Provider-Based Research Networks (PBRNs)

Provider-based research networks (PBRNs) are collaborative partnerships between academically based investigators and community-based physicians who share an ongoing commitment to developing and conducting health-related research. PBRNs provide the infrastructure and support necessary to conduct community-based clinical research studies on an ongoing basis, thus providing stability and continuity that transcends individual studies. PBRNs address many shortcomings of academic medical centers-only research and present several distinct advantages to it; most notably, these entities provide access to a much larger population of prospective clinical research trial participants.

Clinical research trials are the means by which medical researchers explore and answer specific questions about health. Clinical trials, translational research, epidemiological research, health services research, and several other categories are included in the broader definition of clinical research.

Academic medical centers (AMCs) have long been the centers of clinical research, the development of new knowledge, and the transfer of that knowledge to the next generation of researchers and care providers. There, teams of investigators develop research questions and methods for examining them and also carry out the research through voluntary enrollment of study subjects who are often patients at the centers. Having AMCs as the center of the clinical research universe has many advantages, including the presence of both clinical and research infrastructure and the synergy that can be developed among academics, researchers, and clinicians; but it also has several limitations.

In 1961, one of the founders of health services research in the United States, Kerr L. White, presented a statistical estimate with far-reaching implications for both medical education and population-based clinical research: For every 1,000 adults at risk of being ill or using health services in a given month, only one will be referred to an AMC. While the precision of this estimate has been debated and patterns of care may have shifted since 1961, the implications remain relevant today. If this estimate is accurate, although the overwhelming [Page 968]majority of clinical research is conducted in AMCs, less than 1% of the relevant population is being seen at AMCs, and only a small subset of these individuals is enrolling in clinical research trials. A tremendous risk of selection bias exists then, jeopardizing the external validity of the majority of clinical research. Furthermore, limiting clinical research access to only AMCs induces a bottleneck in completing clinical research studies, consequently slowing the pace of medical progress.

In 2006, a contract research organization, Westat, completed and published the Inventory and Evaluation of Clinical Research Networks: A Complete Project Report, a comprehensive worldwide study of clinical research networks. This report identified 262 PBRNs with a variety of funding sources and organizational structures, and spanning multiple types of research and subject populations. The majority of these networks are less than 10 years old; however, others have been in existence for 50 years. Currently, 62% of these networks are funded by the federal government. Another 10% are funded by nonprofit organizations, 9% are funded by a government outside the United States, and 8% are funded by academia. Approximately 60% receive funding from more than one source; 52% report operations in the United States only, while 32% report operations in the United States and internationally, and 16% report exclusively international operations. Universities and AMCs continue to play a dominant role in many networks, while other network members span the healthcare spectrum and include the following: state and federal government healthcare facilities, community hospitals, individual or group physician practices, clinical laboratories, pharmaceutical companies, foundations, contract research organizations, and health maintenance organizations (HMOs).

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