Practice-based research networks: laboratories for improving colorectal cancer screening in primary care practice.

persistently high percentage of Americans 50 years of age or older who have not been screened for colorectal cancer (CRC) despite convincing evidence that screening can reduce CRC-associated morbidity and mortality brings into sharp focus both the need for, and challenge of, translating research into practice. The gap between research and practice, although not unique to the delivery of CRC screening services, has been attributed to a number of interacting factors including limited time and resources of practitioners1 and inadequate systems to support evidence-based practices.2 Another reason offered for the slow and incomplete translation of research findings into practice is the lack of well-designed effectiveness research demonstrating how interventions aimed at improving service delivery can be best implemented under real-world conditions.3 All too often, the evaluation of an intervention aimed at improving the uptake of evidence-based care takes the form of a traditional clinical efficacy trial conducted on a highly selected cohort of patients and clinicians, and most often in an academic medical center where less than 1% of Americans visiting physicians receive their health care.4 Such studies typically exclude individuals whose care is most challenging, such as patients with multiple medical conditions or those least likely to be adherent with recommended treatment or preventive measures. They also tend to examine patient and clinician behavior under controlled situations thus precluding any systematic consideration of the patient's everyday environment or the demanding schedules and economic and other pressures faced increasingly by practices. According to Glasgow, success in translating research into practice requires that interventions be investigated in multiple settings representative of those for which the intervention is intended, and that more attention be paid to issues of external validity, including moderating factors that potentially limit the robustness of the intervention. Since the 1990s, both the National Institutes of Health (NIH) and the Agency for Healthcare Research and Quality (AHRQ) have offered systematic support for establishing or facilitating the growth and development of practice-based research networks (PBRNs). A major purpose of this support is to move the research enterprise beyond academic medical centers and into a variety of community-based practices, where everyday care takes place. In addition to serving as laboratories for studying the care of common conditions, these networks are ideal sites for the type of translation-related effectiveness studies Glasgow recommends. This article will focus on 2 types of PBRNs currently active in the United States those composed mostly of smaller independent primary care practices and those composed of large integrated health systems and will consider the types of research questions related to CRC screening that have been, or could be, addressed in the networks, as well as the research approaches the networks have taken to evaluate methods of improving CRC screening practices across the United States.