Creating Practice Based Research Networks for Global Health JESSIE Jessica Evert MD, Executive Director, CFHI Faculty, UCSF Department of Family and Community Medicine Kim Kimminau PhD, AAFP National Research Network

Practice-based Research Networks PBRNs are groups of clinicians and practices working together to answer community-based health care questions and translate research findings into practice

What are PBRNs’ value? PBRNs are "new clinical laboratories for primary care research and dissemination” 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

174 PBRNs, 29,455 practices, 153,736 clinicians, +86M patients

What pulls US members together? Opportunities to participate in developing research agenda/grant submissions (76%) Opportunities to co-author research presentations/publications (75%) Training in human subjects protection/research ethics (49%) Practice facilitators/coaches (39%) TA for practice transformation (29%) MOC Part IV (20%) Data sharing is a challenge, but not insurmountable Data warehouse capabilities permit pulling electronic data irrespective of HER If data are not electronic, then its chart abstraction, expense, errors and slow!

What pulls US members together? CME (60%) Financial compensation for research participation (51%) Opportunities to participate in learning collaboratives (48%) Performance evaluation / feedback (43%) Academic detailing (23%) Conferences or journal clubs (25%)

PBRNs and EHR Use Data sharing is a challenge, but not insurmountable Data warehouse capabilities permit pulling electronic data irrespective of HER If data are not electronic, then its chart abstraction, expense, errors and slow!

Setting a research agenda Some PBRNs stick to a short list Some PBRNs stick to an annually reviewed list Some focus on one set of conditions – i.e., chronic Some are opportunistic, and review grant and funding options to select focus

4 International PBRNs International Federation of Primary Care Research Networks (153 clinicians) – Crete, Greece Center for Studies in Primary Care (150 clinicians) – Ontario, CA SAIHP PBRN (17 clinicians) – Orissa, India Holistic Heathcare and Research Centre (30 clinicians) – Andra Pradesh, India Theses are the ones registered with AHRQ – suspect there are many more

Infrastructure Requirements of PRBN (AHRQ grants) At least 15 ambulatory practices (devoted to primary care) Statement of purpose Direction responsible for administraative, financial, and planning functions Support staff (at least 1 person) Mechanism such as community advisory board to get feedback from communities of patients served by clinics Organizational structure independent of any one study Communication process (regular newsletter, conference calls, or face-to-tace meetings)

Organizational Infrastructure News-sharing function 2-way communication among member practices Membership roster Funds for meetings/virtual meeting platform Organized way of IRB/human subjects protection Basic network $69,000 annually (2005)

Director Often a physician (or PhD) Desirable to have research experience Evaluate projects in light of focus/mission and resources of network Decision making may lie with BOD, committee or Director (varies) May or may not be directly involved with the research, but is aware of all projects Often arranges mentorship of members with research questions

Director Outreach and recruitment of new members Writing press releases Giving talks/increasing exposure Leading meetings, if they are held Personnel and financial management Minimum 0.2/0.5 FTE

Coordinator/Research Manager Day-to-day operations Training in healthcare management and/or project administration Understand both clinical settings and research 3 overlapping goals: research manager, infrastructure manager, assistant to Director May be attached to an academic department overseeing/coordinating network

Research Manager Identifying potential grant opportunities Assisting in development and submission of grants Developing project-specific protocols Hiring/training/supervising other research support staff Organizing/assisting in work flow of projects Management of project budgets

Research Manager Creating and distributing PBRN newsletter Organizing and scheduling meetings Developing and maintaining websites Setting up/conducting conference calls Assisting in Director duties

One-Way Communication News-sharing function (newsletter & website) Celebrate successes Reinforce contact information Disseminate schedules Promotion (website)

2-way Communication Email Listserv Discussion board on websites Vital for community building

Member Roster Varies in formality and how elaborate it is Roster database Use to identify practices for specific studies Support mailing and communication Provide information/demographics of network

Meetings Regular meetings vary in frequency Often combine presentations of research Often associated with CME credit Used for capacity building of research network Web-based video conferencing for geographically dispersed

Human Subjects Protection Members have to be trained in human subjects protections Often have to deal with multiple IRB boards

Brainstorm about Practice-Based Research Networks for Family Medicine Globally…..