Practice-Based Research Networking for Growing the Evidence to Substantiate Primary Care Medicine

Outpatient general practices, the level at which most people interact with the US health care system, represent a genuine conundrum to researchers. These practices provide a potential gold mine of data for examining the structure, processes, and outcomes of primary medical care. Evidence acquired from outpatient general practices could address important health care issues that cause serious morbidity, such as asthma, diabetes, back pain, headache, and the common cold. In this outpatient arena, research could translate into practice, bridge the performance gap, answer real-world research questions, and benefit health care in our academic communities. We definitely can improve the quality of health care in general practices and prevent avoidable hospitalizations. Researchers in general practices, however, have less control over confounding variables, they are less able to standardize patients, and they are less able to acquire statistically rigorous sample sizes in reasonable timeframes.

The untapped potential of general outpatient practices has been recognized by the giants in our field: Will Pickles, John Fry, Curtis Hames, Paul Nutting, and Larry Green. The dilemma in primary care medicine has always been how to harvest the available data while overcoming the difficulties of pursuing scientific endeavors. In the 1980s, Green, Nutting, and others became vocal advocates of practice networks, a concept long applied in Europe. General, community-based primary care practices formed de facto national or regional networks by using their information infrastructure. For example, the British have a rich history of examining large health care data sets describing patients from numerous primary care practices. Based on this model, the Ambulatory Sentinel Practice Network (ASPN) was established to bring together primary care physicians, mostly practicing family physicians, from the United States and Canada. Their common bond was their commitment to discern proactively the answers to questions that could help them provide better medical care to their patients.

In recent years, the practice-based research networking has grown considerably, propelled by the Committee on the Future of Primary Care, which was convened by the Institute of Medicine. The 1996 Committee report is considered seminal because of its updated definition of primary care and its endorsement of practice-based research networks. The Committee described such networks as “the most promising infrastructural development that [the Committee] could find to support better science in primary care.” Many academic primary care departments have successfully developed regional or statewide practice-based research networks as platforms upon which to build a research infrastructure. Today, regional and national practice-based research networks are offering important contributions to the evidence base of family practice, general pediatrics, and general medicine.

In 1995, a core group of network directors affiliated themselves as the Federation of Practice-Based Research Networks (FPBRN) with a mission to expand the number of practice-based research networks in the United States, provide technical assistance to new networks, promote network-to-network collaboration, and foster a greater appreciation of the unique capabilities and infrastructure needs of networks among government and private funding agencies.

The seeds planted through the advocacy efforts of primary care researchers, organizations representing primary care physicians, and the FPBRN appear to be bearing fruit. In early 2000, the Agency for Healthcare Research and Quality (AHRQ) provided competitive funding to support the infrastructure needs of 19 practice-based research networks. AHRQ released a second request for applications in 2001 for competitive funding to supplement AHRQ-supported networks to pursue bioterrorism research.

More recently, other sponsors, including the National Cancer Institute and the Robert Woods Johnson Foundation, have endorsed practice-based research networks. More information about the resource needs for developing and managing a regional practice-based research network may be obtained from the Federation of Practice-Based Research Networks Web site at http://www.aafp.org/research/fpbrn/ or from the author (johngryan{at}miami.edu). Interested readers are encouraged to attend the annual Convocation of Practice-Based Research Networks, sponsored by the National Network of the American Academy of Family Physicians. The Federation of Practice-Based Research Networks also sponsors preconference workshops at annual meetings of the North American Primary Care Research Group (NAPCRG).

John G. Ryan, DrPH

Assistant Professor and Director, Division of Primary Care/Health Services Research and Development, Department of Family Medicine & Community Health, University of Miami School of Medicine and Vice-Chair, Federation of Practice-Based Research Networks