History of PBRNs

The enormous potential of practice-based research networks (PBRNs) to expand the knowledge base of primary care and to integrate research into practice (and practice into research) was recognized in the United States more than 25 years ago. Beginning with the development of early regional PBRNs in the late 1970s,^1,2 the feasibility of conducting research in networks of primary care practices was quickly established. Throughout the 1980s and early 1990s, a steady stream of research reports from local, regional, and national practice networks then began appearing in the medical literature as the enterprise slowly grew and spread.

A few years later, the Agency for Healthcare Research and Quality (AHRQ) responded by releasing the first of a series of grant solicitations specifically targeting primary care PBRNs. From 2000 to 2004, AHRQ has made awards to primary care PBRNs totaling more than $8 million. Although the individual awards have been modest, the number and diversity of networks applying for these funds have been remarkable. The 45 networks that have to date received AHRQ funding for infrastructure support and pilot projects include among their members more than 10,000 primary care clinicians who care for more than 10 million Americans. In addition, in 2002 the agency invested in the establishment (through a contract with Indiana University and the National Opinion Research Center) of a PBRN Resource Center that has been given the task of assessing the developmental needs of AHRQ-funded networks and helping to meet these needs through educational, technical, and consultative services.

During the past decade, the number and diversity of identifiable primary care networks in the United States have increased dramatically. A brief communication published in 1994 reported that 28 primary care PBRNs were active at that time in North America.⁴ Most of these networks consisted predominantly, if not entirely, of family physician practices. By 2004, a national survey (conducted by the PBRN Resource Center) identified 111 networks in the United States that met certain established criteria for being an active primary care PBRN.⁵ The survey revealed that multiple types of practitioners, including pediatricians, general internists, and advanced practice nurses (in addition to family physicians), are represented in these networks, which are headquartered in 44 states. The data also indicated that a large number of these networks first emerged after 2000, when the seed money and other support offered to PBRNs by AHRQ first became available.