A practice-based research network (PBRN) is a group of practices devoted principally to the care of patients and affiliated for the purpose of examining the health care processes that occur in practices. PBRNs are characterized by an organizational framework that transcends a single practice or study. They provide a "laboratory" for studying broad populations of patients and care providers in community-based settings.[1]
History of primary care research
Before there were research institutes or networks of practices, individual practitioners studied their patients' problems with scientific rigor. Among these were five general practitioners who have been recognized for their seminal work during the past 125 years. They are James Mackenzie, Will Pickles, John Fry, F.J.A. Huygen and Curtis G. Hames. Each of these pioneers demonstrated that important new knowledge could be discovered by practicing family physicians. More recently, practicing primary care pediatricians such as Burtis Breese and William Carey contributed a body of knowledge on child health. These doctors all wondered about their patients' problems and they developed a means of gathering and recording data on their patients.
Each of these research pioneers provide inspiration for the development of practice-based, primary care research networks because each demonstrated that important new knowledge could be discovered by the practicing primary care physician. They each wondered about their patients, developed means of gathering and recording data, and found collaborators and support from their staff and local communities. Unfortunately, they practiced in an era that was over-committed to specialism. Research focused on molecular mechanisms of disease. The rush to specialization by the medical community and the linking of research to specialists resulted in decades of neglect of primary care and virtually no recognition of the need to investigate care in the primary care setting.
Instead, the common wisdom viewed primary care practices as relatively boring places that could be potential sites of application of the fruits of research done elsewhere in research laboratories, hospitals and institutes.[1]
Among the early regional networks started in the 1970s were the Dartmouth CO-OP PBRN in New Hampshire,[2] Family Medicine Information System in Colorado (FMIS)[3] and the Cooperative Information Project.[4] These regional networks learned from each other and succeeded in conducting studies focused on what was happening in primary care. They attracted funding from medical schools, national philanthropic foundations and federal programs such as Health for Underserved Rural Areas. As the 1970s closed, these early networks enjoyed sufficient success to stimulate debate about the next steps in the context of the microcomputer's development. Among them was a small group convened by Gene Farley in Denver in 1978 to consider establishing a national sentinel practice system. It was this idea that lead to the Ambulatory Sentinel Practice Network and provided in retrospect what appears to have been a nidus for the establishment of primary care PBRNs in the United States. In the 1980s, pediatric research networks - the Pediatric Practice Research Group (PPRG)[5] in metropolitan Chicago and the national Pediatric Research in Office Settings (PROS) network[6] of the American Academy of Pediatrics - emerged as well.
PBRNs are feasible and that represent a useful infrastructure for the scientific discovery of family practice and primary care. Experience to date points out the great advantages enjoyed by those with enduring, core financial support—such as the Dutch with their early national commitment to primary care and their willingness to invest in primary care research. It is also obvious that these networks require collaboration, cooperation and a spirit of sharing and trust.
These networks are now at once both a place and a concept. As a place, they are a laboratory for surveillance and research. As a concept, they express the still unmet need for practicing primary care clinicians to accept responsibility to improve frontline clinical care by understanding what is happening in their practices. Successes to date have been sufficient to incite the Institute of Medicine's 1994 committee studying the future of primary care to recommend support to stabilize and expand practice-based primary care research networks.[7]
Currently active
AAFP NRN – AAFP National Research Network Kansas
AANPNR – American Academy of Nurse Practitioners Network for Research Texas
ACCESSPBRN – ACCESSPBRN Illinois
ACCP PBRN – American College of Clinical Pharmacy Practice-Based Research Network Kansas
ACERN – Ambulatory Care Evaluation and Research Network New York
ACORN – Virginia Ambulatory Care Outcomes Research Network Virginia
ACPNet – ACPNet Pennsylvania
APBRN – Alabama Practice Based Research Network Alabama
A-PBRN - Ayurveda Practice Based Research Network United Kingdom
APN-ARC – Advanced Practice Nurse-Ambulatory Research Consortium Ohio
APPD LEARN – Association of Pediatric Program Directors Longitudinal Educational Assessment Research Network Virginia
ARCHNAP St. Louis Ambulatory Care Research Consortium for Nurses in Advanced Practice Missouri
AT-PBRN – Athletic Training Practice-Based Research Network Arizona
^Green, LA (1978). "A family medicine information system: the beginning of a network for practicing and residency family physicians". Journal of Family Practice. 7 (3): 567–76.
^Nelson, EC (1981). "The cooperative information project, part 1: a sentinel prac – tice network for service and research in primary care". Journal of Family Practice. 13 (5): 641–9.