History and Funding of PBRNs

What Is a PBRN?  

AHRQ defines a primary care practice-based research network, or PBRN, as a group of ambulatory practices devoted principally to the primary care of patients, and affiliated in their mission to investigate questions related to community-based practice and to improve the quality of primary care. PBRNs involve practicing clinicians in asking and answering clinical and organizational questions central to primary health care. This definition includes a sense of ongoing commitment to network activities and an organizational structure that transcends a single research project. PBRNs often link practicing clinicians with investigators experienced in clinical and health services research, while enhancing the research skills of the network members.

History

While the PBRN movement in the United States goes back over 30 years, it has experienced significant growth over the past decade.¹ The number of Primary Care PBRNs in the United States has grown substantially, from a reported 28 in 1994² to 173 in 2015 (as of May 2015).

To understand the expansion and evolution of PBRNs over the decades, it is helpful to know the history behind PBRNs, including how they were conceptualized and evolved. In 2006, Larry Green and John Hickner published an article describing the history and evolution of PBRNs in the U.S.³ In this article, the authors introduce the accomplishments of some of the pioneers of primary care research and explore the various mechanisms and organizations that have supported PBRNs during their development. A copy of this article is publicly available through the Journal of the American Board of Family Medicine.

PBRNs have been described as "new clinical laboratories for primary care research and dissemination."⁴ 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. 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. 

Increasingly, PBRNs are recognizing their potential to expand their purpose, and are supporting quality improvement activities within primary care practices and the adoption of an evidence-based culture in primary care practice. Many PBRN leaders have begun to envision their networks as places of learning, where clinicians are engaged in reflective practice inquiries, and where clinicians, their patients, and academic researchers collaborate in the search for answers that lead to the improved delivery of primary care. 

Examples of types of PBRN research include studies in comparative effectiveness research: 

• Treatment of common diseases and symptoms, prevention and early diagnosis. 
• Organization and clinical systems. 
• Continuity and coordination of care. 
• Clinical decision support. 
• Impact of decisions made by patients about health care and health practices for themselves, their families and their communities. 

PBRNs are uniquely positioned for dissemination and implementation research. 

PBRNs provide a natural laboratory for a wide variety of physician and patient studies and are a rich source of medical data. PBRNs may be the best setting for studying the process of care and the manner in which diseases are diagnosed, treatments initiated, and chronic conditions managed in a "real world" setting. PBRNs provide a resource where effectiveness can be measured⁵ and where the interface between patients and their community primary care physicians can be explored.⁶

Funding

Why Does AHRQ Support PBRNs? 

As part of the December, 1999 legislation (Public Law 106-129) reauthorizing and renaming the Agency, AHRQ was directed to use research strategies and mechanisms that link research directly with clinical practice in geographically diverse locations throughout the country, including the use of "provider-based research networks especially (in) primary care." 

To better address issues of disparities in health care quality, outcomes, cost, and access for various segments of the U.S. population, amended section 901(b)(2) authorized the Agency to implement research strategies and mechanisms that specifically include PBRNs. 

In 2000, the United States had approximately 24 primary care PBRNs. AHRQ has since provided direct funding for PBRNs through targeted grant and contract programs, and has provided technical and networking assistance for many more. In 2012, AHRQ research identified more than 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.

What Is the History of AHRQ Funding for PBRNs?

Between 2000 and 2005, AHRQ funded four major competitive grant programs for PBRNs. In addition to funding opportunities, AHRQ is supporting PBRNs through a national resource center, an annual national conference, Web events, an electronic PBRN research repository, and a dedicated community extranet.

The opportunities listed below represent funding reserved exclusively for PBRNs. In addition, PBRNs successfully compete for grant funding from AHRQ and other Federal agencies for solicitations that are not reserved exclusively for PBRNs. For example, three PBRNs received American Recovery and Reinvestment Act (ARRA) funding in 2010 for dissemination of comparative effectiveness research findings within PBRN settings.

Archived Fact Sheets:

• Primary Care Practice-Based Research Networks
• Centers for Primary Care Practice-Based Research and Learning (2012)
• PBRN P30 Centers
• PBRNs Translating Research Into Practice (TRIP) Awards (2004-2005)
• AHRQ PBRN Small Research Grants
  • RFA HS-05-011 (2006)
  • RFA HS-03-006 (2003)
• AHRQ Practice-Based Research Network Awards (2002)
• Practice-Based Research Network Planning Grants (2000)
• Early Practice-Based Research Network Support (pre-2000)

What Additional Support Has AHRQ Given to PBRNs? 

