Lessons Learned and Challenges Ahead: Report from the OCHIN Safety Net West Practice-based Research Network (PBRN)

Foundation Built on a Shared Vision and Commitment

A major facilitator in the development of our PBRN was the shared vision for conducting high-quality research in the safety net. As one founding member commented, “There was an ideological commitment to serving the greater good, and that outweighed individual clinic interests.” The PBRN was founded on this unity of purpose: “We could do research as a community.” Founding members had a clear understanding of the added value of being part of a network; one noted that, “At the end of my career, I'll look back and say that this was one of the most exciting, and unforeseen, opportunities I ever had.” Table 1 summarizes lessons learned.

The shared vision and commitment to the safety net has kept a dedicated and cohesive group of providers, researchers, and staff (mostly volunteers) inspired and moving forward. Although these factors both shaped our identity and helped us to target grant funds earmarked for priority populations, the importance of having a unique identity, shared vision, and clear purpose must be balanced with a willingness and ability to be flexible and adaptable, lest we become too narrowly focused, which could reduce options for innovation, funding, or sustainability.

Leadership, Mentorship, Collaboration

Our PBRN benefited from passionate leaders, internal institutional support (money, staff, and space), and already-established relationships in Oregon's health care community. External resources and mentors were also crucial, such as guidance from other PBRNs and the opportunity to attend the national PBRN conference sponsored by the Agency for Healthcare Research and Quality. Our PBRN also benefited from cross-organizational collaborations, as described by one of the interviewees: “When the lines are blurred between organizations, and people wonder who works for who [sic], that's good! That means there's true cooperation and sharing of resources.”

Engaging Busy Clinicians

Although the opportunity to develop a PBRN within OCHIN was unique, the overall desire to come together to learn from each other and share resources is similar to that reported by others, who found that a major influence supporting PBRN development was participants' perceptions that a PBRN could add value to both research opportunities and practice quality.^6,7 Despite our vision and commitment, it still can be difficult to engage busy clinicians who have many competing priorities. We struggle to involve clinicians in all aspects of network decision making, from setting the research agenda by identifying “questions that come up in [the] clinic every day” to ongoing participation in the research itself. Furthermore, although being a PBRN of community health centers has been a facilitator, these practices often are stretched to care for as many patients as possible with limited resources, and thus have limited time to engage in research activities. We found that recently retired clinicians or those working part-time may have more time and energy to contribute. As grant budgets are prepared, we strive to advocate for realistic compensation for engaged providers and clinics, including both provider time and clinic impact fees.

Bridging the 2 Worlds of Academia and Community

Although a motivating factor of other PBRNs,^6⇓⇓–9 our 2 different worlds—academia and the community—do not always understand each other, possibly because our PBRN is based in the community rather than an academic setting. Building cohesion among PBRN clinicians and researchers required time to develop relationships so that our clinicians and researchers better appreciate each others' realities. This effort was key to our success, and having clinician champions for research projects was invaluable when recruiting clinics to participate in our first intervention study. Similarly, we benefited from engaging researchers committed to longitudinal partnerships with clinicians. It also helped to include “boundary spanners” on the team who have both clinical and research experience.

Harnessing EHR Data

The opportunity to harness data from many practices was another major facilitator of our PBRN′s development and echoes others' observations about the power of networks to collect data on large numbers of diverse patients.^7,9 Our PBRN′s data from a large patient population is in one shared and linked EHR, which is centrally housed and maintained at OCHIN. This unique data resource helped to catalyze the formation of our PBRN and obtain some early grants to conduct secondary data analyses.

Although this data resource facilitated our PBRN′s development, it also raised concerns regarding data ownership that needed careful attention. Building a PBRN with a common EHR, or the ability to merge data from multiple EHRs into a common repository, requires that trust and boundaries around data sharing be established. Much time was required to negotiate policies related to compliance about data protections, sharing, and ownership. In the current era of EHRs and multisite network building, such issues are increasingly relevant; the time required to develop these policies cannot be underestimated. It is important to have realistic expectations and the patience to move through the requisite (and often tedious) discussions about data-sharing policies and the more general procedures and bylaws required to govern a new organization. We also met frequently with our institutional review board to educate their analysts about our work and to get their assistance with the development of data-sharing policies and data use agreements.