Implementing High-Quality Primary Care Rebuilding the Foundation of Health Care (2021) / Chapter Skim
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10 Enhancing Research in Primary Care
10 Enhancing Research in Primary Care
Pages 333-356
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From page 333... ...
, and lack of research that draws on primary care–specific databases, such as clinical registries, not only adversely affects primary care outcomes but also leads to the lack of a population-based understanding of illness and disease along the health care spectrum. Better PCR support could lead to answers to questions that are critically important for improving population health.
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From page 334... ...
It added that current clinical research may have little to offer to primary care clinicians, lessons from well-done PCR are not available to inform the larger picture of health care organization and delivery, and the paucity of PCR and development leaves primary care insufficiently prepared to confront the challenges and
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From page 335... ...
Recommendation 8.2 National Database and Primary Care Data Set called for a new national health care needs database beyond existing national health surveys. Recommendation 8.3 Research in Practice-Based Primary Care Research Networks called for providing "adequate and stable financial support to practice-based primary care research networks" (p.
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From page 336... ...
and an increasing number of EHRs collect patient-reported outcomes, the nation has opportunities to assimilate large regional and national databases, standardize and normalize these data, and use this information to enhance the understanding of population health and health disparities and the relationship of primary care to both. Tapping EHR and claims data fully for research would meet the 1996 IOM report's data recommendation partway, but doing so fully also requires having better data sources on people who do not seek care.
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From page 337... ...
Study participants mentioned challenges to coordination of HSR and PCR portfolios, including the breadth and volume of research activities across the federal HSR and PCR enterprise, differing research time frames among agencies, and the lack of targeted funding for a lead agency to coordinate PCR in particular. The committee agrees that a separate interagency prioritization process for PCR would ensure that the country's vital needs for primary care 1 Consolidated Appropriations Act of 2018, Public Law 115-141 (March 23, 2018)
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From page 338... ...
• Establish a review process and data systems to proactively identify potential overlaps across agency research portfolios. • Maintain the Agency for Healthcare Research and Quality as an inde pendent agency within HHS to serve as the funded hub of federal HSR to ensure its unique and central role.
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However, most clinical trials exclude people with the comorbid conditions (Fortin et al., 2006) , social and medical complexity (Peek et al., 2009; Ronis et al., 2019)
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are credited on the NIH website (NIH, 2019) for the formation of the Office of Emergency Care Research, which has the important task of working across NIH institutes to identify, coordinate, and support research relevant to emergency medicine.
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From page 341... ...
Primary Care Basic Science Research Questions Many PCR questions can be pursued through categorical funding mechanisms, such as those available through NIH and the HSR tracks at AHRQ. Research questions that use primary care in service of a narrowly focused disease or medical condition question tend to be advantaged over those needed to build primary care delivery knowledge (Slawson et al., 2001)
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From page 342... ...
• How does primary care prioritize care based on a whole-person focus, and how does that affect person and system outcomes? • How can we network the primary care platform to share best evi dence and best practices for prioritizing and managing care during a public health crisis or pandemic?
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From page 343... ...
. The Primary Care and Interventions Unit of the United Kingdom's National Health Service occasionally asks primary care physicians about gaps in research that would help them care for people (Lecky et al., 2020)
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From page 344... ...
A few related NIH programs have been launched to formalize laboratories for implementation science, including NCI's Implementation Science Centers in Cancer Control, but these are not limited to primary care, and many have been established in academic health center systems. The current NIH Roadmap for Medical Research includes two major research laboratories (bench and bedside)
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NIH's investments in CTSA flow through the National Center for Advancing Translational Sciences, dedicated solely to this distributed research mechanism. This model could work nicely for PCR centers or PBRNs.
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From page 346... ...
Primary care practices and even primary care researchers struggle to access existing clinical data, and they have to ask vendors for them. This unacceptable situation is stifling PCR.
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From page 347... ...
The mechanisms are in place, but without a particular preference for primary care and the limited hubs for PCR, the pipeline for primary care researchers will remain small and lacking in significant and sustained investment. Other countries have successfully organized research around primary care, and the United States often relies on their research.
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From page 348... ...
Evidence-based guidelines ignore the complexity of primary care, and the unintended consequences of focusing quality improvement only on narrowly defined evidence are profound. The neglect of basic PCR, and lack of research that draws on primary care–specific databases, such as clinical registries, not only adversely affects primary care outcomes but also leads to the lack of a population-based understanding of illness and disease along the health care spectrum.
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From page 349... ...
2004. Mixed methods studies: A foundation for primary care research.
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2010. Linking practice based research networks and clinical and translational science awards: New oppor tunities for community engagement by academic health centers.
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strategies related to health center patients' social determinants of health. Journal of the American Board of Family Practice 30(4)
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2015. Health information technology needs help from primary care research ers.
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2020b. Investing in the future of health care: A strategic assessment of federally funded health services research and primary care research.
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Washington, DC: Robert Graham Center and Agency for Healthcare Research and Quality. Phillips, R
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1996. A framework for primary care research.
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2019. Practice-based research networks: Strategic opportunities to advance implementation research for health equity.
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