• Annual PBRN Meeting—AHRQ continues to provide funding for a conference dedicated to advancing PBRN research through presentations, workshops, and networking. 
• PBRN Resource Center—The PBRN RC was a collaborative effort among participating PBRNs, through the support of Abt Associates, the MacColl Center for Health Care Innovation at Group Health Research Institute, the NIATx Foundation, and a variety of technical experts. The mission of the PBRN RC was to support AHRQ in providing resources and assistance to all registered primary care PBRNs engaged in clinical and health services research. The PBRN RC staff and experts provided support to registered PBRNs through information resources, Web-based collaborative space, group learning experiences, and research tools. The PBRN RC encouraged iterative information sharing among PBRNs along the continuum from idea development to preliminary work to dissemination of published final products. The PBRN RC also worked to identify innovative, sustainable strategies and approaches to support primary care PBRNs in developing the capacity to fulfill dual roles as both research and learning networks. 
• PBRN Web Events—PBRN researchers, directors, and staff participate in ongoing discussions dedicated to advancing PBRN operations, quality improvement research, health information technology, and PBRN research methodologies. 
• National Webinars—Presentations to assist researchers and support staff in topical areas such as PBRN operations, Quality Improvement Research, Heath Information Technology, and Research Methodology. These opportunities for information exchange empower the participants through expert consulting and training to share and improve skills. 
• Electronic Repository of PBRN Research—An extensive, AHRQ-maintained database of research produced by primary care PBRNs. 
• PBRN Extranet (Web portal)—The PBRN Research Portal is a secure AHRQ-provided Web site for members of AHRQ-certified PBRNs. The Research Portal complements the PBRN public website by providing research resources and enhancing communication and collaboration among PBRN members. 

What Are Some Highlights of PBRN Research? 

• The development of My Wellness Portal, a patient-centered, prevention oriented, Web-based personal health record that can help improve patient-centered care, increase the delivery of individualized recommended preventive services, and increase clinician knowledge of patients' medical histories. 
• The development and validation of a primary care-specific Health Literacy Toolkit. 
• A Web-based Interactive Personal Health Record that improves rates of delivery of clinical preventive services. 
• Validation of an instrument to measure Patient Safety Culture in Medical Office Settings. 
• Effective approaches for facilitating patient self-management during a pandemic influenza event.⁷ 
• Field testing of a new ambulatory care electronic Medication Errors and Adverse Drug Events Reporting System (MEADERS).⁸

References

1. Lanier D. Primary care practice-based research comes of age in the United States. Ann Fam Med 2005: 3 (Suppl 1):S2-S4.
2. Niebauer L, Nutting PA. Primary care practice-based research networks active in North America. J Fam Pract 1994:38:425-426.
3. 3. Green LA, Hickner J. A short history of primary care practice-based research networks: From concept to essential research laboratories. JABFM 2006:19(1):1-10.
4. Westfall JM, Mold JW, Fagnan LJ. Practice-based research-"Blue Highways" on the NIH roadmap. JAMA 297: 403-6. 2007.
5. Bell LM, Grundmeier R, Localio R, Zorc J, Fiks AG, Zhang X, Stephens TB, Swietlik M, Guevara JP. Electronic health record-based decision support to improve asthma care: a cluster-randomized trial. Pediatrics 2010;125: e770-e777.
6. Parchman ML, Zeber JE, Palmer RF. Participatory decision-making, patient activation, medication adherence and intermediate clinical outcomes: a STARNet study. Ann Fam Med 2010;8:410-17.
7. Nagykaldi Z, Calmbach W, DeAlleaume L, Temte J, Mold J, Ryan J. Facilitating patient self-management through telephony and web technologies in seasonal influenza. Inform Prim Care 2010;18:9-16.
8. Hickner J, Zafar A, Kuo GM, Fagnan LJ, Forjouh SN, Knox LM, Lynch JT, et al. Field test results of a new ambulatory care Medication Errors and Adverse Drug Events Reporting System (MEADERS). Ann Fam Med 2010;8:517-25.