The Agency for Healthcare Research and Quality (AHRQ) Practice-Based Research Network (PBRN) Relationship: Delivering on an Opportunity, Challenges, and Future Directions

摘要

id="p1">Practice-based research networks (PBRNs) often lack sufficient funding to develop the underlying infrastructure necessary to conduct high-quality, pragmatic, policy-relevant studies. One mechanism introduced by the Agency for Healthcare Research and Quality (AHRQ) that held the potential to address this issue was the PBRN Master Contract Program. The program allows the AHRQ to fund tightly focused “research activities” and to create a partnership through the PBRN contracts. Although PBRNs expected Master Contracts to strengthen them, several issues limit the utility of these contracts. The funding levels are lower than that provided from other sources for comparable work. Although some Task Order Officers are diligent, responsive, and supportive, too frequently their zeal for specific results and heavy handed approaches have led to significant “scope creep” and unrealistic expectations. Finally, a mechanism to allow PBRNs and network clinicians to influence the direction of the research questions has not been well developed. We see value in a new approach that supports the ability of the AHRQ to (1) garner support from other government agencies to engage PBRNs in studies relevant to policymakers and PBRNs; (2) capitalize on the collaborative nature of PBRNs by developing projects that support collaboration; (3) provide modest funding for infrastructure; (4) avoid the unnecessary and costly regulatory oversight from OMB; and (5) develop sustained “lines of research” on a scale, currently unavailable through the Master Contract, that can meaningfully contribute to the shaping of health policy. id="p-2">The last decade has seen a remarkable growth in primary care practice-based research networks (PBRNs). In the late 1990s, when the Ambulatory Sentinel Practice Network (ASPN)id="xref-ref-1-1" class="xref-bibr" href="#ref-1">1 attempted to form a PBRN collaborative, it could locate 12 potential member networks. By 2008, the Agency for Healthcare Research and Quality (AHRQ) PBRN registry included more than 100 such networks.id="xref-ref-2-1" class="xref-bibr" href="#ref-2">2 Much of this growth can be attributed to support, both financial and intellectual, from the AHRQ. In 1999, the AHRQ began providing infrastructure support to help develop and expand PBRNs. Small infrastructure support grants led to more investigator-initiated research opportunities and the Primary Care-PBRN Master Contract. AHRQ has helped secure additional PBRN support from the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), and from private foundations. Many of the PBRNs represented in this theme issue of the JABFM have received AHRQ support and many of the manuscripts were supported through AHRQ funding. id="p-3">With support from the AHRQ, PBRNs have matured as structures that are ideally suited for health care transformation, dissemination, and implementation research.id="xref-ref-3-1" class="xref-bibr" href="#ref-3">3,id="xref-ref-4-1" class="xref-bibr" href="#ref-4">4 PBRNs are well aligned to expand the knowledge base concerning the redesign of primary care systems to meet the needs of a reformed, high-quality, high-efficiency health care system. For PBRNs to fulfill their potential, the ongoing relationship between the AHRQ and PBRNs must prosper.