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Research ArticleSpecial Communications

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

Timothy S. Carey, Jacqueline R. Halladay, Katrina E. Donahue and Samuel Cykert
The Journal of the American Board of Family Medicine September 2015, 28 (5) 658-662; DOI: https://doi.org/10.3122/jabfm.2015.05.140353
Timothy S. Carey
From the Cecil G Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC (TSC, JRH, KED, SC); the Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill (TSC, SC); the Department of Family Medicine, University of North Carolina, Chapel Hill (JRH, KED); and the North Carolina Area Health Education Centers, Chapel Hill (SC).
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Jacqueline R. Halladay
From the Cecil G Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC (TSC, JRH, KED, SC); the Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill (TSC, SC); the Department of Family Medicine, University of North Carolina, Chapel Hill (JRH, KED); and the North Carolina Area Health Education Centers, Chapel Hill (SC).
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Katrina E. Donahue
From the Cecil G Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC (TSC, JRH, KED, SC); the Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill (TSC, SC); the Department of Family Medicine, University of North Carolina, Chapel Hill (JRH, KED); and the North Carolina Area Health Education Centers, Chapel Hill (SC).
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Samuel Cykert
From the Cecil G Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC (TSC, JRH, KED, SC); the Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill (TSC, SC); the Department of Family Medicine, University of North Carolina, Chapel Hill (JRH, KED); and the North Carolina Area Health Education Centers, Chapel Hill (SC).
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    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 SupportsIDS Challenges for ResearchPBRN Solutions and Strategies
    Provides consistent administrative policies for research participation across practicesPresence 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 outputBuild grant budget justification to compensate practice expenses incurred
    Build in CME, maintenance of certification
    Priorities may support a philosophy of rapid dissemination and implementationPractices 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 wholePackage 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 projectsEngage 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 dataEngage 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 researchHarmonize diagnostic, test, treatment, and utilization variables and codes across IDSs, including community health centers
    Fragmentation of safety net clinic PBRNs as unique entities that are not included in studies that include other practice typesStandardization 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 CDWEnsure 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 fashionBudget 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 enhancementsMay be reactive to external forces, may inhibit innovative solutionsCan 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.

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The Journal of the American Board of Family     Medicine: 28 (5)
The Journal of the American Board of Family Medicine
Vol. 28, Issue 5
September-October 2015
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Practice-based Research Networks (PBRNs) in the Era of Integrated Delivery Systems
Timothy S. Carey, Jacqueline R. Halladay, Katrina E. Donahue, Samuel Cykert
The Journal of the American Board of Family Medicine Sep 2015, 28 (5) 658-662; DOI: 10.3122/jabfm.2015.05.140353

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Practice-based Research Networks (PBRNs) in the Era of Integrated Delivery Systems
Timothy S. Carey, Jacqueline R. Halladay, Katrina E. Donahue, Samuel Cykert
The Journal of the American Board of Family Medicine Sep 2015, 28 (5) 658-662; DOI: 10.3122/jabfm.2015.05.140353
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