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Practice-Based Research in Primary Care: Facilitator of, or Barrier to, Practice Improvement?

¹ Department of Family and Community Medicine, University of California at San Francisco, San Francisco, Calif
² Department of Family Medicine-Research Division, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ
³ Department of Family Practice, College of Human Medicine, Michigan State University, East Lansing, Mich

CORRESPONDING AUTHOR: Thomas Bodenheimer, MD, Department of Family and Community Medicine, University of California at San Francisco, Bldg 80–83, SF General Hospital, 1001 Potrero Ave, San Francisco, CA 94110, Tbodenheimer{at}medsch.ucsf.edu

PURPOSE In what ways is primary care practice-based research a facilitator of practice improvement vs a barrier to practice change? This article aims to alert investigators to the pitfalls they may face in undertaking the dual agenda of research and practice improvement.

METHODS We derived examples of the relationship between the research and practice improvement goals of 17 Prescription for Health (P4H) grantees from verbal communications with the grantees, field notes from interviews and site visits, and entries made by grantees to an online diary managed by the P4H Analysis Team.

RESULTS An analysis of key themes identified factors facilitating and impeding the dual goals of research and practice improvement. The requirements of conducting research mandated by institutional review boards, including patient enrollment and consent, often constituted barriers to practice improvement. The choice of practices in which to conduct research and improvement activities and the manner in which the practices are approached may affect the outcome of both research and practice improvement goals. Approaching practices with a time-limited project mentality can interfere with a process of permanent practice change. The RE-AIM construct (reach, efficacy/effectiveness, adoption, implementation, and maintenance) is useful in designing research interventions that facilitate practice improvement.

CONCLUSIONS Projects that meld research studies and practice improvement goals must pay attention to the potential conflicts between research and practice change, and must attempt to design research studies so that they facilitate rather than inhibit practice improvement.

Key Words: Research • practice improvement • behavior change • primary care • practice-based research

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