A practice-based research network (PBRN) is a group of practices devoted principally to the care of patients and affiliated for the purpose of examining the health care processes that occur in practices. PBRNs are characterized by an organizational framework that transcends a single practice or study. They provide a "laboratory" for studying broad populations of patients and care providers in community-based settings. [1]
Before there were research institutes or networks of practices, individual practitioners studied their patients' problems with scientific rigor. Among these were five general practitioners who have been recognized for their seminal work during the past 125 years. They are James Mackenzie, Will Pickles, John Fry, F.J.A. Huygen and Curtis G. Hames. Each of these pioneers demonstrated that important new knowledge could be discovered by practicing family physicians. More recently, practicing primary care pediatricians such as Burtis Breese and William Carey contributed a body of knowledge on child health. These doctors all wondered about their patients' problems and they developed a means of gathering and recording data on their patients.
Each of these research pioneers provide inspiration for the development of practice-based, primary care research networks because each demonstrated that important new knowledge could be discovered by the practicing primary care physician. They each wondered about their patients, developed means of gathering and recording data, and found collaborators and support from their staff and local communities. Unfortunately, they practiced in an era that was over-committed to specialism. Research focused on molecular mechanisms of disease. The rush to specialization by the medical community and the linking of research to specialists resulted in decades of neglect of primary care and virtually no recognition of the need to investigate care in the primary care setting. Instead, the common wisdom viewed primary care practices as relatively boring places that could be potential sites of application of the fruits of research done elsewhere in research laboratories, hospitals and institutes. [1]
Among the early regional networks started in the 1970s were the Dartmouth CO-OP PBRN in New Hampshire, [2] Family Medicine Information System in Colorado (FMIS) [3] and the Cooperative Information Project. [4] These regional networks learned from each other and succeeded in conducting studies focused on what was happening in primary care. They attracted funding from medical schools, national philanthropic foundations and federal programs such as Health for Underserved Rural Areas. As the 1970s closed, these early networks enjoyed sufficient success to stimulate debate about the next steps in the context of the microcomputer's development. Among them was a small group convened by Gene Farley in Denver in 1978 to consider establishing a national sentinel practice system. It was this idea that lead to the Ambulatory Sentinel Practice Network and provided in retrospect what appears to have been a nidus for the establishment of primary care PBRNs in the United States. In the 1980s, pediatric research networks - the Pediatric Practice Research Group (PPRG) [5] in metropolitan Chicago and the national Pediatric Research in Office Settings (PROS) network [6] of the American Academy of Pediatrics - emerged as well.
PBRNs are feasible and that represent a useful infrastructure for the scientific discovery of family practice and primary care. Experience to date points out the great advantages enjoyed by those with enduring, core financial support—such as the Dutch with their early national commitment to primary care and their willingness to invest in primary care research. It is also obvious that these networks require collaboration, cooperation and a spirit of sharing and trust.
These networks are now at once both a place and a concept. As a place, they are a laboratory for surveillance and research. As a concept, they express the still unmet need for practicing primary care clinicians to accept responsibility to improve frontline clinical care by understanding what is happening in their practices. Successes to date have been sufficient to incite the Institute of Medicine's 1994 committee studying the future of primary care to recommend support to stabilize and expand practice-based primary care research networks. [7]
The Medical University of South Carolina (MUSC) is a public medical school in Charleston, South Carolina. It opened in 1824 as a small private college aimed at training physicians and has since established hospitals and medical facilities across the state. It is one of the oldest continually operating schools of medicine in the United States and the oldest in the Deep South.
The University of North Texas Health Science Center is a public academic health science center in Fort Worth, Texas. It is part of the University of North Texas System and was founded in 1966 as the Texas College of Osteopathic Medicine, with its first cohort admitted in 1970. UNT Health Science Center consists of six schools with a total enrollment of 2,329 students (2020–21).
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SUNY Downstate Medical Center is a public medical school and hospital in Brooklyn, New York. It is the southernmost member of the State University of New York (SUNY) system and the only academic medical center for health education, research, and patient care serving Brooklyn's 2.5 million residents. As of Fall 2018, it had a total student body of 1,846 and approximately 8,000 faculty and staff.
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Adolescent medicine also known as adolescent and young adult medicine is a medical subspecialty that focuses on care of patients who are in the adolescent period of development. This period begins at puberty and lasts until growth has stopped, at which time adulthood begins. Typically, patients in this age range will be in the last years of middle school up until college graduation. In developed nations, the psychosocial period of adolescence is extended both by an earlier start, as the onset of puberty begins earlier, and a later end, as patients require more years of education or training before they reach economic independence from their parents.
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An academic medical centre (AMC), variously also known as academic health science centre, academic health science system, or academic health science partnership, is an educational and healthcare institute formed by the grouping of a health professional school with an affiliated teaching hospital or hospital network.
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