PBRNs are Back, Baby!

On June 16, 2024, Starfield VI Summit, supported by NAPCRG, brought together 50 practice-based research network (PBRN) leaders and government officials to imagine how PBRNs can generate relevant new knowledge to advance health in the current moment of challenge and opportunity.

New Opportunities

Using an appreciative inquiry approach, participants celebrated the substantial contributions of PBRNs to moving research from the ivory tower to the settings where most people get most of their care most of the time. The conference identified ripe new opportunities that have the potential to rejuvenate PBRNs as a source of new knowledge that is relevant to patients and the primary care practices that serve them. These opportunities include:

• The NIH Director is investing $30 million to advance the ability of rural Americans to participate in NIH research, and sees PBRNs as the way to make this happen.¹ The American Diabetes Association recently hired longtime PBRN leader Kevin Peterson as their VP for Primary Care and is investing in PBRN research, supporting DARTNet Institute to engage PBRNs.² AHRQ, which always has tried to do a lot with a little to support PBRNs, has been on a listening tour and is developing learning modules to support PBRNs.³

• National Institute of General Medical Sciences is supporting the Clinical & Translational Research Networks and is requiring these networks to have a PBRN.^4,5 PCORI’s requirement of real stakeholder engagement and Community Engaged Research framework and their substantial funding provide opportunities for PBRNs that are increasingly recognized.⁶

Top-Down AND Bottom-Up

This moment of opportunity comes on the heels of substantial challenges in practice autonomy, administrative burden, infrastructure support, and workforce. These challenges have made PBRNs an increasingly top-down enterprise, with decision making held in the hands of funders and academic partners. This imbalance of top-down leadership and power has strangled the most vital aspects of PBRNs⁷—the wisdom of those on the frontlines of caring for people in primary care, and their commitment to advocate for them.⁸ The Starfield VI Summit recognized that successful PBRNs have both top-down and bottom-up leadership.⁹ For this current moment of opportunity to be successful, PBRNs need to increase support for clinicians and practices to lead the generation of knowledge that is relevant to the needs of the patients and communities they serve.

Reinforcing the Foundation

We have an opportunity to think beyond cultivating individual pathways for research career development. We can and must optimize infrastructure that can be tapped into or built to meet the needs of primary care research, engage the potential of the breadth of primary care practices across the United States, and bolster PBRNs with educated and engaged membership. This moment calls for initiatives to address local capacity needs with regional or discipline-wide solutions, PBRN training for practice teams, and raising awareness about how to participate in PBRN research.

Leadership From Primary Care Organizations

If this moment of opportunity is to yield the hoped-for gains in new knowledge to support improved health care, equity, health, and primary care’s vital contribution, then primary care organizations, particularly those in family medicine, must take on the mantle of leadership to bring their experience with PBRN “living laboratories” to inform new investment in PBRNs.¹⁰ To realize the potential of PBRNs, many networks will need to step up their data and research infrastructure. It is critical that primary care practice-based research networks be more than recruitment sites for centrally controlled clinical trials. They are sources of the wisdom of what matters most for caring for whole people in the context of their families and communities. That wisdom must be supported if PBRNs are to be successful.