Research ArticleAbout Practice-Based Research Networks

Preventing the Voltage Drop: Keeping Practice-based Research Network (PBRN) Practices Engaged in Studies

Barbara P. Yawn, Allen Dietrich, Deborah Graham, Susan Bertram, Marge Kurland, Suzanne Madison, Dawn Littlefield, Brian Manning, Craig Smail and Wilson Pace
The Journal of the American Board of Family Medicine January 2014, 27 (1) 123-135; DOI: https://doi.org/10.3122/jabfm.2014.01.130026

Article Figures & Data

Figures

Tables

  • Table 1. The Four PBRN Studies Included in this Study
    Study NamePractices (n)Study DesignStudy Duration (months)Central SitesStatusFundingPractice ChangeDiscontinued Practices (n)
    Introduction of Spirometry into Primary Care18Before/after observational18OMC and AAFP NRN Care NetCompleted in 200620NHLBIUsing spirometry to evaluate patients with asthma and COPD1 (unable to enroll patients)
    TRIPPD (Translating Research into Primary Care Practice for Postpartum Depression)28Randomized controlled trial60OMC and AAFP NRNCompleted in 201021,22AHRQIntroducing screening, diagnosis, and management support for postpartum depression4 (2 practices dissolved, 1 practice had long-term illness of local primary investigator, 1 practice could not meet enrollment goals)
    The Asthma Tools Study28Randomized controlled trial60OMC and AAFP NRNIn progressAHRQUsing new asthma tools in managing children and adults with asthma1 (Practice destroyed by tornado, unable to continue while trying to rebuild)
    BELT (Black Asthmatic's Exacerbations with LABA vs Tiotropium)30Randomized controlled trial36OMC, AAFP NRN, and Harvard Medical SchoolIn progress23AHRQAssessing the impact on exacerbation rates of 2 classes of long-acting bronchodilators in black adults with asthma3 (1 practice unable to do work, 2 sites unable to meet enrollment goals)

    • AAFP NRN, American Academy of Family Physicians National Research Network; AHRQ, Agency for Healthcare Research and Quality; NHLBI, National Heart, Lung and Blood Institute; OMC, Olmsted Medical Center.

  • Table 2. Summary of Elements of the Eight Methods
    MethodMain ElementsSubcategories
    Centralized training1. Select an attractive city

    1. Link to another meeting

    2. Choose a “vacation” city

    2. Brief and focused presentations
    3. All central team members make presentations
    4. Introduce all site champion teams and announce randomization

    1. Celebrate with both groups

    2. Extra support for usual care initial disappointment

    5. Introduce site champions to the central site liaison
    6. Introduce the topic of the protocol and reasons for the study
    7. Provide detailed information in the slides and handbooks

    1. Continually refer to the handbook when champions return home

    2. Use the handbook to reinvigorate, remind, and refresh

    8. Introduce the intervention to appropriate sites

    1. Use practical examples based on patient care

    2. Let the group brainstorm anticipated problems and solutions

    3. Introduce the concept of implementation flexibility

    9. Provide time for each set of site champions to discuss their local implementation strategies while central team members are present to answer questions.
    10. Take and share pictures of site champions and central teams

    1. It may be harder to ignore calls from someone whose picture is right over the phone

    2. Helps central team to remember more details about each champion

    11. Provide time to complete human subjects training with central team mentors

    1. Reinforce that support is readily available

    2. Helps when the champions may have to repeat training in 2 to 3 years

    12. Provide concise slide set for site champions to use to train practices when they go home
    13. Use humor and interactive, supportive sessions to model behavior for interactions for the rest of the study period
    Liaisons1. Assign to specific practices for the entire study
    2. Serve as primary contact for practices to the central team
    3. Include in all study meetings
    4. Become an early warning system for practice problems and “voltage drop”
    FAQs1. Develop and use a consistent format with study logo at top
    2. Send to sites on a consistent day of the week
    3. Share by fax or E-mail as sites request
    4. Use for continuing education, maintaining same style as central training
    5. Reinforce complex or apparently confusing steps in implementation
    6. Recognize accomplishments such as enrollment numbers
    7. Share local sites' stories

    1. Successes

    2. New strategies or tools developed by sites

    3. Occurrence and burden of natural disasters

    1. Floods, earthquakes, fires, hurricanes, tornadoes

    2. Share interpractice support given

    8. Use humor and cartoons to illustrate issues and celebrations
    9. Develop and use mini crossword puzzles or other study-related “contests”
    10. Share case reviews and questions
    11. Celebrate holidays
    Incentives1. Foster recognition and acknowledgement

    1. Press releases for local media

    2. Framed certificates of participation for display in the local office

    2. Set achievable goals and recognize them when they are met
    3. Provide small but fun rewards, eg, boxes of microwave popcorn
    4. Use variety to continue encouraging participation
    5. Increase the frequency at lulls in enrollment or other dips in activity
    6. Provide larger rewards for major achievements like meeting total enrollment goals

    1. Pizza party

    2. Ice cream social

    7. Provide personalized thank you from the PI for special recognition
    Case reviews1. Assume sites have important insight to offer and expect to learn from sites
    2. Highlight positive aspects of care
    3. Ask what could be done to make care even better
    4. Relate the care questions to the intervention
    5. Allow site attendees to teach each other
    6. Present alternatives from other sites or the PI's experience or expertise
    7. Guide problem solving
    8. End by setting up the next review and perhaps follow up on the cases presented
    Appreciation1. Respect is mainstay
    2. Acknowledge all members of the practice
    3. Praise the work of the site champions during case reviews and in FAQs
    4. Schedule interactions at the convenience of the sites
    5. Consider using emails for some interactions—especially PI to site physician champions
    6. Give site champions study shirts or mugs
    7. Give modest holiday gifts for all practice members

    1. Candy or fruit for winter holidays

    2. Cookies or gift card for an ice cream party in summer

    IRB support1. Offer to do initial submission
    2. Provide support for all IRB interactions

    1. Serious adverse events reporting

    2. Annual reports

    3. Copy and mail new consent forms required annually
    4. Offer to provide telephone support for all site-required IRB interactions
    5. As requested, teach sites to do its own IRB submissions with oversight and support

    • FAQ, frequently asked question; IRB, institutional review board; PI, primary investigator.

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