Design

Same small groups work to start planning instrumentally first steps to make their emerging visions for the future of PBRNs a reality

  • Next steps to ‘build the house’ (infrastructure group) - not just a single “mega-structure” but a collection of ‘inter-connected’ houses with a common space for interaction.

  • NIH-funded Centers of Excellence in Primary Care Research

  1. Build partnerships that will be able to respond to funding announcements to improve healthcare policy- leverage the Center to create new jobs that the community values

    1. Include FQHCs

  2. Repository of clinical/EMR data across populations/systems e.g. data hub with agreements with HIE entities

  3. Implementation and Dissemination Core- Clinical PBRN outcomes research, speed-up getting effective interventions in to practice

  4. Data analysis core – use or develop methodologies that leverage the PBRN infrastructure and data opportunities

  5. Administrative core – institutional commitment to accountability/support the Center e.g. advocate internally in organization for a wider vision of care; negotiate partial return of F&A to the Center of Excellence to support infrastructure; fund 10% of faculty time to do research for 3 years in “sentinel practices” where all docs have designated, protected research time, and all practice staff are recruited/trained to participate. Use each person at the upper limit of their scope of work. Negotiate buy-in from health system managers on the value proposition of the Center (how does what we produce by doing this benefit the organization financially); negotiate for research “RVUs”

  6. Training Core for Practice-based research: educate Family docs in integration of research culture into the “job of doctoring”; develop ‘toolkits’ for medical students, residents, fellows relevant to PBRN research

  7. Distinctive methodologies – that relate to the CASFM working group methodologies

    1. For example, that use patient advisory boards in response to NAPCRG “Responsible Research in Communities” policy, that study the effectiveness of practice facilitators, define standards for relationships with CTSA or a larger research entity e.g. how PBRNs can best collaborate with CTSAs so that PBRNs are not dis-enfranchised or ghettoized.

  8. Use a model that ties financial revenue from research to the clinical institution eg. Using the NIH Cancer Center model for cancer studies e.g. quality incentives that generate income for the primary care clinic in which the research takes place and produce infrastructural support between projects e.g. “support the animals” model (like animal researchers have in place between projects)

  9. Connect to other organizations doing similar work at NIH e.g. NCI, NCATs/AHRQ/Common Fund activities may provide more/future funding; American Association of Nurse Practitioners; American Osteopathic Assn., American Association of Physician Assistants.

  10. Until this is prioritized/funded, health systems will always cut out pieces of research infrastructure when funding is tight OR attempt to co-opt it for other non-research purposes