The Evolution of PBRNs: Creating a framework to be responsive and

relevant to practices and community stakeholders

Tuesday, July 12th

10:45am-12:15pm

Lyle J. (“L.J.”) Fagnan, MD –Network DirectorCaitlin Dickinson, MPH –Project Manager

Maggie McLain McDonnell, MPH –Project Manager

Welcome!

Introductions

Setting the Stage: PBRN Organizational Framework

Small Group Session

Small Group Reflections

Session Goals

• Learn how ORPRN has evolved

• Discuss possible organizational framework benefits

• Reflect and share your PBRN’s priorities

• Practice creating an organizational framework

Appeal to Participants

• Share!

– Please feel free to ask any

question at any time

• Engage!

– Take out your smart phone

• Brainstorm!

IntroductionsOregon Rural Practice-based Research Network at

Oregon Health & Science UniversityORPRN's mission is to improve the health of rural Oregonians by promoting knowledge transfer between communities and clinicians.

History of PBRNs

• PBRNs in the U.S. began about 40 years ago

Green LA, Hickner J. (2006). A short history of primary care practice-based research networks: from concept to essential research laboratories. JABFM, 19(1):1-10.

History of PBRNS. Agency for Healthcare Research and Quality. https://pbrn.ahrq.gov/about/history-pbrns

28

111

173

1994 2003 2015

PBRNs in U.S.

PBRNs in U.S.

History of PBRNs

• According to an 1999 article published in JAMA, PBRNs had four general objectives:1. Capture health care events that…characterize primary care in community-based patient populations.2. Provide access to the practice experience and care provided by full-time primary care clinicians.3. Focus on practice-relevant research questions, with appropriate research design.4. Strive for involvement of network clinicians in defining the research questions, participating in the study design, and interpreting study results.

Nutting PA, Beasley JW, & Werner JJ. (1999). Practice-based research networks answer primary care questions. JAMA, 281(8):686-688.

ORPRN’s “Four Pillars Model”

3 main challenges in recent years:

1. Shift in physician-owned practices to hospital or insurance company-owned practices

2. Changes in funding

3. Prioritization of health care reform = learning collaboratives over clinical research

1. Shift in Practice Ownership

• While the majority of physicians still work for “cottage industry” practices, more physicians are selling their practices to hospitals and younger physicians are choosing to work for hospitals.

How does this trend affect PBRNs?

Kirchhoff SM. (2013). Physician practices: Background, organization, and market consolidation. Washington, DC: Congressional Research Service.

2. Changes in Funding

• Industry-sponsored grants > NIH-sponsored grants1

– Flat funding for NIH since 2014

– Greater competition for research $

– Reduced funding from NIH- estimated that NIH pays 20-40% below actual cost of completing a trial2

– A recent survey completed by PBRN researchers notes a significant drop in NIH training grant applications3

1 Ehrhardt S, Appel LJ, Meinert CL. (2015). Trends in national institutes of health funding for clinical trials registered in clinicaltrials.gov. JAMA, 314(23):2566-2567.

2 Institute of Medicine (US) Forum on Drug Discovery, Development, and Translation. Transforming Clinical Research in the United States: Challenges and Opportunities: Workshop Summary. Washington (DC): National Academies Press (US); 2010. 3, Challenges in Clinical Research. Available from: http://www.ncbi.nlm.nih.gov/books/NBK50888/

3 Unpublished research from Dr. Melinda Davis.

3. Health Care Reform Prioritization

• Challenge to recruit practices to participate:

– Busy practices

– Lack of financial and administrative support

– Participating in clinical research costs practices money

• Practices are overwhelmed with unfunded tasks

Calmbach WL, Ryan JG, Baldwin LM, & Knox L. (2012). Practice-based research networks (PBRNs): meeting the challenges of the future. JABFM, 25(5):572-576.

Hickner J, Green LA. (2015). Practice-based research networks (PBRNs) in the United States: Growing and still going after all these years. JABFM, 28(5):541-545.

Institute of Medicine (US) Forum on Drug Discovery, Development, and Translation. Transforming Clinical Research in the United States: Challenges and Opportunities: Workshop Summary. Washington (DC): National Academies Press (US); 2010. 3, Challenges in Clinical Research. Available from: http://www.ncbi.nlm.nih.gov/books/NBK50888/

ORPRN’s “Four Pillars Model”

Potential Benefits of Organizational Frameworks

• Engage stakeholders to determine direction

• Focus on the future

• Aid decision-making

• Help with alignment

• Guide change

• Communicate purpose to stakeholders

• Shape strategy

• Facilitate evaluation and improvement

Small Group Session

1) Gather in a group of 5-6 people.

2) Discuss in small groups: items on handout.

3) Record small group discussions.

5) Small groups report out key ideas and/or findings.

4) Using flip charts, draw an ideal framework.

Small Group Reflections

• What did you think of this process?

– How would you use it?

• Why do you think an organizational framework could be valuable for PBRNs?

• How can you share what you learned here to be impactful to your organization and the communities you serve?