Article Figures & Data
Figures
- Figure 1.
Locations and number (n) of participating clinicians.
Tables
- Table 1.
Thematic Summary of Practice-Based Research Network (PBRN) Clinician Motivation Emphasizing Personal Satisfaction
Primary Theme Main Types of Satisfaction SDT Component* Quote Enjoyment of research without the restrictions of academic work/life Intellectual stimulation around medicine Autonomy, Competence, Relatedness “I think I have the best of both worlds. In terms of clinical practice, I think that medicine is more enjoyable in a nonacademic setting, away from all the politics that are part of academia.”“ They are the farm teams of research, growing investigators from the large field of doctors interested enough to participate, but not so much so as to quit their day jobs and go into academia. That is me. I may be growing slowly, but at least I’m growing.” Sparking diverse interests and creating an opportunity to form a PBR community identity with other practitioner-researchers Stimulation and connectivity with learning environments generated through PBR Relatedness “This experience [a network study within residency programs] has been especially poignant for me in that it hopefully will create a learning community among residencies.” Opportunities to create positive behavior change among patients and other practitioners Competence “I have enjoyed attending the convocation, meeting like minds, and have been encouraged to pursue the study of the Review of Systems. This has become a project of the Residency Branch with collaborators in several states. I have also enjoyed thinking about how to engage current residents in the scholarly activity of family medicine.” Creates new opportunities for leadership and role models Relatedness “Participating in practice-based research encourages critical thinking skills and develops the necessary mindset to question basic assumptions, accept new and better solutions, and work towards increasing the value of the health care—this has to come from within the profession.” “I wanted to be involved in showing other practitioners that attention to this teaching (physical activity, healthy eating and energy balance) really does make an impact on patients.” “The path continued to wind across the United States as I was able to find mentors to teach me and I was asked in turn to advise others new to the moves of the network arts. We all became learners and teachers simultaneously; taken up with the excitement of this new challenge.” Reward in creating a primary care evidence base that reflects diversity of real-world office settings and diverse populations Rewarding to have non-academic clinical experiences increase the relevance of academic research efforts Autonomy, Competence “I felt my private practice experience and input were valued and applied during discussions about which avenues research should take. I was also able to bring back simple cost effective low tech solutions to major data management problems in my private practice.” Rewarding to improve patient care by increasing the relevance of research findings through PBR Autonomy, Competence, Relatedness “[Learning about a seminal PBRN study] illustrated to me the value of doing research grounded in clinical practice, the power of PBR to rigorously challenge the conventional ‘ivory tower’ wisdom, and the ability of a network of practicing clinicians to make an important contribution to the practice of medicine.” Satisfying to have interventions to support patients’ real needs Relatedness “The work I have done in my exam room and in front of my computer has been published, read, and cited—it is now influencing the direction of future research.” Provided answers for practice to questions from practice ”Research has allowed me to see another side of my patients—I was pleasantly surprised to learn that one of my patients is considered the leader and cheerleader for his group (within a diabetes self-management group visit intervention).” “After getting settled into clinical practice and the birth of my first daughter I continued participation in network studies, including the headache and influenza studies. Within 1 year I become more interested in the network studies and meetings. I identified a mentor and chose the primary care management of type 2 diabetes as my primary area of research interest.” “The research network provided an opportunity to participate in the discussion of research concerns, the opportunity to collect data that in my office would be only anecdotal and in a network meaningful, and the opportunity to meet primary care physicians from around the country. I ‘live’ in 3 exam rooms and infrequently see my associates during the day and rarely talk about patients, and even less about systems problems. The research network and convocation give me an opportunity to meet friends and explore questions that do not have priority during the patient care hours.” “Since before completing medical school I have been plagued with local clinical questions such as ‘What is the evidence to support this diagnosis/treatment? Treating my patients as populations makes me feel like I am being more thoughtful and scientific when I am assessing the quality of my services. If we can pool the results of common questions from regular practices, the medical literature may have more credibility when it comes to motivation for changes in practice patterns.” “When I first approached the University about doing some research on spider bites it seems to have been dismissed by the urban academic community as something of little clinical significance. It was only when working with the research network director that it was clear we could put together a huge number of cases in a short period by linking rural practices together. This is probably a good example of the disconnect between urban academia and the practical problems faced by ‘field doctors’ and the critical shortage of research in many areas of medicine less glamorous than critical care.” Engagement with others in clinical