THE CHALLENGE TO BUILD RESEARCH CAPACITY IN FAMILY MEDICINE: IS OUR DISCIPLINE READY?

Research in family medicine is critical to the success of our discipline. Research enables improved patient outcomes, more informed health policy, more effective education and training strategies, and enhanced academic credibility. As health care reform is implemented in the United States, there is an increased need to investigate translational opportunities to improve patient health and safety at reduced costs. A strong research foundation is needed for our future. Is family medicine ready for this challenge? The answer is as yet unclear.

To begin with, there is no ongoing comprehensive assessment of family medicine’s research capacity. This limits strategic planning to grow research for the discipline and develop and train researchers to support the increasing needs of robust primary care. Different attempts to monitor family medicine’s research capacity have been published, but these efforts have been individual, one-time efforts focused on publications and grants.^1–3 Metrics by which research capacity should be measured and monitored needs to be better defined and ongoing assessments should be regularly maintained.

Some of the limited or indirect measurements of our research capability have been worrisome:

• The Development of the NIH Roadmap and the Clinical and Translational Science Awards (CTSA) generated opportunities for some departments of family medicine.⁴ An update from a year ago showed that roughly one-third of all funded CTSAs have family medicine faculty in leadership positions.⁴ The authors noted that while this is good for a few, the majority of family medicine departments do not have substantive involvement in a CTSA. This may be due to medical schools not having a CTSA or that the institutional CTSA commitment to community engaged research is not linked to their family medicine departments.

• Lucan, et al concluded, after a thorough investigation of family medicine’s involvement in NIH that

...departments of family medicine and family physicians in particular, receive a miniscule proportion of NIH grant funding and have correspondingly minimal representation on standing NIH advisory committees. Family medicine’s engagement at the NIH remains near historic lows, undermining family medicine’s potential for translating medical knowledge into community practice, and advancing knowledge to improve health care and health for the US population as a whole.⁵

Not all the blame falls on NIH, however: family medicine researchers submit very few grants, compared with other disciplines. Additionally, NIH Research Project Grant tracking data shows that since 2006 the number of family medicine grants submitted to NIH has declined.

• ADFM assessed research capacity in a survey of departments of family medicine conducted Dec 2009–Jan 2010 with 92 department chairs responding. Departments of family medicine have significant variability in research capacity, with many having no researchers, and few departments having greater than 10 research full time equivalents. Roughly one-third of departments reported no faculty participating on grant review panels and another third had only 1 to 2 faculty members participating on panels.

However, there may be opportunities to improve our research capacity:

• Expansion of the Agency for Healthcare Research and Quality (AHRQ) funding: AHRQ has a responsibility to support research that can improve health care quality, access and patient safety while reducing costs. The FY 2010 appropriation total for AHRQ totaled $397 million, an almost 7% increase over the total requested by the President. In addition to FY 2009 appropriations, AHRQ received $700 million to conduct comparative effectiveness research (CER) in the 2009 American Recovery and Reinvestment Act. CER is a useful tool to support clinical decision-making and improve health care quality, but family medicine researchers must become experienced investigators in this methodology to compete for funding.

• New source of federal funding for patient-centered outcomes research: HR 3590, the Patient Protection and Affordable Care Act establishes a non-profit corporation known as the Patient Centered Outcomes Research Institute administered by a governing board composed of the directors of AHRQ and NIH along with appointed stakeholders. This Institute would identify research priorities, establish research project agendas, and study how health problems can be studied, monitored, treated, and managed. The Institute would be funded through a patient-centered outcomes research institute trust fund with funds available without appropriation.

Another opportunity for building research capacity is to combine resources and work together. In the above mentioned ADFM survey, 91% of departments of family medicine indicated they would support collaborative clinical research. This is perhaps our greatest resource—the possibility of creating significant research through our pooled clinical communities to investigate strategies for improved patient care. While our readiness remains to be documented, our enthusiasm for the new opportunities on the horizon seems ripe for collaborative engagement.

This Annals commentary was prepared by the Chair of the ADFM Research Development Committee and members of the Executive Committee with review by the full Executive Committee.