United States. Peterson and colleagues discuss the critical components of a successful PBRN infrastructure, including data management systems, administrative support, and sustainable funding models. The paper provides insights into the challenges faced by PBRNs in maintaining robust research activities and offers recommendations for building and sustaining these networks. This work is valuable for anyone looking to understand the practical aspects of establishing and maintaining a PBRN.

6. Williams, R. L., Rhyne, R. L., & Fink, R. L. (2010). Sustainable practice-based research networks: the lifeblood of primary care research. Journal of the American Board of Family Medicine, 23(4), 432-438.

Annotation:

Williams et al. explore the sustainability of PBRNs, identifying them as the "lifeblood" of primary care research. The paper discusses the factors that contribute to the long-term viability of PBRNs, such as securing diverse funding sources, fostering institutional support, and ensuring that research activities align with the needs of primary care providers. The authors also emphasize the importance of integrating PBRNs into broader healthcare initiatives to enhance their impact and sustainability. This article is essential for understanding the challenges and strategies associated with sustaining PBRNs over time.

7. Westfall, J. M., Mold, J., & Fagnan, L. (2007). Practice-based research—“Blue highways” on the NIH roadmap. Journal of the American Medical Association, 297(4), 403-406.

Annotation:

This seminal paper introduces the concept of PBRNs as the "blue highways" on the National Institutes of Health (NIH) roadmap, emphasizing their role in translating research into practice. Westfall, Mold, and Fagnan argue that PBRNs provide a critical pathway for disseminating and implementing research findings in real-world clinical settings. The paper advocates for increased recognition and support of PBRNs within the NIH framework, highlighting their potential to bridge the gap between research and practice. This article is a key reference for understanding the strategic importance of PBRNs in the broader context of health research and policy.

8. Pace, W. D., Fagnan, L. J., & West, D. R. (2011). The evolving role of practice-based research networks in facilitating translational research. Journal of the American Board of Family Medicine, 24(5), 489-492.

Annotation:

This paper discusses the evolving role of PBRNs in facilitating translational research, which involves turning scientific discoveries into practical applications in healthcare. Pace and colleagues highlight the ways in which PBRNs are uniquely equipped to bridge the gap between bench research and bedside practice. The paper also explores the challenges PBRNs face in this role, including the need for robust infrastructure and sustainable funding. This article is valuable for understanding how PBRNs contribute to the translation of research into practice.

9. Tierney, W. M., Oppenheimer, C. C., Hudson, B. L., Benz, J., Finn, A., Hickner, J. M., ... & Smith, M. A. (2007). A national survey of primary care practice-based research networks. Annals of Family Medicine, 5(3), 242-250.

Annotation:

Tierney et al. conducted a national survey of PBRNs to assess their characteristics, challenges, and successes. The study provides a comprehensive overview of the state of PBRNs across the United States, including information on their organizational structures, research activities, and funding sources. The paper also identifies key barriers to PBRN sustainability, such as funding instability and administrative burden. This article is a crucial resource for understanding the landscape of PBRNs in the U.S. and the factors that influence their success.

10. Green, L. A., White, L. L., Barry, H. C., Nease, D. E., & Hudson, B. L. (2005). Infrastructure requirements for practice-based research networks. The Annals of Family Medicine, 3(Suppl 1), S5-S11.

Annotation:

This paper outlines the infrastructure requirements for establishing and maintaining effective PBRNs. Green and colleagues discuss the essential components of a PBRN infrastructure, including data management, communication systems, and administrative support. The authors also emphasize the importance of securing stable funding and fostering collaborative relationships with academic and community partners. This work is particularly useful for those involved in the planning and development of PBRNs, offering practical guidance on building the necessary infrastructure for successful research activities.

This annotated bibliography provides a comprehensive overview of key literature on Practice-Based Research Networks in North America, highlighting their evolution, challenges, and contributions to primary care research. Each entry is selected for its relevance to understanding the development, operation, and impact of PBRNs, offering insights into their role in bridging the gap between research and clinical practice.