thinking improves clinical skills and creates meaningful connections that compensate for practice isolation or long work hour Engagement in PBR is a satisfying way to enhance clinical skills Competence “I believe that active participation in PBRN has improved my critical-thinking skills and my patient care, kept me at the forefront of contemporary primary care practice, and served as a source of (and stimulus to) continuing medical education.” Rewarding connections with others are energizing Autonomy, Relatedness “Conducting research keeps my mind sharp, enhances by critical thinking skills, and encourages me to keep up with the latest treatment advances.” “Feeling the need for continuing research to keep abreast of changes, keep skills up. And being curious, I heard about the research network for those nonacademics who represented private practice. I’ve been hooked ever since.” “The connections keep me going. The meetings are in the evenings after a long day in the office, but I always feel energized after a meeting and have a fresh perspective.” “I think practice-based research networks are a good tool for physicians because they allow physicians to network and improve not only how we practice medicine but also improve patient care. It also allows private practice physicians not to feel isolated, but to be involved in practice enhancement programs.” “To help my loneliness I started reading articles and biographies of famous family physicians: William Budd, William Pickles, James McKenzie, Fred Banting, and, ironically, Curtis Hames. I did not live far from Curtis Hames and he invited me to come to his home and spend time with him. He asked me if I was interested in doing any research and I said I was but I didn’t know how to get started.” * Three components of self-determination theory (SDT) are (1) competence, (2) autonomy, and (3) relatedness.
PBR, practice-based research.
- Table 2.
Thematic Summary of Practice-Based Research Network (PBRN) Clinician Motivation Emphasizing Improving Local Clinic-Based Care
Primary Theme Main Types of Satisfaction Quote Implementing health information technology Improve quality of care Regarding patient safety/evaluation of office errors: “The near misses’ reports generated by the practice not only encouraged the physicians, but also the office staff to understand the importance of patient safety.” Answering primary care questions of most importance to practicing clinicians Improve quality of care “The only valid reason to do applied research is to improve quality. Therefore, research and quality improvement are so closely linked that it usually makes no sense to distinguish them one from the other. Research is not a goal (as in, We have to do more research.’); it is a set of tools that can often be used to overcome the obstacles encountered when trying to achieve goals.” Participation in a PBRN increases the relevance of research for local clinic population/vulnerable population not often part of research studies (rural migrant community) Increased relevance of research to clinic/community It [the research network] has the great advantage of potentially having an impact on my own patients by seeing their problems and eventually finding a different more effective way to deal with them.” Information to improve practice operations and quality improvement/Listserv to ask questions Improved clinical care “The network provides me with an experienced panel to answer all kinds of questions that may occur: things as simple as how to code a procedure to clinical questions that are answered via the listserv.” Connecting with the academic health center through the use of PBRN practice enhancement assistants Make practice-based research possible “The Practice Enhancement Assistant is able to take the oftentimes complex and difficult to understand research protocols and make a simpler understanding for each person's part in the protocol.” “Practice Enhancement Assistants often help practices with both office procedures and preparing or finding good patient education materials.” Provided safe environment to explore patient safety and quality improvement (in this case, patient safety and increasing immunization rates) Improved quality of care/patient safety “Many things we fear as clinicians, such as insurance companies looking at prescribing habits, make us hesitate to participate … but the research network wants to work with us to improve quality of care—people we seek out and want to be involved with.” Improving the delivery of chronic illness care and population-based medicine/implementing a disease registry/training in PDSA cycles Improved clinical care and quality improvement “When measured against our contemporaries we continually rise to the top because we chose to participate in this [QI] project. We frequently outperform the large systems with expensive electronic medical records because we participated in this diabetes project. We have expanded our measurements to coronary artery disease, hypertension, depression and asthma. We see the value in measuring and actively managing disease processes to provide world-class care to our patients. Had we not participated in this study I wonder if we would be five years behind in assessing and improving the quality of care that we provide to our patients.” “The network has allowed me to have a better practice and be better at disease management.” [The network's practice enhancement assistant implemented a diabetes registry and trained the practice in PDSA cycles.] Practice innovation/redesign/able to feel positive about family medicine at a time when American medicine is abandoning it Quarterly performance reviewing/Turning Research into Practice study led to improved quality of care “We would not have made these [care-related] changes without the supportive environment of the research network. We were able to stand back and examine our practice in a manner otherwise impossible. We are then able to modify our behavior and improve our practice performance.” PDSA, Plan-Do-Study-Act.
