Environment/Policy work group

The report examines the current environment for Practice-Based Research Networks (PBRNs) as explored by the attendees of the Starfield Summit IV. It focuses on actionable recommendations to improve the ability of PBRNs to serve their core function within primary care research.

Background

• Primary Care Importance: A well-functioning primary care system is the foundation of highly functioning health care systems.

• Underfunding: The US primary care system is underfunded compared to other parts of the health care system, including health-related research funding.

• Role of PBRNs: PBRNs are crucial for advancing knowledge within primary care through ongoing research, dissemination, and implementation.

Summit Overview

• Assumptions: PBRNs are a core research approach within primary care but are struggling to survive and serve as main drivers of innovation.

• Attendees: Included individuals with US and international PBRN experience, Family Medicine professional organizations, and major health care and services funding organizations.

• Sponsors: DARTNet Institute, North American Primary Care Research Group, American Diabetes Association, American Board of Family Medicine, and American Academy of Family Physicians.

• Format: One-day, invitation-only, in-person meeting with short presentations and small group work focused on appreciative inquiry.

Main Constructs and Subcomponents

• Location-Based Environments:

  • Communities: Interested communities, community stewardship, and responsible research.

  • Clinical Organizations: Support at leadership level, demonstrating benefit.

  • Clinical Care Sites: Prepared clinicians and staff, network support and respect, diversity of clinical sites and people cared for.

  • PBRN Home: Impact of academic, professional society, health care organization, and standalone PBRN homes.

• Researcher Pipeline:

  • MD or MD/PhD: Clinician researchers.

  • PhD: Research-focused individuals.

  • Early Learners: Medical, psychology, pharmacy students, and residents.

  • RapSDI Model: Reproduced and supported by other PBRNs.

• Funder Environment:

  • Expanded Role: Role of PBRN research in specialty/disease-oriented funding environments.

  • Funding Sources: Federal (NIH, AHRQ, CDC, FDA, HRSA, NSA), quasi-federal (PCORI), foundations, advocacy groups, and private industry.

• Reimbursement Systems:

  • Expanded Role: Role of PBRN research in specialty/disease-oriented funding environments.

  • Funding Sources: Federal (NIH, AHRQ, CDC, FDA, HRSA, NSA), quasi-federal (PCORI), foundations, advocacy groups, and private industry.

• Infrastructure:

  • Critical Cores: Admin core, research core, unique methodologies, analytical core, data core, engagement core, training core.

  • New Funding Opportunities: NIH, advocacy organizations, novel foundations (e.g., Bezos).

Discussion

• Environmental Constructs: Detailed examination of constructs and their subcomponents.

• Staff Definition: Inclusion of all clinical site staff from front desk to clinic.

• Learners: Importance of including medical students and other early learners in the research pipeline.

Conclusion

The report emphasizes the need for actionable recommendations to improve the environment in which PBRNs operate, ensuring their sustainability and effectiveness in advancing primary care research.

Infrastructure Working group

The meetings focused on the infrastructure needs for Practice-Based Research Networks (PBRNs) and the practical steps to translate ideas into reality. The discussions highlighted the importance of sustainable infrastructure funding, practical steps to support PBRNs, and the evolving roles and missions of PBRNs.

Seven persons participated twice

Key Points Discussed

• Infrastructure Funding:

  • Emphasis on the need for sustainable infrastructure funding for PBRNs.

  • Suggestions included developing relationships with national centers like NCI or CTSA to ensure recurring grant opportunities that include infrastructure costs.

• Practical Steps:

  •   Developing relationships with funding bodies and creating pilot funding mechanisms for new researchers.

  • Addressing the varying needs of PBRNs based on their size and affiliation.

  • Ensuring flexibility and innovation within PBRNs while maintaining their missions.

  • Supporting new PBRNs to emerge and grow.

• Consortium Model:

  • Creating consortiums to handle infrastructure needs as a potential solution to support smaller PBRNs.

