This section shares feedback from NCEPCR’s stakeholder group (described below), as well as a discussion of gaps based on the portfolio analysis of AHRQ's recent investments in primary care research conducted for this report. AHRQ will consider this input as the agency implements the goals and vision for NCEPCR, finalizes the forthcoming primary care research agenda, and works to disseminate information to the field.
NCEPCR's Stakeholder Group Recommendations
NCEPCR has engaged primary care stakeholders to elicit input about NCEPCR’s role within the primary care research field; better understand information needs of primary care research audiences; and help identify effective approaches to increase knowledge about, and use of, primary care research, tools, and resources.
In late spring 2023, NCEPCR convened a group of 20 emerging and recognized leaders in primary care and primary care research to serve as an expert panel. The group met virtually on June 5-6, 2023, and will meet (both virtually and in-person) again twice before July 2024.
Overall, the group recognized AHRQ as a strong contributor to the primary care research field, although few were familiar with NCEPCR. The group acknowledged the limited funding for primary care research broadly, and that AHRQ is working with a relatively small overall research budget. Given this backdrop, during their first meeting, the group provided feedback and insights relevant for shaping the near-term future work and focus of NCEPCR. Highlights of this feedback are summarized below.
- Clarify funding priorities and role relative to other entities that support primary care research. Given the resource constraints in primary care research at AHRQ, the expert panel recommended that NCEPCR work to clarify its funding priorities and develop its specific role or niche relative to other federal agencies and public or private initiatives. This would help to create alignment across initiatives and avoid redundant efforts, identify research and information gaps and areas where NCEPCR should take the lead. Along similar lines, the group suggested it would be helpful for NCEPCR to further clarify their definition of "primary care research," and be specific about the types of primary care research it plans to support.
- Serve as a convening center. The expert panel reported that it would be helpful for NCEPCR to serve as a "home" for primary care research activities, play the role of a convener among entities that support primary care research, and help to set a unified agenda for the field. Centralization will help primary care researchers and other interested parties understand what research has been conducted or underway; recognize who the various interested parties and audiences are for this work; and bring those parties together to align goals and effectively disseminate information.
- Improve dissemination. The expert panel considered AHRQ to be a trusted source of primary care information – but reported it can be difficult to see the agency’s full influence because their primary care relevant resources are dispersed across the agency’s website—making them difficult to find. The group recommended improving NCEPCR’s website to increase access to relevant information and to make it easier to search for and find tools and resources. They called for the development of more toolkits and resources that translate useful information into digestible formats for practical use by clinicians and other audiences, with content that has been vetted by clinicians. Additionally, the group suggested making it clearer to website users how they can search the AHRQ website for primary care relevant information, tools, resources, and clinical findings.
- Bolster primary care research infrastructure. The expert panel consistently described the need to support research infrastructure, including non-project specific administrative support and other innovative ways to help sustain research capabilities and develop primary care research careers over time and between grants.
- Encourage research focused on workforce issues, health equity, patient and community participation, and interdisciplinary collaborations. The expert panel recommended that NCEPCR fund more grants with a focus on workforce development and health equity. In addition, they suggested building grant mechanisms to encourage grantees to meaningfully engage with the communities where their research takes place. This means collaborating with communities most impacted by health inequities not just as an audience for findings, but as partners that provide ongoing input on research priorities, conduct, and dissemination. In addition, the group suggested that AHRQ consider encouraging and rewarding grantee teams that feature interdisciplinary collaborations, to help drive innovative and lasting solutions.
Addressing Primary Care Research Gaps
As described in the Overview of AHRQ’s Recent Investments in Primary Care Research section, AHRQ's recently funded grants are not equally distributed across the topic areas AHRQ has identified as important for primary care research. Among AHRQ grants with active funding in fiscal years 2021 and 2022, a good proportion aligned with digital healthcare (48%), practice and quality improvement (46%), person-centered care (31%), healthcare systems and infrastructure (28%), and health equity (23%). However, there has been less focus on behavioral health (14%), and only a small proportion of grants with a focus on public health and community integration (7%) and workforce (4%). Given the recommendations of the advisors (as described above), an increased focus on health equity and primary care workforce may be of particular importance for NCEPCR to consider going forward.
In addition, given the importance of developing the workforce of primary care researchers, NCEPCR may want to consider funding more dissertation grants (R36s) and other career development grants ("K" awards) as a part of their future funding for investigator-initiated primary care research.
Next Steps
AHRQ is working to finalize a primary care research agenda. This agenda will be informed by discussions that took place as part of AHRQ’s Primary Care Research Conference, held in December 2020; existing and historical AHRQ priorities; the HHS Initiative to Strengthen Primary Care;6 the administration’s priorities; and additional insights about high-impact research areas and important gaps offered by academic institutions, primary care advocacy organizations and think tanks, and other HHS agency partners.7 The 2020 National Academy of Sciences, Engineering, and Medicine (NASEM) Report on Implementing High-Quality Primary Care: Rebuilding the Foundation of Healthcare and its 2023 consensus study report Achieving Whole Health: A New Approach for Veterans and the Nation will also be used to guide the new research agenda. In addition, AHRQ and NCEPCR are committed to listening to and learning from patients and families as part of this process.
NCEPCR is working to develop a more coordinated primary care research portfolio and agenda at AHRQ; create more targeted primary care research funding opportunities; support and expand a diverse primary care research workforce; and develop a more robust dissemination strategy to share valuable tools and resources with the field. If fully funded to the level of the President’s budget ($11M for FY2024)(7) NCEPCR will have the capacity to more meaningfully and sustainably engage in activities to achieve NCEPCR’s mission. The recommendations of the stakeholder group are very much in line with NCEPCR’s goals and purpose, including to:5
- Coordinate primary care research activities across AHRQ.
- Curate and synthesize information about primary care research across federal HHS agencies
- Communicate important primary care research findings to the field.
- This includes developing an online resource center to share and disseminate information, evidence, methodologies, instruments, measures, and data sets.
- Convene primary care research activities across AHRQ.
- This includes hosting webinars, seminars, and conferences to bring primary care researchers, clinicians and clinical teams, quality improvement experts, healthcare decision makers, and other interested parties together to accelerate the dissemination and implementation of evidence into practice.
- Catalyze new and innovative primary care research by identifying research gaps and funding primary care research projects.
- Cultivate a diverse primary care research workforce by funding investigator-initiated primary care research.
NCEPCR is also updating and reorganizing its website to make it easier for interested parties to navigate, find information of interest, and come together in virtual spaces. This includes developing a searchable database of primary care tools and resources and hosting an online space for building primary care research communities. NCEPCR has begun reengaging with primary care Practice Based Research Networks (PBRNs) to identify meaningful web-based tools and resources and other ways that AHRQ can support the work of PBRNs.
As AHRQ works to finalize its forthcoming primary care research agenda and implement the work of NCEPCR, the agency will consider and incorporate the feedback from the advisory group along with the research gap information shared in this report, which is the first of what will be an annual or biennial presentation of AHRQ's investment in primary care research.
Note
b. We include the term “stakeholder” here for purposes of consistency. However, for inclusive language purposes, we limit the use of this term in this report, and use the terms “expert panel”, “group” and “audiences” instead as relevant
