Promoting Research in Practice Settings

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While major scientific advances have occurred in recent decades in the biomedical sciences and medical therapeutics, these advances have not been fully realized when considering patient outcomes in community practice settings. As part of the National Institutes of Health Roadmap program, initiatives have been designed to improve the access of patients to clinical research at the point of primary care, increase the ethnic and racial diversity of patients in studies, and enhance the translation of research findings into practice (Zerhouni, 2005). These goals are consistent with the construct of community-based participatory research (CBPR), as well as the work of practice-based research networks (PBRNs).

The underlying principles of CBPR delineate that the approach to health research should include fostering a mutually beneficial partnership between communities and researchers (Williams, Shelley, & Sussman, 2009). Specifically, these principles create the benchmarks that community partnership is a key element of the entire research process; that results of research should be actively shared with the community; and that research should be considered part of an overall long-term commitment to the community. This approach helps to ensure that research priorities align with community needs, that research methods are culturally acceptable and relevant, and that clinical tools emanating from research are culturally appropriate and linguistically accurate. PBRNs that incorporate the principles of CBPR can effectively serve as an interface between researchers, community providers, and health care consumers.

The PBRN movement began in the 1980s as a mechanism for health care practices to affiliate, explore, and study clinical problems common across practice sites. With the added involvement of health research scientists from academic settings, such partnerships have contributed to the practice-relevant research literature and have provided mechanisms to promote the translation of research findings into practice. Founded in 2000 by Dr. Margaret Grey, former president of the National Association of Pediatric Nurse Practitioners and current Dean of the Yale School of Nursing, the Advanced Practice Registered Nurse Research Network (APRNet) was one of the original 19 PBRNs funded by the Agency for Healthcare Research and Quality, and it was the first funded network developed and run entirely by nurses (Deshefy-Longhi, Swartz, & Grey, 2002). APRNet members conducted computerized data management and practice evaluation projects, research of special relevance to minority and/or underserved populations, and projects translating research into practice. APRNet also conducted clinically relevant research studies in settings that are directly informed by the work of nurse practitioners.

Pediatric Research in Office Settings (PROS) is the PBRN that was established by the American Academy of Pediatrics in 1986 (http://www.aap.org/pros/why.htm). Nurse practitioners are included in the PROS membership. Among the many research studies that PROS has conducted in pediatric primary care practice settings are projects on management of childhood asthma, evaluation of the febrile infant, and smoking cessation for adolescents.

The bi-directional process of integrating the roles of practice networks in clinical research and facilitating the dissemination of current research findings into practice is challenging. Some of the barriers to conducting research in practice settings include lack of available time, training, and access to needed resources. Yet many practitioners wish to be involved in these types of activities as a means of establishing effective collaborative relationships with academic colleagues and participating in the generation of new knowledge that will promote evidence-based practice. For practitioners, PBRNs offer the opportunity to actively participate in research with academic colleagues, generate questions that emanate from day-to-day practice, and receive preliminary reports of research findings and quality improvement initiatives to incorporate into practice. In research publications, participating practitioners are usually acknowledged and sometimes have the opportunity to co-author.

If this type of work appeals to you, whether you consider yourself an academic who needs a better connection with community practices or a practitioner who wishes to be involved in projects beyond direct patient care (or you are somewhere in the middle), there may be a PBRN near you! You can check out the registry at the PBRN Resource Center (http://pbrn.ahrq.gov) or take a look at PROS. By better merging the interests and expertise of clinicians and researchers within a broad community context, we will take major steps toward improving patient outcomes.

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References 

1. Deshefy-Longhi T, Swartz M, Grey M. Establishing a practice-based research network of advanced practice registered nurses in Southern New England. Nursing Outlook. 2002;50:127–131
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2. Williams R, Shelley B, Sussman A. The marriage of community-based participatory research and practice-based research networks: Can it work? A Research Involving Outpatient Settings Network (RIOS Net) study. Journal of the American Board of Family Medicine. 2009;22:428–435
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3. Zerhouni EA. Translational and clinical science-time for a new vision. New England Journal of Medicine. 2005;353:1621–1623
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