Practice-Based Innovations: More Relevant and Transportable Than NIH-funded Studies

• Health Policy
• Practice-based Research
• Primary Health Care
• Program Sustainability
• Translational Medical Science

We previously published an assessment of US primary care workforce innovations that involved a review of more than 4400 abstracts and more than 350 articles published since 2000.¹ Based on the combined experience of the research team, we determined that the literature did not capture the observable landscape of primary care innovation. We therefore followed the first study with a purposeful sampling of investigators based on the literature and snowball sampling to follow up leads. In the second study, we identified and interviewed 250 primary care leaders associated with 190 practice settings at the cutting edge of workforce innovation with the intention of identifying exemplars for further investigation.²

The majority of published accounts of primary care workforce innovation focus on specific diseases or disease clusters and a fidelity to research design, resulting in incremental innovations that are not sustainable. In addition, National Institutes of Health–funded studies seem to favor biomedical data, thus missing many of the contextual factors critical to localized success. In contrast, the innovative practices of our study developed solutions to everyday problems, informed by awareness of local context and funding constraints. Such solutions, built on practice-based evidence,³ enjoy greater sustainability, improved attention to context-specific preconditions, fluid adaptations to workflow, and greater potential for translation (Table 1). Many practices report visiting peer sites as part of their problem-solving approach, noting that understanding context is critical to disseminating productive models.

Context-based innovations that are primarily grounded in the everyday competing demands of high-quality primary care settings are more likely to create sustainable solutions to real-world problems. Such practice-based solutions learn from cycles of failure and adaptation and ultimately foster effective change at a faster pace than solutions currently found in the published literature. To meet the innovation needs of primary care, and the health needs of the US population, funders and funding mechanisms must equally embrace fidelity, flexibility, contextual relevance, and grounding in the reality of everyday primary care practice as necessary elements for successful translational funding requests. The National Institutes of Health should also support the creation and adoption of new metrics and methods appropriate for testing and evaluating practice innovation to capture contextual learning.

• Received for publication February 4, 2014.
• Revision received April 16, 2014.
• Accepted for publication April 21, 2014.