- Table 3.
Thematic Summary of Practice-Based Research Network (PBRN) Clinician Motivation Emphasizing Community- and System-Level Improvements
Primary Theme Main Types of Satisfaction Quote PBRN enables exploring and enhancing the quality of health care delivered in rural community Improved clinical care and quality of health care in real world setting/increased relevance to community “I had an understanding from early in life in rural areas and populations were not well studied. This led me to…earn a masters in public health as well as to complete a medical degree. This joint track really allowed me to do both clinical medicine as well as get some exposure to the looking at the bigger issues of healthcare, part of that being research and understanding how things are affected in rural areas as opposed to urban areas.” Participation in PBRN increases the relevance of research for local clinic population/vulnerable population not often part of research studies (rural community) Improved clinical care related to increased relevance of research to clinic/community “I feel it is important to put research in places where it can benefit people and their community.” Participation in PBRN increases the relevance of research for local clinic population/vulnerable population not often part of research studies (rural migrant community) Improved clinical care related to increased relevance of research to clinic/community “Evidence-based practice is important and there is not a lot of data out there on problems more common to a rural than an urban setting.” Answered questions from practice with data from practice Provided epidemiologic data to document a community health problem “Community based research and outreach were developed from the specific needs of the immigrant community affected.” Development of a communications network to streamline office processes and coordination with local health departments Improved clinical care/care coordination “I feel we finally got some hold of this monster (flu vaccine demand) and took it back from the consumer demand chaos of years past. This year the medical community directed traffic.” Implementing tools to enhance the public health role of family medicine practices. In this case, the development of an influenza tracking system (real time surveillance) that was linked to community education and follow-up Improved care to the larger community “When we see the trend going up (influenza cases), we can use that data to convince our school teachers to get their flu shots.”
In this issue
Jump to section
Related Articles
Cited By...
- Practitioner Participation in National Dental Practice-based Research Network (PBRN) Studies: 12-Year Results
- Pragmatic Trials in Maintenance Dialysis: Perspectives from the Kidney Health Initiative
- Clinician and Staff Perspectives on Participating in Practice-based Research (PBR): A Report from the Wisconsin Research and Education Network (WREN)
- Understanding the Context of Health for Persons With Multiple Chronic Conditions: Moving From What Is the Matter to What Matters
- Preventing the Voltage Drop: Keeping Practice-based Research Network (PBRN) Practices Engaged in Studies
- Practice-based Research Networks (PBRNs): Meeting the Challenges of the Future
- Lessons Learned and Challenges Ahead: Report from the OCHIN Safety Net West Practice-based Research Network (PBRN)
- A Novel Protocol for Streamlined IRB Review of Practice-based Research Network (PBRN) Card Studies
- No Longer Simply a Practice-based Research Network (PBRN): Health Improvement Networks
- Advantages of the Dental Practice-Based Research Network Initiative and Its Role in Dental Education
- What Do We Get From Participating in Practice-based Research Networks?