Talk to the Veterans Crisis Line now
U.S. flag
An official website of the United States government

Health Services Research & Development

Veterans Crisis Line Badge
Go to the ORD website
Go to the QUERI website

SHP 08-157 – HSR&D Study

New | Current | Completed | DRA | DRE | Portfolios/Projects | Centers | Career Development Projects

SHP 08-157
A Practice-Based Research Network for Clinical Micro-System Research
Michael L. Parchman MD MPH BA
South Texas Health Care System, San Antonio, TX
San Antonio, TX
Funding Period: April 2008 - September 2008

BACKGROUND/RATIONALE:
A PBRN is an organization comprised of full-time primary care clinicians and researchers, united by a shared commitment to generating new knowledge that will improve care and patient outcomes through studies conducted within their primary care clinical micro-system setting. PBRNs are the "laboratory" for primary care clinical micro-system research. By using the practical, collective wisdom and clinical experience of practicing clinicians to examine common problems seen in primary care, quality and outcomes of patient care can be improved. VA primary care outpatient clinics (OPCs) are a type of clinical micro-system: a small group of people who work together on a regular basis to provide care to discrete subpopulations of patients with common clinical and business aims, linked processes, a shared information environment and produces performance outcomes. This project will combine the strengths of a cadre of experienced health services researchers at the VERDICT REAP with the experience of full time primary care clinicians in VA staffed outpatient clinics in order to take the first step in creating such a laboratory for clinical micro-system research.

OBJECTIVE(S):
A Practice-Based Research Network (PBRN) is an organization comprised of full-time primary care clinicians and researchers, united by a shared commitment to generating new knowledge that will improve care and patient outcomes through studies conducted within their primary care clinical micro-system setting. The goal of this short term research project was to develop a Practice Based Research Network in South Texas comprised of clinicians from the 8 primary care VA staffed non-contract OPCs. This is the first step toward establish a VA-based primary care "Practice-Based Research Network" (PBRN) in VISN 17. The specific aims over the 6 month project period were to: (1) Recruit 8 VA primary care OPCs in the South Texas Veterans Health Care System to form a PBRN. (2) Conduct an in-depth assessment of each of the 8 VA primary care OPC and prepare a report for each clinic. (3) Administer a Delphi Survey of clinicians concerning their priorities for clinical micro-system research that will culminate in a PBRN convocation. (4) Hold a one day PBRN convocation at the Audie Murphy VAMC for PBRN members.

METHODS:
These aims would be accomplished by: (1) Recruiting the 8 VA primary care OPCs in the South Texas Veterans Health Care System to form a PBRN. (2) Conducting a one-week in-depth assessment of each of the 8 VA primary care OPC and prepare a report for each clinic. (3) Administering a Delphi Survey of clinicians concerning their priorities for clinical micro-system research that will culminate in a PBRN convocation. (4) Hold a one day PBRN convocation at the Audie Murphy VAMC for PBRN members.

FINDINGS/RESULTS:
Specific Aim #1: The medical directors of all 8 VA staffed primary care clinics were contacted and agreed to participate. All 8 medical directors attended the PBRN convocation and are currently providing feedback concerning the design of the first PBRN research study.
Specific Aim #2: An in-depth assessment of the performance and structure of each of the 8 VA primary care OPCs was performed.
Specific Aim #3: A two round Delphi survey of a representative group of clinicians in each of the 8 VA primary care OPCs was completed. A total of 25 clinicians participated with an average of 3 per clinic. The top three areas for research priorities of the PBRN were: (1) The relationship between clinical reminders in CPRS and the patient's perception that their needs are being met. (2) The impact of new "walk-in" policy on meeting needs of scheduled patients. (3) Patient's health literacy and expectations for care.
Specific Aim #4: A two hour convocation of members of the PBRN was held in Corpus Christi Texas on September 17, 2008 during the Annual Primary Care Service Line meeting. Medical directors from all 8 clinics were present along with additional clinicians and Administrative Officers from each of the 8 clinics.. Results of the Delphi survey were presented and discussed. Participants voted on the priority of research items and agreed on the above listed order for future research projects.

IMPACT:
The development of regional Practice-Based Research Networks (PBRN) across the VA would greatly benefit the research efforts of the VA HSR&D. A practice-based research network is a collaborative platform allowing clinicians to examine health care questions within their own practices and on their own patients. By engaging the physicians throughout the entire research process, findings are generalizable and more readily implemented into practice. Funding the development of regional VA PBRNs as part of the research infrastructure in the VA would afford great opportunities for more rapid translation of research findings into practice and serve as an "incubator" for research studies that are relevant to improving outcomes of care for veterans.

PUBLICATIONS:

VA Cyberseminars

  1. Parchman ML, Gerngross P, DeNucci D. Practice-Based Research Networks in VHA: Supporting collaboration to accelerate improvement. QUERI Implementation Practice Seminar. [Cyberseminar]. 2009 Jul 30.
Conference Presentations

  1. Parchman ML. The Practice Based Research Network at the VA (PBRN-VA) Mental Health Initiative. Poster session presented at: VA Implementing a Public Health Model for Meeting the Mental Health Needs of Veterans Annual Mental Health Conference; 2010 Jul 27; Baltimore, MD.


DRA: Health Systems
DRE: none
Keywords: none
MeSH Terms: none

Questions about the HSR&D website? Email the Web Team.

Any health information on this website is strictly for informational purposes and is not intended as medical advice. It should not be used to diagnose or treat any condition.