PCR069: The development of practice-based research network in North America in 1978 to 1994: a historical literature review

Yang Wang, PhD; Zhijie Xu, MD; Yanli Xu, MD, PhD; Jianjun Han, MPH, MBA, FCSMEA-CGP

Abstract

Context: Building a practice-based research network (PBRN) is crucial for developing the primary care discipline. Its historical principles and models constitute essential references for building new PBRNs in countries and regions with underdeveloped primary care systems.
Objective: To systematically collect and organize historical information about the organization, purpose, research approach, data collection, funding, and key experiences regarding PBRNs in North America between 1978 to 1994.
Study Design: Literature review.
Dataset: Publications searched from the PBRN Literature database, PubMed/MEDLINE, EMBASE, Web of Science, Cochrane library, Google scholar.
Publications studied: Of 284 identified historical publications, 103 were included. These were published by peer-reviewed journals (articles) or reputable institutions (grey literature), and are full texts or abstracts. Non-original studies should introduce PBRNs’ organization, purpose, research approach, data collection, funding, and key experiences. Original studies should be conducted by PBRNs based on data sharing and inter-institutional cooperation across clinics.
Results: PBRNs were supported by family medicine or related academies and institutions. They generally have approximately 50-300 members (managers, researchers, liaison officers, and clinical practitioners). Their aims include developing primary care knowledge, supporting academic family physicians, and improving primary care practice. Their research explored primary care services, patients, and physicians mainly using cross-sectional designs and stably or temporarily collected data from multiple clinics. Their funding requirements included research funds (government, private foundations, companies), maintenance budgets (academies, academic institutions), and data collection costs (family physicians). Favorable conditions are sufficient initial funding, rigorous co-design by experienced principal investigators and family physicians, a culture of equality, unity, and communication, and low burden on clinicians.
Conclusions: Building PBRN in an underdeveloped primary care system requires academies and research institutions’ support, unity-centered organizational structures, the common aim of developing primary care knowledge, service and practitioners, a practice-based research question, rigorous co-design, reliable data collection methods with light burden on clinicians, and sufficient maintenance funds in the early stages.
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Jack Westfall
jwestfall@aafp.org 11/20/2021

terrific study on the early years of PBRNs. thanks for this research and presentation. hope we might connect. thanks

Yang Wang
wy475574395@gmail.com 11/20/2021

Dear Dr. Westfall, thank you for your encouragement and recognition, which makes me very excited. Primary care research in China has just started. It faces obstacles similar to those of the United States in 1980-1990, but in a different context. After many attempts and failures, we realized that this is a systematic issue, and solving this issue may require the efforts of a decade and a generation of researchers. The original PBRN design may contain the essential and precious spirit of primary care discipline, and achieved the integretion of humanities and science. It can also be the seed of primary care research in China. My colleagues and I are currently working on the second phase of this research and hope to report it on NAPCRG in 2022.

Diane Harper
harperdi@med.umich.edu 11/21/2021

I truly appreciate the international perspective that you bring to this conference! You have the opportunity to truly build from ground up the community based influence of making a community healthier with their PCPs- despite any political miscommunications.

Yang Wang
wy475574395@gmail.com 12/1/2021

Dear Dr. Harper: I sincerely thank you for your encouragement. Primary care industry and disciplines are developing in China-although difficult, but developing. I believe the common spirit of health care practitioners and researchers can beyond politics, nation, and race. The improvement of community health in China will be realized by this, and next generation of Chinese primary care practitioners and researchers. We are trying to do some positive work for it. It is hard, but we need to do. Thanks again.

Gillian Bartlett
gillian.bartlett@health.missouri.edu 11/23/2021

This is extremely helpful work as many centers are at these early stages for PBRNs - even in the US and Canada - we still have many underdeveloped primary care systems. Are you planning to translate your full paper to English? Also, will you consider in your future work the difference between PBRN's and practice based learning networks (more of a ongoing loop between research and practice)? Thank you for sharing this work.

Yang Wang
wy475574395@gmail.com 12/1/2021

Dear Dr. Barlett: Thank you for your recognition and encouragement. This paper is the knowledge which we gained from the first stage of our research program. In stage two (expected to be completed in June 2022), we will conduct a bibliometric analysis and scoping review of primary care research generated by PBRN from 1990 to 2020. We plan to publish it in English. I will send the paper to you at that time. In fact, almost at the same time as my research, a very excellent paper with similar topic was published on JABFM. I hope to recommend Dr. Dania's work to you. I think it may be better than our work. Its link is: https://www.jabfm.org/content/34/4/762 The aim of our work is to support the develop of PBRNs in China. According to our discussion with some local researchers and managers, by the differences in the system and context between primary care in China and North America, PBRNs in China in the future which may appear in local form: although the purpose is same(developing primary care research and improving primary care practice for patients), but its structure and process may be modified. Exploring this issue may be the focus of our work in stage three.

Andy Pasternak
avpiv711@sbcglobal.net 11/26/2021

Cool study, especially since I'm working with our university at starting a PBRN

Yang Wang
wy475574395@gmail.com 12/1/2021

Dear Dr. Pasternak: Thank you for your encouragement. Building a PBRN may be more complex than completing a research, and it also has more practical value.

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