  • Consortiums could provide centralized functions like grant writing, IRB support, and other essential services.

• Engagement and Participation:

  • Emphasizing the importance of engaging practices and maintaining relationships with them.

  • The need for face-to-face interactions to build trust and ensure successful participation in research studies.

• Roles and Missions of PBRNs:

  • Adjusting the roles and missions of PBRNs to align with the new environment.

  • Considering PBRN leaders as business-like managers with managerial education.

  • Balancing top-down and bottom-up management approaches.

• Value Proposition:

  • Highlighting the value of PBRNs to institutions, including maintaining relationships with practices and supporting clinical training sites.

  • Emphasizing the importance of documenting and incorporating the indirect costs of PBRN work into organizational calculations.

• Research Ready Practices:

  • Developing research-ready practices to streamline future collaborations.

  • Building base relationships and processes to reduce the lift for future projects.

• Workforce Development:

  • Facilitating the development of clinical investigators who want to participate in research regularly.

  • Developing PBRN leaders who can run PBRNs effectively and engage practices in meaningful research.

• Program-Based Support:

  • Advocating for program-based support rather than project-based funding to maintain infrastructure and institutional knowledge.

  • Ensuring that funding mechanisms account for the true expenses of PBRN-related work.

  • Participants were not interested to pursue the “funded Center grant” pathway, i.e. to specify details of an RFA for future promotion /use by AHRQ or NIH

  • Rather, they asserted and agreed that funding for PBRN infrastructure should be included, and required to be included in CTSAs, National Cancer Centers and other similar large institutional grants, such that the infrastructure is both invested in and maintained as a core “fixed cost”, similar to the fixed cost of maintaining laboratory facilities, rather than maintaining those human or other resources as part of “project funding” that must of necessity be repeatedly re-funded by the next project, or be at-risk of loss. This should be a requirement for renewal of CTSA and NCI Cancer institute funding.

• Next Steps:

  • Summarizing notes and conversations from the sessions.

  • Sharing insights with other workgroups focused on environment and policy, and human resources and pipeline development.

  • Planning for a workshop at NAPCRG to report on the discussions and develop a comprehensive strategy to support PBRNs

Conclusion

The infrastructure working group meetings concluded with a plan to continue discussions and share insights across different workgroups. The ultimate goal is to develop a comprehensive strategy to support PBRNs and ensure their sustainability and growth.

Training/pipeline working group

The document outlines discussions from the Primary Care Research Workforce meeting held on September 20, 2024. The focus was on creating a pipeline for future researchers, defining roles, and advocating for primary care research.

Key Points Discussed

• Research Impact and History:

  • Cataloging research that has changed practice.

  • Creating a public-facing document on the history of PBRNs and their importance.

  • Developing a list of 100 questions that can only be answered by family medicine research.

• Advocacy and Communication:

  • Encouraging physicians to be involved in research rather than just consuming it.

  • Highlighting practice-changing research at conferences like NAPCRG.

  • Advocacy for smaller grants to support early-stage researchers.

• Funding and Infrastructure:

  • Encouraging physicians to be involved in research rather than just consuming it.

  • Highlighting practice-changing research at conferences like NAPCRG.

  • Advocacy for smaller grants to support early-stage researchers.

• Roles and Pathways:

  • Defining various roles for family physicians (FPs) in research, including question development, data collection, and logistical support.

  • Creating pathways for mid-career FPs to get involved in research.

  • Pairing residents and students with practicing clinicians who are involved in research.

• Engagement and Readiness:

  • Conducting readiness assessments for new practices joining PBRNs.

  • Evaluating interests, knowledge, and capacity of practice staff.

  • Ensuring clinical and administrative teams are aligned for successful research participation.

• Challenges and Solutions:

  • Addressing barriers to research participation, especially in rural health practices.

