Era 2. Expansion into Mainstream of Research (1988–1999)
| Events Calling for Something New | Developmental Response |
|---|---|
| Large, nationally important health care issues compelled practice-based research Such health policy issues revealed the need for development and expansion of primary care and research about emerging primary care issues. | Seminal studies were published via ASPN. Examples: Otitis media, HIV seroprevalence, lab errors, depression in primary care ASPN shared its methods widely among regional primary care PBRNs and PBRNs in other specialties and urged the establishment of AHCPR. |
| Balancing what practices and clinicians want with the needs of national research policy questions was seen as key to relevance, independence, financial sustainability and growth. Some funders aligned with PBRN purposes, e.g., Agency for Health Care Policy and Research (AHCPR); now AHRQ with legislative requirements focused on primary care. | ASPN responded to clinicians in practices AND wider national policy questions in a way that clinicians experienced as also locally meaningful. Bring other family medicine research networks into the annual ASPN Convocation to share results and methods, build partnerships, and contemplate new studies. Help lead national PBRN conferences sponsored by the new AHRQ Center for Primary Care Research. |
| Trends in research design and implementation emerged to challenge practice-based research. Addressing more complex clinical and public policy questions required methods not familiar to PBRNs, e.g. group randomized trials. Important questions outnumbered experienced PIs available to PBRNs. | Recruit experienced PIs to become familiar with PBRN practice values and the strengths and constraints inherent in PBRN research |
| Growing financial challenges came with more complex projects and network As ASPN rose to meet new research challenges came increased difficulty sustaining more complex network infrastructure required for more complex projects. Need recognized for alliance with a larger entity capable of ongoing infrastructure support | Overlapping sources of funding established Foundations, NIH, AHCPR, HRSA, CDC grants & contracts provided substantial funds for larger studies. Established indirect cost rates for ASPN and capture as direct research expenses those that could not be funded through indirect cost rates. Partner with the AAFP as the AAFP National Research Network (NRN). |
| At the end of this era: ASPN had deployed a portfolio of research methods matched to different questions and published many studies, including several large ones funded by nationally recognized research organizations, e.g., AHCPR on otitis media, NIMH on Depression Care, CDC on Lab Errors, and AHRQ on Referral in Primary Care. ASPN and many other PBRNs had become an established respected source of new and timely knowledge. Many PBRNs were established as a component of the health and health care research enterprise. AHRQ championed PBRNs and enabled networks to share strategies and methods. ASPN partnered with AAFP and entered Era 3 as the AAFP National Research Network. | |
Abbreviations: PBRN, practice-based research network; ASPN, ambulatory sentinel practice network.