# Presentation: 869173

## Understanding Clinician Research Interests in a Primary Care Practice-Based Research Network

- Rebecca Van Vorst, MSPH
- Agency for Healthcare Research and Quality
- PBRN Research Conference
- Bethesda, MD
- May 16, 2007

## Project Collaborators

- Emily Watterworth – MPH Student Intern State University of New York at Albany
- Paul Bachman, MD, MPH
- Kevin Karpowicz, MD, MPH
- Louis Snitkoff, MD, FACP
- Ephraim Back, MD, MPH
- Steven Szebenyi, MD, MMM

## Characterize the Capital-Adirondack PBRN 
Explain why we think its important to understand the research interests of our PBRN members
Describe our process for collecting clinician and staff surveys
Identify the perceived barriers to and motivators of participating in primary care research in our PBRN 

- Explain why we think its important to understand the research interests of our PBRN members
- Describe our process for collecting clinician and staff surveys
- Identify the perceived barriers to and motivators of participating in primary care research in our PBRN

- _Overview_

## The Foundation for Healthy Living mission is to increase and disseminate knowledge about health care and improve the health of our communities.

**Notes:**
Cap-Ad is one of a small number of PBRNs not housed in an academic institution. 
We are administratively housed in the FHL:
501(c)3 public charity; we are not a foundation that has an endowment.
We are a grant seeking health services and research foundation and receive our funding principally through grants and contract work.
The majority of the Foundation’s work is done through collaboration and partnerships.

## May 2007

**Notes:**
Cap-Ad experienced substantial growth since our inception in 2004. We began with 14 practices....

We completed our first study in 2006
and have 2 studies currently in progress.
And several other grants under review 
Recently affiliated with the AAFP NRN 
We are in the process of forming an affiliation with other PBRNs across upstate New York – in what will become the Regional PBRN of New York – that will also be housed in the Foundation for Healthy Living.

## “Clinician cooperation is most 
likely when the research topic is of 
personal interest to the clinician...or 
important to his or her patients.” 

Kutner et al. 2005. Cancer Control.

- likely when the research topic is of
- personal interest to the clinician...or
- important to his or her patients.”
- Kutner et al. 2005. Cancer Control.

**Notes:**
As our network has grown, we’ve recognized that in order to get our clinicians fully invested in any research agenda, we need to have a solid understanding of the research interests and needs of our network clinicians. 

## Implement a PBRN wide survey to:
characterize our PBRN and its members
understand our members’ general areas of research interest
ascertain network members’ perceptions of conducting research in the practices

- characterize our PBRN and its members
- understand our members’ general areas of research interest
- ascertain network members’ perceptions of conducting research in the practices

- _Cap-Ad Practice and Clinician Survey Project_

## Methods

- Created 3 surveys
- Practice, clinician and office personnel
- Sources for surveys:
- Oregon Rural Practice-Based Research Network (ORPRN )
- Pediatric Research in Office Settings (PROS)
- AAFP National Research Network (NRN)
- Primary Care Network Survey (PRINS)
- All surveys included signed cover letter by practice administrator
- Conducted in-person interviews in the practices
- Clinicians and office personnel

**Notes:**
In the interest of time, I am not going to focus on the office personnel surveys today other than mentioning that we did collect this data.

## Practice Survey

- Completed by practice managers
- 27 Questions
- Practice contact information
- Practice demographics
- Patient demographics

##    Clinician Survey – Part A

- Clinician Demographics
- 29 Questions
- Contact information
- Specialty, education
- Scope of medical practice
- Technology utilization
- Current involvement with QI and research projects
- Interest in participating in PBRN activities
- Name “champion” in practice

##    Clinician Survey – Part B

- Areas of Research Interest
- 57 Questions
- Health conditions or related issues
- Service delivery related issues
- System issues
- Asked to rate perceived prevalence of health conditions in primary care practice

## Survey Results* 

- 241 Surveys Completed
- 32 Practice Surveys
- 103 Clinician Surveys (response rate: 25% - 78%)
- 106 Office Personnel Surveys

- *includes only practices that joined before 2007

**Notes:**
I should mention we are still in the process of collecting the surveys from the most recent expansion of the network practices so these data I am going to present are only from those practices that were part of the network through 2006. 

## Practice Surveys

- Types of Practices:
- 77% Family Practice/Multi-Specialty
- 13% Pediatric
- 10% Internal Medicine
- Office visits/wk
- _Average:_ 396 visits/wk (Range: 80-1300 visits)
- Location of practices:
- 52% suburban/urban
- 35% rural
- 13% inner city of an urban area

## Clinician Demographics

- 66% MD/DO; 19% PA; 10% NP; 5% other
- 50% female
- Average age of clinicians: 46 (range: 27-75)
- Years in practice: 14 (range: 1- 43)
- Years at practice site: 8.73 (range: .5 - 43)

## Specialty

## Clinician Activities

## Involvement in QI/Research

- Currently involved in any quality improvement project?
**31% Yes**
- Currently involved in a research project?
**94% No**
- How interested are you in Research?
- 			**4.8  **[1 = none, 10 = very]
- How interested are you in improving the care delivered to your patients?
**9.2  **[1 = none, 10 = very]

## Clinician Interests - Health Conditions

## Clinician Interests – Service Delivery Related Issues

## Clinician Interests – System Research Characteristics

## In-Person Interviews

- 43 Completed
- 	18 Clinicians, 25 Office Personnel
- 	Assessed:
- Current involvement in QI or research projects
- Perceived motivators/barriers to conducting research
- Likelihood of research participation

## Motivators of and barriers to participating in primary care research

- Motivators
- Improve quality of care for OUR patients
- Allow for the sharing of ideas
- Enhance the relevance of studies to practice
- Barriers
- Lack of Time
- Limited Staffing
- Lack of Resources (Money, EMR, etc.)

## Research Incentives 

- Practices want...
- Money
- Food
- Feedback and to be kept informed of results
- “*Feedback is always helpful, whether it be positive *
*	**or negative.  It would allow us to learn more *
*	**about our practice and how to focus on individual problems*.” – Office Manager

## Lessons Learned

- Assessing clinician interests not only provides valuable information as networks look for research projects but it may be a critical motivator in securing clinician participation
- Get active endorsement from practice administration
- Look for additional resources
- Despite everything one hears, clinicians will complete surveys!

**Notes:**
....and is an essential first step to knitting the network together around similar interests

Get active endorsement from practice administration 
Ask medical directors or administrators to provide personalized signed cover letters or to send out introductory emails to their clinicians that explicitly asks them to complete the surveys.

Whenever able, utilize help from med students or student interns to collect the surveys and visit the practices. We used a MPH intern who last summer spent more of her time on the road, visiting practices, conducting interviews and collecting surveys. Emily was able to take a great deal of burden off of us while achieving her own internship goals of learning about the organizational structure of primary care practices.