  • Articulating the "why" for FPs to engage in research, including monetary benefits, addressing burnout, and clinical inquisitiveness.

  • Communicating the benefits of research to leadership and clinicians.

• Collaboration and Support:

  • Harnessing the power of academic medical centers (AMCs) to partner with practices.

  • Encouraging chairs to use their power to make space for primary care research.

  • Creating modules for Board certification to incentivize research participation.

• Community and Education:

  • Engaging community members and boards of practices in research.

  • Developing research that can help with CME credits and Board certification.

  • Pairing medical students with researchers to foster interest in primary care research.

Conclusion

Engaging community members and boards of practices in research. Developing research that can help with CME credits and Board certification. Pairing medical students with researchers to foster interest in primary care research.

Integration of Practice-Based Research into Family Medicine and Primary Care Research

Practice-Based Research Networks (PBRNs) have become a vital component of family medicine and primary care research, serving as a bridge between academic research and real-world clinical practice. Their integration into the broader field of primary care research has led to significant advancements in the quality, relevance, and applicability of research findings to everyday clinical settings.

Key Aspects of Integration

1. Real-World Relevance

• Focus on Practicality: PBRNs conduct research in the environments where healthcare is actually delivered—clinics, practices, and communities. This focus ensures that the research questions are directly relevant to primary care practitioners and their patients, addressing the specific challenges they face.

• Patient-Centered Research: By operating within the primary care setting, PBRNs emphasize patient-centered outcomes, aligning with the broader goals of family medicine to provide comprehensive, continuous, and coordinated care.

2. Collaboration Between Academics and Clinicians

• Bridging the Gap: PBRNs facilitate collaboration between academic researchers and practicing clinicians. This partnership allows for the generation of research questions that are clinically relevant and the implementation of research findings in a way that is practical and feasible in everyday practice.

• Mutual Benefit: Academic researchers gain access to real-world data and insights, while clinicians benefit from evidence-based tools and interventions that improve patient care. This symbiotic relationship enhances the overall quality of primary care research.

3. Quality Improvement and Implementation Science

• Continuous Improvement: PBRNs play a crucial role in the integration of quality improvement initiatives within family medicine. Research conducted within PBRNs often leads to the development of best practices that are then disseminated and implemented across other practices, driving continuous improvement in care delivery.

• Implementation Science: PBRNs are also central to the field of implementation science, which focuses on how best to integrate research findings into routine clinical practice. This is particularly important in primary care, where the translation of research into practice is often more challenging due to the variability of settings and patient populations.

4. Education and Training

• Cultivating a Research Culture: PBRNs contribute to the education and training of the next generation of family physicians and primary care providers. By involving medical students, residents, and practicing clinicians in research, PBRNs foster a culture of inquiry and evidence-based practice within primary care.

• Pipeline Development: PBRNs are instrumental in developing research pipelines within primary care, ensuring that new practitioners are equipped with the skills and knowledge necessary to engage in and apply research throughout their careers.

5. Health Equity and Community Engagement

• Addressing Disparities: PBRNs are uniquely positioned to address health disparities by conducting research that is directly relevant to underserved and marginalized populations. By engaging with communities and tailoring research to local needs, PBRNs contribute to more equitable healthcare outcomes.

• Community-Based Participatory Research: Many PBRNs adopt a community-based participatory research approach, actively involving patients and community members in the research process. This enhances the relevance and impact of the research, ensuring that it addresses the specific health concerns of the communities served.

Conclusion

Practice-Based Research Networks (PBRNs) have become an integral part of the broader field of family medicine and primary care research. By bridging the gap between academic research and clinical practice, PBRNs ensure that research is relevant, practical, and directly applicable to the challenges faced by primary care providers. Through their focus on real-world settings, collaboration, quality improvement, education, and health equity, PBRNs enhance the overall quality and impact of primary care research, ultimately leading to better patient outcomes and more effective healthcare delivery.