Practice-based Research Networks at the Crossroads of Research Translation

摘要

id="p1">Practice-based research networks (PBRNs) are “experimental farms” for research that matters in clinical practice. One of the defining characteristics of PBRNs is their ability to operate across a wide range of the bidirectional “pipeline of research translation,” from clinical trials to informing health care policy. Developing effective translational approaches requires significant experimentation with new or innovatively combined research methods and theoretical frameworks. While the first decades of PBRN research generated a substantial body of evidence for improving individual practices (horizontal movement), PBRNs now find themselves at the multidimensional crossroads of patient-centeredness and community/population health (vertical movement). This practice-based research theme issue of the Journal of the American Board of Family Medicine provides a rich, cross-sectional synopsis of PBRN activities encompassing T2 translation, core practice-based research, implementation and dissemination research, community practice, and contributions to health care policy. id="p-2">Looking through old practice-based research network (PBRN) materials to prepare for a talk at the 20th Anniversary Oklahoma Physicians Resource/Research Network (OKPRN) Convocation this year, I found a promotional CD that we created more than 10 years ago. Remembering some excellent sound-bites, I fast-forwarded to the middle of the recruitment video, and there, among strangely bulky computer monitors, towering stacks of patient charts, and thick PalmPilots, was one of our champion clinicians, Dr. Scott Stewart from Shawnee, Oklahoma, uttering the enduring words that became the guiding principle of our PBRN: “I like working with OKPRN because they do research that matters in my practice.” id="p-3">Scott's clear, instinctive understanding of a PBRN stayed with me and guided me over the years every time I was tempted to look at research only from my academic rolling chair. OKPRN has not been alone on this multidecade journey toward mutual growth from the early “ASPN Days,”id="xref-ref-1-1" class="xref-bibr" href="#ref-1">1 when building an “enduring infrastructure” of primary care research was initiated, against all odds, in the United States. The past 10 to 15 years have seen an amazing and hopeful transformation and maturation of PBRNs in every sense. Small, unrecognized groups of enthusiastic family doctors and researchers working on a “shoestring budget” were gradually joined by well-established, multidisciplinary teams of health professionals from a variety of countries filling large conference rooms. Difficult way-searching on the never-traveled road of practice-based research has been replaced by confident application of systematic and innovative methods that PBRNs created for themselves to reach ever farther and answer ever more difficult but relevant questions. The early lack of support for PBRN research gave way to multimillion-dollar funding opportunities when even the most prestigious academic institutions took notice of PBRNs and the potential of their work. id="p-4">The journey of PBRNs has just started, but this 2014 annual theme issue of the Journal of the American Board of Family Medicine is already a testament to the resiliency, ingenuity, relevance, and substantial impact of PBRNs on “research that matters in practice.” One of the defining characteristics of PBRNs is their ability to operate across a wide range of the bidirectional “pipeline of research translation” (id="xref-fig-1-1" class="xref-fig" href="#F1">Figure 1), from performing clinical trials to informing health care policy. While the historic paradigm of clinical research was usually limited to academic publication of human studies—and translation often meant turning basic science findings into clinical trials (T1 translation)—PBRNs today continually encourage funders, researchers, and end users (clinicians and patients) to open their horizon to at least 4 steps of research translation. T2 research translation converts the results of clinical trials conducted under ideal conditions into interventions that can be tested in “messy” real-world practices and communities. These practices and communities (the heart of PBRNs) can be conceptualized as “experimental farms.” They are “out in the wild” but are specifically prepared to become pioneer testing sites of emerging innovations not entirely ready for full-scale implementation. T3 translation, which can also be viewed as quality improvement, applies systematic methods to move community-based beta tests into general practice through dissemination and implementation (D&I) research. Last, through ongoing interaction between practice and policy, T4 research translation can facilitate the inculcation of state-of-the-art practices into health care policy. Development of effective translational approaches requires significa