Practice-based Research Networks (PBRNs) in the Era of Integrated Delivery Systems

Timothy S. Carey; Jacqueline R. Halladay; Katrina E. Donahue; Samuel Cykert

doi:10.3122/jabfm.2015.05.140353

Article Figures & Data

Tables

View popup

Table 1. Challenges and Potential Solutions to Practice-Based Research Network Research Missions in the Changed Practice Environment of Integrated Delivery Systems and Electronic Health Records

Activity IDS Supports	IDS Challenges for Research	PBRN Solutions and Strategies
Provides consistent administrative policies for research participation across practices	Presence of an additional bureaucratic layer that requires negotiation (eg, need for subcontracts vs simple invoicing)	Develop standard governance agreements to share data across systems (eg, business agreements)
Clinical initiatives can align with practice-based research questions (eg, meaningful use, patient-centered home certification, maintenance of certification)	Practice interest is lessened because of pressure from the IDS to maximize their clinical output	Build grant budget justification to compensate practice expenses incurred Build in CME, maintenance of certification
Priorities may support a philosophy of rapid dissemination and implementation	Practices at the IDS geographic periphery suffer neglect regarding system integration, support of usual services, and administrative consideration of projects not related to the system as a whole	Package research with practice support services (eg, EHR support, patient education, mHealth, practice facilitation, purchase and maintenance of data mapping/ harmonization products)
Increased interest in research from the IDS through the lens of a “learning health care organization”	Adjacent IDSs may compete with each other for clinical market share; this competition could potentially have the unintended effect of reducing collaboration on research projects	Engage patients and other stakeholders with the idea of existing in a continuously learning health system and how all may benefit from this approach
	IDSs may be in direct competition with PBRNs; may not see the worth of PBRN work when they are already connected and have data	Engage providers and staff in publications, presentations, and pursuit of better outcomes for patients based on sound science Initially avoid topics that might be “hot buttons” for administrators Look for win–win grants and contracts that require collaboration with multiple systems; PBRNs bring a primary care focus and insight, and IDSs bring a hospital focus
EHR and data warehouse
Allows data collection and analysis consistency.	Reduced presence of safety net practices, since community health centers may not be part of the IDS and use a different EMR; this risks reducing the presence of participants with low socioeconomic status and minorities in research	Harmonize diagnostic, test, treatment, and utilization variables and codes across IDSs, including community health centers
Allows data collection and analysis consistency.	Fragmentation of safety net clinic PBRNs as unique entities that are not included in studies that include other practice types	Standardization of interoperability methods (data transfer among EHR systems) across IDSs
Provides an additional research tool for recruitment and quality improvement interventions.	Limited staff availability, even with funding, to program EMR modifications or extract data from CDW	Ensure the ability of commercial EHRs to provide prompts to enroll patients in studies, as well as adjust the care process through order sets and targeted and evidence-based educational materials
	Lack of responsiveness to providing requested data in a timely fashion	Budget programmer time for all projects
		Joint governance of data warehouse by care delivery and academic components of IDS
Consistent roll out of quality improvement and regulatory practice enhancements	May be reactive to external forces, may inhibit innovative solutions	Can test novel interventions in practices that are early adopters External grant funds may partially support such innovation.

CDW, clinical data warehouse; EHR, electronic health record; EMR, electronic medical record; IDS, integrated delivery system; PBRN, practice-based research network.