| Focus Group Themes | Current WREN Approaches | Future Opportunities |
|---|---|---|
| I. Receptivity | ||
| To research in general | ∙ WREN members are solicited for involvement in research projects and surveys throughout the year. ∙ Nonsystematic results are provided to participating clinics during and after the project. | ∙ Provide overviews of WREN and its research portfolio onsite at clinics throughout the state. ∙ Ensure principal investigators provide systematic and timely feedback of results to clinics. |
| To WREN | WREN retains 5 clinics under contract that receive funding for a 20% FTE research support person at each site* made possible by University of Wisconsin Clinical & Translational Science Award funding through the NIH.† Other clinics are compensated from specific grant funds. | ∙ Improve relationships between WREN and health system administrators. ∙ Ensure that WREN is not a stranger to clinics when a research opportunity arises. |
| To specific projects | Identify potential project sites via existing membership database and personal knowledge. | Survey nonmember clinics for research interests and capabilities. |
| II. Outcomes as a result of participation | ||
| Improved clinical care (eg, disease management, patient encounters) and system changes within the clinic (eg, developed process workflow) | Anecdotal surveys/focus groups of WREN members to assess impact. | More systematic post-project interviews to document sustainability and spread; may be nested within funded dissemination and implementation research. |
| Increased knowledge/awareness about: | ||
| Care management and research | ∙ Nonsystematic feedback of project results to clinics. ∙ Monthly WREN e-newsletter. | ∙ Systematic and rapid turnaround of results for every project. ∙ Provision of project results during on-site WREN overviews. |
| Other clinics and networking | Highlight clinic accomplishments in WREN e-newsletter and at annual convocation. | Develop WREN PBR participant mentoring program, where existing clinic participants are paired with new ones. |
| III. Barriers | ||
| Competing priorities | Nonsystematic personal contacts with health system administrators and research directors to identify areas where PBR can provide enhanced implementation and/or rigorous program evaluation for health system clinical initiatives. | ∙ Systematic evaluation of health system–based needs that PBR projects could inform. ∙ Meet with system administrators, managers, and staff in project planning stage to learn competing priorities at all levels. |
| Time | ∙ Work with principal investigators to ensure WREN projects avoid requiring clinic staff to be “research personnel,” eg, WREN staff, rather than clinic staff, perform patient consent processes (in person and remotely), data collection, and follow-up. ∙ Perform clinician and staff project education using short, repeated, validated, E-mailed educational “snippets” (“spaced education”) that can be accessed at convenient times. | ∙ Make sure system administrators and managers are supportive of time requirements, and that staff know their time is protected. ∙ Prospectively identify low-burden, high-impact projects for PBR. |
| System limitations | Prospectively identify the details of project participation so the clinic staff and administrators are fully informed of project expectations. | ∙ Prospectively develop projects aligned with system priorities so PBR can assist clinic operations to rigorously assess the impact of health system initiatives to provide added value. ∙ Negotiate with clinic physicians, staff, managers, and system administrators regarding implementation process, and obtain (written) assurances that administrators and managers support the project's processes and methods. ∙ Develop formal arrangements with several integrated health systems on how best to propose and permit PBR. |
| Project implementation challenges | ∙ Prospectively identify the details of project participation so the clinic staff and administrators are fully informed of project expectations. ∙ Perform site visits and practice facilitation. | Be a meaningful partner in project initiation conversations—even for multisite projects—to ensure there are no surprises at the start of project implementation. |
| IV. Facilitators | ||
| Support from research coordinator | WREN staff perform all project-related procedures (consenting, data collection, etc.) for most projects. | ∙ Utilize more EHR-based outcome measures that unburden both clinic and research staff from data collection. ∙ Perform research to validate and to incorporate into usual care a variety of patient-reported outcome measures that (1) improve care and (2) can be used to assess outcomes for pragmatic trials. |
| Additional incentives | ∙ Recognize participating clinics at annual meeting and via e-newsletters. ∙ Provide certificates of participation to clinics to display onsite. ∙ Provide CME credits for physicians. | ∙ Provide template press releases to clinics regarding PBR participation and project outcomes. ∙ Educational credits for staff. ∙ Emphasize recertification for physicians. |
| Clinic staff | WREN RRCs develop ongoing collegial relationships with clinic staff. | Prospectively identify clinic managers and health system administrators, and develop collegial relationships with them. |
| V. Advice to researchers | ||
| Project development/early planning | Open statements (online) to researchers that the best time to consult WREN is during formulation of the research question; the worst time to approach WREN is 2 weeks before the grant is due. | ∙ Prospectively seek out collaborations with researchers to promote the concept that PBR is a venue in which to perform patient-oriented research. ∙ Build in incentives integral to project design, eg, maintenance of certification, meaningful use, and alignment with medical home initiatives. |
| Communication | ||
| Before project (eg, clear timeline and project expectations) | ∙ Prospectively identify the details of project participation so the clinic staff and administrators are fully informed of project expectations. ∙ Identify any challenges to project initiation that need to be overcome. | ∙ Negotiate with clinic administrators, managers, and staff regarding the method of implementing project protocols. ∙ Schedule “talk back” teleconferences with participating sites before project initiation so they can elucidate their understanding of what they will be doing and how. Encourage group teleconferences so sites can learn from each other. |
| During the project (eg, check-ins) | WREN RRCs provide ongoing feedback through practice facilitation and informal E-mail and telephone conversations. | Develop specific protocols for communication during and after practice facilitation activities. |
| Following the project (eg, offer feedback and dissemination of results) | ∙ Nonsystematic feedback of results to participating clinics. ∙ Publication of project results in the WREN monthly e-newsletter. | ∙ Personal phone calls to clinic managers to relay information on the project results and the anticipated impact of incorporating the results into clinic activities. ∙ In-person meetings. |
| Get to know the clinic | ∙ WREN RRCs visit clinics on an as-needed basis depending on project requirements. ∙ WREN director and program manager selectively visit clinics and visit with CEOs, medical directors, clinicians and staff. | ∙ Hold in-person meetings at the clinics to learn about what is important to the physicians and staff who work there, the issues they are facing that affect their current work, and how they think they can work with WREN on developing a protocol for an individual project. ∙ Provide overviews of WREN and its research portfolio onsite at clinics throughout the state. |
↵* See http://www.fammed.wisc.edu/research/wren/about for details on the “Full Support Clinic” model.
↵† The “Community-Academic Partnership” program of the University of Wisconsin Institute for Clinical and Translational Research (ICTR).
CME, continuing medical education; EHR, electronic health record; FTE, full-time equivalent; NIH, National Institutes of Health; PBR, practice-based research; RRC, regional research coordinator; WREN, Wisconsin Research and Education Network.