Thomas Paul, Graffy Jonathan, Wallace Paul, Kirby Mike
Centre for Study of Policy and Practice in Health and Social Care, Thames Valley University, Westel House, London, England.
Ann Fam Med. 2006 May-Jun;4(3):235-9. doi: 10.1370/afm.521.
Theory of effective network operation in primary care is underdeveloped. This study aimed to identify how primary care networks can best integrate academic and service initiatives.
We performed a comparative case study of 4 primary care research networks in North London, England, for the years 1998-2002. Indicators were selected to assess changes in (1) research capacity, (2) multidisciplinary collaboration, and (3) research productivity. We compared the profiles of network outcome with descriptions of their contexts and organizational types from a previous evaluation.
Together, the networks supported 133 viable projects and 30 others; 399 practitioners, managers, and academics participated in the research teams. How the networks organized themselves was influenced by the circumstances in which they were formed. Different ways of organizing were associated with different outcome profiles. Shared projects and learning spaces helped participants to develop trusted relationships. A top-down, hierarchical approach based on institutional alliances and academic expertise attracted more funding and appeared to be stable. The bottom-up, individualistic network with research practices was good at reflecting on practical primary care concerns. Whole-system methods brought together stakeholder contributions from all parts of the system.
Networks can help integrate academic research and service development initiatives by facilitating interorganizational interactions and in shared leadership of projects. Researchers and practitioners stand to gain considerably from an integrated approach in both the short and the long term. Success requires agreement about a set of pathways, learning spaces, and feedback mechanisms to harness the insights and efforts of stakeholders throughout the whole system.
基层医疗中有效网络运营的理论尚不完善。本研究旨在确定基层医疗网络如何能最佳地整合学术和服务举措。
我们对1998 - 2002年期间英国伦敦北部的4个基层医疗研究网络进行了比较案例研究。选择指标来评估（1）研究能力、（2）多学科协作和（3）研究生产力的变化。我们将网络成果概况与先前评估中对其背景和组织类型的描述进行了比较。
这些网络共支持了133个可行项目及另外30个项目；399名从业者、管理人员和学者参与了研究团队。网络的组织方式受到其形成时环境的影响。不同的组织方式与不同的成果概况相关联。共享项目和学习空间有助于参与者建立信任关系。基于机构联盟和学术专业知识的自上而下的层级方法吸引了更多资金且似乎较为稳定。自下而上的、具有研究实践的个体化网络善于反思基层医疗的实际问题。全系统方法整合了系统各部分利益相关者的贡献。
网络可通过促进组织间互动和项目的共同领导来帮助整合学术研究和服务发展举措。研究人员和从业者无论从短期还是长期来看，都有望从整合方法中大幅受益。成功需要就一套途径、学习空间和反馈机制达成共识，以利用整个系统中利益相关者的见解和努力。
