Title: PracticeBased Research Networks PBRNs: a Resource for Translation Research
1Practice-Based Research Networks (PBRNs) a
Resource for Translation Research
- Lyndee Knox, PhD
- LA Net
- Associate Professor
- University of Southern California
- knox_at_usc.edu
- www.lanetpbrn.net
2If we want more evidence-based practice, we need
more practice-based evidence. Larry W. Green,
2004
3Overview
- What are Primary Care Practice-Based Research
Networks or PBRNs? - Case example LA Net
- Can they be a resource to RCMIs?
4What is a PBRN?
- A group of ambulatory practices devoted primarily
to patient care -- affiliated with each other to
investigate questions related to their practice - Begun 30 years ago in US as a way to study
process of primary care
5PBRNs in the US
- Insert Kevin Petersons map
6Overview stats
- 89 PBRNs in US
- 14.7 million patients
- 12,957 providers
From AHRQ National PBRN Resource Center Survey,
2005 N89 out of 111 identified PBRNs
7But why in primary care setting? In an average
month
1000 people
800 with symptoms
113 PCP visits
New Ecology of Medical Care - 2000
8Examples of Current Health Disparity Studies by
PBRNs
- Office-based modified colon endoscopy as an
alternative to flexible sigmoidoscopy (LA Net) - CAM Use and Disclosure by Latin American
Immigrant Patients (LA Net) - Longitudinal Study of Hyperlipidemia in a Primary
Care Population (ProHealth)
9- Ethnic Disparity in the Use of Joint Arthroplasty
(ResNet) - Black womens health study cheek cell collection
(SCOR) - Gene polymorphisms in relation to cancer in black
women and Black women's health study (SCOR)
10- Follow-up study for causes of illnesses in black
women (SCOR) - Diabetes in Southwestern Hispanic/Native American
Adolescents and Young Adults (RIOS Net) - WINGS Obesity Prevention in American Indian
Children(WReN) - Health Disparities Collaboratives (Clinical
Regional Advisory Network-Region III, Inc. (CRAN)
11LA Net
- Located in LA County
- Founded 2002 w/ funding from HRSA/AHRQ
- 180/- providers, 20 clinic partners in Los
Angeles County - Fluid membership opt in or out based on
interest
12Infrastructure
- STAFF
- .25 FTE Director
- 1 FTE Coordinator, .2 FTE Statistician, .2
Research Assistant - Governance council of providers (80)
researchers (20) - OTHER
- Website www.lanetpbrn.net
- Email list, listserv
- Annual forum, travel, supplies, seed grants for
provider-generated studies - Emergent electronic data collection
infrastructure (ePCRN tools) - Average Op budget for PBRNs 150K (small) to
250K (larger) Green, 2006
13LA Net project generation
- TOP DOWN (40)
- Respond to RFAs from funding agencies
collaborate with outside researchers - BOTTOM UP (60)
- Study ideas come from providers
- Use participatory process called the Reflective
Practitioner
14LA Net Studies (examples)
- Unsedated modified colon endoscopy as an
alternative to flexible sigmoidoscopy
provider-generated study to increase access to
screening colonoscopy for publicly funded
patients in response to 8-month wait times for
patients w/indications - Complementary alternative medicine use
disclosure by Latino immigrant patients
provider-generated study in response to negative
health outcome in elderly Latino patient who
failed to disclose CAM use to his provider - National Childrens Study Pilot Study
feasibility of using community providers to
recruit and follow a longitudinal cohort of women
likely to become pregnant/and later their infant
into adulthood
15ePCRN
- To establish a National Primary Care Registry
- To give providers tools to generate quality
monitoring reports for their clinic patients - To facilitate recruitment of patients into RCTs
- Promotes translation of research findings into
practice - Provides investigational tools for Practitioners
16National Primary Care Registry Pilot Project
(ePCRN) - NIH
OKPRN
MAFPRN
Indiana FPRN
National Registry U of Minnesota MAFPRN Beta
100 practices nationally
PROHealth
APBRN
LA Net
AAFP NRN
PSARN
SNOCAP
17Registry Organization
- Local registry of patients
- Automatically generated
- Identifying information
- Diseases (ICD9s from billing)
- Labs
- Central registry of de-identified data
- Patient identifying information stripped out
- Remainder of data retained
- Automatically updated periodically from the local
registries.
18 LA Net Roll Out
ePCRN National tools ePCRN National tech support
PHASE 2
PHASE 3
PHASE 1
San Gabriel Family Practice
Community Clinic Partner/s
Broader expansion SPAs, LA Care, CCALA, RCMI as
possible partners
Billing (IDX) Lab (Quest)
Site registry
Site registry
USC Family Practice
Small practice partner/s
Billing (IDX) Lab (Quest)
Site registry
Site registries
Site registry
LA REGIONAL REGISTRY
NATIONAL REGISTRY
19PBRNs as resource/partners for RCMIs
- Identify patients for RCTs (through ePCRN
infrastructure and other) - Increase internal validity (e.g. applicability to
practice setting) of studies through facilitating
early and on-going input from frontline providers
(and patients). - Infrastructure to support implementation,
dissemination and best practices research. - PBRNS as learning communities for providers
researchers.
20Locations of PBRNs and RCMI Sites
Pediatrics PBRN
Internal Medicine PBRN
Family Medicine PBRN
Nursing/Nurse Practitioner PBRN
Other PBRN (includes Community Health Centers and
multispecialty primary care networks)
RCMI Sites
21Existing PBRN RCMI (or PRC) Collaborations
- Centex PBRN Texas A M School of Rural Public
Health application to establish an RCMI - Collaborative pilot study w/Centex Employing
Diabetes Self-Management Models to Reduce Health
Disparities in Texas - Samuel Forjuoh SFORJUOH_at_swmail.sw.org
- SpurNet U Texas School of PH PRC
- Evaluating the Effect of Professional Education
on Provider Interventions for Informed Decision
Making About Prostate Cancer Screening
1,762,738 - Robert Volk bvolk_at_bcm.tmc.edu
22Summary
- PBRNs are available and they work
- They can be effective partners for RCMIs for
translation research, and for increasing the
relevance and eventual translatability of
medical research