Era 1. Launching a Brave New Idea (1978–1988)
| Events Calling for Something New | Developmental Response |
|---|---|
| Mismatch between research and real-world needs A drive to investigate and define optimal care for patients seen in community practice and how it might differ from guidelines promulgated by academic centers. | A few leaders with words for the problem, local experience, a new idea, and a starter plan ASPN proposed in 1978; endorsed by NAPCRG in 1979 |
| National doubts about the feasibility of gathering scattered, independent practices into a research enterprise PC practices not seen as places with research skills, questions, or answers. “Research starts with questions, not networks”; “Practicing docs won’t do research.” | Pull together practices already successfully doing research Initiate a binational network with operations supported by enthusiastic volunteerism and in-kind efforts. Publish early studies pertinent to frontline practice, with evaluations of data completeness and accuracy. |
| PBRN research about primary care was not appreciated by most medical journals. Most editors didn’t view primary care practice as a source of important questions and answers. | Face to face visits with editors of journals to show PBRN purposes and capacities Publish in an expanding set of appreciative journals. |
| No playbook for how to establish and operate a PBRN Little preexisting body of “how-tos” for running a network and studies. Processes and policies not clarified or institutionalized. | Develop PBRN policies and procedures Criteria and processes were developed for developing studies, governance and decision-making, data14 requirements and protections, publication procedures, communication channels. Share widely with other PBRNs and learn from other PBRN’s experience. |
| Pressing need for early financial support to complement the energetic volunteerism Funding for the PBRN itself—to maintain the network and collaboration as well as project-specific funds With bridge funding when primary funding suddenly went away | Embed network in existing departments of family medicine and NAPCRG while obtaining foundation funding When primary funding stopped, FM organizations insisted practices continue as ASPN and together with health-oriented foundations, funded development and early projects, building network expenses into project budgets. Practices and their network champions enthusiastically continued network membership and studies. |
| The opportunity to take a developmental step toward challenging studies of societal importance. The need to show success with well-funded timely important findings to pressing issues; demonstrate practice capacity to do research | Obtain peer-reviewed research funding for large, challenging studies. Diversify funding from other sources, such as a cooperative agreement with the Centers for Disease Control (CDC) to determine the seroprevalence of human immune deficiency virus in frontline practice. |
| At the end of this era: ASPN was a viable, committed network of US/Canada family physicians and practices dedicated to asking and answering questions about “health problems experienced by most of the people most of the time.” Proof of concept led to larger and more diversified funding for more challenging studies and expand into the mainstream of research. ASPN was poised for growth. | |
Abbreviations: PBRN, practice-based research network; ASPN, ambulatory sentinel practice network.