2003 Practice-Based Research Network (PBRN) Small Research Grants
Primary care practice-based research networks (PBRNs) are groups of primary care clinicians and practices working together to answer community-based health care questions and translate research findings into practice. In 2003, the Agency for Healthcare Research and Quality (AHRQ) awarded small research grants totaling more than $750,000 to eight PBRNs.
The Agency for Healthcare Research and Quality (AHRQ) solicited proposals in early 2003 for the fourth round in a series of grant awards targeted to Primary Care Practice-Based Research Networks. The program called for exploratory/pilot projects or feasibility studies intended to facilitate future, large-scale research. AHRQ was interested specifically in projects focused on:
- Methods of translating research into practice.
- Innovative uses of information technology in primary care practices.
- The feasibility of implementing electronic health records and assessing their impact on safety, quality, and effectiveness of care.
- Optimal methods for delivering preventive services.
- Methods for improving detection and response to emerging public health threats.
- Strategies for reducing health care disparities in priority populations.
Eight PBRN organizations, described in detail below, received grants of $100,000 each for their research investigations.
Small Grant Recipients
Network: Brigham and Women's Primary Care Practice-Based Research Network (BWPC-PBRN)
Principal Investigator: David Bates, M.D., M.Sc.
Project Number: HS014420
Summary: The purpose of the project, "Trial to Reduce Antibiotic Use in a Primary Care PBRN," was to develop and test an electronic health record-based application for the care of patients with acute respiratory infections. The investigators developed an initial prototype for a "smart form" that was found in usability testing to have impressive functionality and the potential to save time and aid physicians in avoiding inappropriate antibiotic prescribing. The effectiveness of the application was tested in a randomized controlled trial involving 16 clinicians during the 2005-2006 cold and influenza season.
- Linder JA, Bates DW, Williams DH, et al. Acute infections in primary care: accuracy of electronic diagnoses and electronic antibiotic prescribing. J Am Med Inform Assoc 2006;13(1):61-6.
Network: Great lakes Research Into practice Network of Michigan (GRIN)
Principal Investigator: Donald Nease, M.D.
Project Number: HS014413
Summary: The project, "Infrastructure for Translational Research in a Practice-Based Research Network," was intended to prepare the GRIN network for larger translational trials focused on the impact of a special computerized reminder system (CRS). Detailed on-site structural and functional assessments of infrastructure and clinical/staff attitudes were undertaken in network practices, in preparation for trials using CRS. Investigators are developing an action plan tailored specifically for each practice, in which the steps necessary to make the practice ready for participation in larger translational trials will be described.
Network: Iowa Research Network (IRENE)
Principal Investigator: Arthur J. Hartz, M.D., Ph.D.
Project Number: HS14410
Summary: Investigators with the project, "Computerized Interviews to Assist Secondary Prevention," have developed and pilot tested a new information technology based on patient-guided tablet computers that gathers and summarizes information within practices about the self-care behaviors of patients with diabetes. Patient responses to a questionnaire gathered electronically in the waiting room are being compared to those responses collected from a paper document. The questionnaires assess diabetes-related health behaviors—especially those related to the secondary prevention of complications—barriers to such behaviors, and support available to the patient. The computer program then summarizes the questionnaire inputs and identifies those issues that the clinician should discuss further with the patient during their visit. The technology will be tested in rural Iowa practice settings.
Network: Minnesota Academy of Family Practice Research Network (MAFPRN)
Principal Investigator: Barbara Yawn, M.D.
Project Number: HS14476
Summary: Severity assessments are the basis for most asthma treatment recommendations, and widespread confusion related to assessment scoring is an apparent barrier to the ability of primary care clinicians to adhere consistently to treatment guidelines. Investigators with the project, "Developing an Asthma APGAR," have developed an asthma severity rating instrument (Asthma APGAR) and have tested its face validity with a group of clinicians. The project is testing the feasibility of the instrument and its use by rural family physicians for the routine care of asthmatics. Qualitative methods are being used to assess the tool's potential for widespread use.
Network: Pediatric Practice Research Group (PPRG)
Principal Investigator: Adolfo Ariza, M.D.
Project Number: HS14431
Summary: The purpose of the project, "Piloting Tools to Improve Nutritional Health in Primary Care," was to implement in clinical practice and assess a new computerized system (Health Indicators Analyzer [HIA]) designed to improve growth interpretation and nutritional counseling in pediatric practices. In practices where the HIA was implemented, physicians perceived that its use improved the ability of parents and children to recognize overweight/obesity conditions. Visit time spent discussing growth increased significantly when the HIA was used. However, the percentage of parents very satisfied with the growth information they received decreased significantly following the HIA implementation.
Network: Pediatric Research in Office Settings (PROS)
Principal Investigator: Jonathan Klein, M.D.
Project Number: HS14418
Summary: "Smoking Cessation in Pediatric Practice" was a pilot study to test the feasibility of implementing a smoking cessation intervention in adolescent primary care settings. Pediatricians enrolled in the study were offered adolescent smoking cessation training materials via a Web site or in the form of paper documents. Clinician training in brief counseling interventions using the 5A Model (Ask, Advise, Assess, Assist, Arrange) included participation in standardized patient role play and assessments based on focus groups, in-depth interviews, and surveys. Approximately 50 percent of the pediatricians who completed the training were successful in implementing the 5As screening and counseling intervention in their practices. Paper training materials were preferred by the physicians over the Web-based materials.
Network: Southern Primary-care Urban Research Network (SPUR-Net)
Principal Investigator: Grace Kuo, Pharm.D., M.P.H.
Project Number: HS14406
Summary: The purpose of the study, "The Effect of EMR on Medication Safety," was to study the extent to which an electronic medical record (EMR) with computerized provider order entry and a clinical decision-support system affected the frequency, type, severity, and preventability of medication errors, compared to primary care settings using a paper medical record. The cross-sectional study assessed mediation errors in two network clinics that used an EMR, and in another two that used a paper medical record. The EMR appeared to help prevent certain types of medication errors (e.g., documentation or monitoring errors), while creating other types of medication errors (prescribing errors due to missing information or errors in spelling). The EMR also was associated with increased medication counseling in primary care clinics.
Network: Wisconsin Research Network (WREN)
Principal Investigator: Jonathan Temte, M.D., Ph.D.
Project Number: HS14417
Summary: The goal of the project, "Bioterrorism and Influenza Surveillance Network," was to explore the creation and function of a network of primary care clinicians conducting drop-in surveillance protocols appropriate for a bioterrorist attack or an emerging infectious disease. The efficiency of recruiting clinicians for surveillance work from the PBRN was compared with recruitment from a statewide academy of family physicians. Inexpensive, Web-based reporting and communication tools for bi-directional communication were developed and their use was compared across the clinician groups. Clinicians affiliated with a PBRN had significantly higher recruiting efficiencies and were six times easier to recruit for surveillance activities. Once recruited, however, high system compliance rates were observed in both clinician groups, with few differences noted.
Current as of May 2006
2003 Practice-Based Research Network (PBRN) Small Research Grants. May 2006. Agency for Healthcare Research and Quality, Rockville, M.D. http://www.ahrq.gov/research/pbrn/pbrn2003.htm