Lindbloom Erik J, Ewigman Bernard G, Hickner John M
University of Missouri-Columbia, Columbia, Missouri 65212, USA.
Med Care. 2004 Apr;42(4 Suppl):III45-9.
Medical research has traditionally been based in academic centers, and the findings are frequently not applicable in community primary care settings. The result is a large gap between the possible and the practical in delivering high-quality primary medical care in the United States. Practice-based research networks (PBRNs), laboratories for primary care clinical research, are the appropriate vehicles for uniting the worlds of community primary care practice and clinical research. Although they have received little attention in the mainstream of clinical and health services research, PBRNs have already reported a variety of findings useful for primary care providers, and these networks have helped to identify key issues in healthcare delivery that affect important outcomes. In this report, we outline the rationale for and history of PBRNs. We describe the organization and work of several productive PBRNs, giving examples of their studies that have changed the standards of modern primary care practice. Finally, we describe a developing electronic process for identifying research questions obtained directly from primary care providers that can be used to focus the national primary care research agenda on questions of clinical relevance and importance. As electronic technologies are fully developed and tested, they will facilitate communication between clinicians and researchers, thereby improving the effectiveness and efficiency of practice-based research.
传统上，医学研究以学术中心为基础，其研究结果往往不适用于社区初级保健环境。结果是，在美国提供高质量初级医疗服务方面，可能做到的与实际可行的之间存在巨大差距。基于实践的研究网络（PBRNs）作为初级保健临床研究的实验室，是连接社区初级保健实践和临床研究领域的合适载体。尽管PBRNs在临床和卫生服务研究主流中很少受到关注，但它们已经报告了各种对初级保健提供者有用的研究结果，并且这些网络有助于识别影响重要结果的医疗服务提供中的关键问题。在本报告中，我们概述了PBRNs的基本原理和历史。我们描述了几个富有成效的PBRNs的组织和工作情况，并举例说明它们那些改变了现代初级保健实践标准的研究。最后，我们描述了一个正在发展的电子流程，用于识别直接来自初级保健提供者的研究问题，这些问题可用于将国家初级保健研究议程聚焦于具有临床相关性和重要性的问题上。随着电子技术得到充分开发和测试，它们将促进临床医生和研究人员之间的交流，从而提高基于实践的研究的有效性和效率。
