1. ... for our health Lessons Learned During 24 Years of Practice-Based Research with WREN Paul D. Smith, MD, Professor University of Wisconsin Department of Family Medicine Paul.Smith@fammed.wisc.edu Supported by the University of Wisconsin Institute for Clinical and Translational Research (UW ICTR), funded through an NIH Clinical and Translational Science Award (CTSA), grant number 1 UL1 RR025011

2. Topics Today WREN description Research support model Recruitment methods

3. Topics Today Business model Lessons learned Keys to success

4. Why WREN? Most biomedical research in the US during past 50 years has been conducted at about 200 tertiary care centers that provide specialized care and conduct research with highly selected patients.

5. WREN Research is done here 1000 people 113 people (76.3%) 1 person (1.2%) General Population Primary Care Academic Medical Centers Adapted from Green L et al. N Engl J Med 2001;344:2021-2025 Most research is done here

6. What is WREN? Founded in 1987 Program of the University of Wisconsin Department of Family Medicine Clinical Translational Science Award

7. What is WREN? Primary care clinicians and researchers State wide Annual budget ~ $450,000

8. What is WREN? Primary interest in improving care of patients ▪ Conducting practice-based research ▪ Quality improvement projects ▪ Education ▪ Impact

9. WREN Clinicians About 160 members About 130 clinicians 44 Communities 21 different health care organizations 13 different UW Health clinics

10. WREN Individual clinicians VS entire practices “Full Support Practice” ▪ Clinician champion ▪ Practice liaison ▪ Contract ▪ $10,000/year for ~ 20% FTE

11. WREN Full Support Practices Milwaukee ▪ Aurora Medical Group ▪ Milwaukee Health Services Mauston Tomah Richland Center

12. Eau Claire Madison Tomah Mauston Dubuque WREN full support clinic WREN individual clinician site WREN Practices Milwaukee Green Bay Wausau Richland Center

13. WREN Steering Committee 11 members 1 MCW member 4 general members, not affiliated with a University Sets WREN priorities

14. WREN Advisory Committee Purpose: ▪ Make recommendations to the Steering Committee regarding overall direction, policy and procedure changes. ▪ Advocate for Wisconsin citizens in general in regards to WREN activities. ▪ Advocate for WREN to the general public and potential funders.

15. WREN Staff Paul Smith, Director Mike Grasmick, Network Coordinator Veronica Harper, administrative assistant

16. WREN Staff - RRCs Regional Research Coordinators ▪ Peggy O’HalloranEau Claire ▪ Mark RemikerMadison ▪ Kate JudgeMadison ▪ Hannah LouksMilwaukee

17. Questions?

18. WREN Research Support Model Central WREN staff Principal Investigators ▪ WREN Clinicians ▪ Non-WREN collaborators

19. Regional Research Coordinator Develop ongoing working relationships Assess clinic capacity to conduct research Technical assistance/training for practice staff Assure adherence to protocols

20. RRCs Two way communication Share best practices/problem solve Assist with chart review and patient recruitment

21. Types of WREN Projects Translational Research Dissemination/QI Projects that (will) directly impact patient care

22. WREN Projects A variety of clinical topics ▪ Asthma treatment ▪ Cancer screening ▪ Heart disease prevention ▪ Evaluation of dyspepsia

23. WREN Projects ▪ Office radiography use ▪ Health literacy ▪ Number of problems per encounter ▪ Office visit complexity ▪ Infectious disease reporting

24. Current Projects Trust in Health Care Collaborating with pharmacist to improve asthma care Testing an internet chronic kidney disease management tool

25. Current Projects Meditation as adjunct to usual care for treatment of alcohol addiction Improving care of the elderly Facilitating improvement in CKD care ▪ 3 year AHRQ funded intervention studies

26. Questions?

27. Recruitment Methods Practices Clinicians Patients ▪ At clinics- front desk, nurse, doctor ▪ EHR + Mail (opt out) + phone

28. Business Model Infrastructure funding + grants Investing in a relationship Don’t give it away (often) ▪ “Are you working for free? – don’t!”

29. Business Model Know what it costs to do your work ▪ Calculate hours and double Justify the supervisor’s work in your grant budget Identify and avoid “scope creep”

30. Business Model Talk about money early Transparency with all partners Open process Share data (e.g., salary, % effort) Negotiate using collaborative process Be willing to walk away ▪ Money’s not right, project’s not right

31. Business Model Market your network ▪ How are you uniquely positioned for research? ▪ What type (topics) of research does your network do? ▪ Reach out to PIs and people that can refer PIs to you

32. Business Model Get your name out there ▪ Website ▪ Newsletter ▪ Presentations ▪ Publications

33. Questions?

34. Lessons Learned- the Hard Way Don’t give it away Be very clear about expectations and responsibilities Talk about money early Ask, you might just get what you want

35. Lessons Learned Be careful what you ask for, you might just get it. Slow growth is less stressful than rapid growth Plan for sustainability with multiple funding sources Plan for leadership succession

36. Keys to Success Research question that matters Minimal burden on clinicians Enough to do to maintain interest, but not too much

37. Keys to Success Effective communication Two way feedback with clinics Involvement of clinics and WREN staff

38. Keys to Success Adequate funding for projects Infrastructure funding Have a business model

39. For More Information www.wren.wisc.edu paul.smith@fammed.wisc.edu

40. Questions?

41. ... for our health