Most of us get our health care from a doctor’s office or a clinic, not a hospital. Whether it’s primary care or a specialty, such as cardiology, ophthalmology or pediatrics, these practices deliver what’s known as ambulatory care.
There are at least 6,000 ambulatory care practices in New Jersey, according to the U.S. Centers for Medicaid and Medicare Services. Yet, they are underrepresented in the broader health care ecosystem. New Jersey has the second highest per capita income in the country, yet the 2020 America’s Health Rankings suggest the state ranks 41st in income inequity, 44th in access to primary care providers, 45th in flu vaccination coverage, 44th in drug-related deaths and has one of the lowest rankings for health disparities.
Physician practices here and across the country deserve to have a seat – and a voice – at the table to obtain access to the latest evidence and innovations that can allow them to operate more efficiently, evaluate and improve the quality of patient care and ultimately, the health of patients and the community in New Jersey.
A local practice-based research network (PBRN) is one solution to amplifying clinical practices and improving population health. A PBRN brings together practices focused on digging into the questions and challenges they face in improving quality of care, efficiency and community engagement, and links them with experienced research scientists who can help. Practice-based research moves health care research from academic settings into the real world.
Last year, COVID-19 forced practices in New Jersey and much of the country to temporarily shut down, but it didn’t eliminate patients’ needs. High-risk patients with complex conditions like diabetes, often need to come in for routine tests and prescription refills. Kids need to stay up to date on vaccination schedules. Expectant mothers need consistent prenatal care. Almost overnight, practices had to figure out how to continue providing safe and high-quality care and ensure that no one fell through the gaps.
To patients of some practices, the scramble to re-optimize the office workflows and transition to solutions like telehealth appeared seamless, even if it was not. What did the practices do that allowed them to respond so quickly?
They followed the research. But practices shouldn’t have to do this on their own – particularly during a public health emergency like a pandemic.
Many of the operational changes made at practices in the wake of COVID-19 were real-life applications of evidence learned from research and conversations with fellow health care professionals. We have a lot to learn about what these applications and changes mean going forward for practices, and patients, and furthermore, what they mean to communities across New Jersey.
A PBRN can offer the resources and opportunities needed to identify and investigate health care questions that are relevant and meaningful to practices. The creation of a PBRN also signifies that there is ongoing commitment and investment in activities and infrastructure that transcends a single research project. PBRNs can further provide physicians with continuing education and medical students and residents with training opportunities.
The concept of a PBRN is not new – dating back over 30 years – and continues to play an instrumental part in learning about health care best practices, as well as the implementation and dissemination of science into practice settings. At present, there are about 185 PBRNs across the United States, whose practices are serving over 100 million patients, according to the U.S. Agency for Healthcare Research and Quality.
Now more than ever, we have so many opportunities to conduct research with practices. Studying the ways in which practices responded to the pandemic can help us prepare not only for future public health emergencies but also for implementations of health care innovations and policy changes. For example, many practices independently stood-up their telehealth systems in a matter of days and developed their own educational materials to teach patients how to use web portals.
Additionally, many community health centers, also known as Federally Qualified Health Centers, are known for using team-based care models that bring behavioral health and primary care providers into the same room during visits to address both physical and mental wellness. With telehealth and social distancing, community health centers had to innovate to sustain a version of this model.
These practices and others can further leverage research through membership in a PBRN and amplify their efforts to improve care quality for their patients. PBRNs also have allowed practices and researchers to focus on specific initiatives, such as increasing linguistically and culturally competent services for diverse populations and improving care for vulnerable patients in their communities.
By participating in studies made possible by PBRNs, clinical practices have been able to improve their patients’ outcomes, such as better cardiovascular disease measures, greater colorectal cancer screening rates in a rural population, and increased smoking cessation among vulnerable populations.
The Rutgers Institute for Health, Health Care Policy and Aging Research has started to lay the groundwork for a New Jersey Practice-Based Research Network (NJ PBRN), open and free to all physician practices in New Jersey, and will kick off with the Institute’s fourth Catalyst Symposium to be held virtually on June 3-4, 2021.
The timing and the mission could not be more critical to increase the presence of New Jersey physician practices in academic research, bringing them to the table to improve population health and equity for all New Jerseyans.
Dr. XinQi Dong, is director of the Rutgers Institute for Health, Health Care Policy and Aging Research and the inaugural Henry Rutgers Distinguished Professor of Population Health Science. He is a population health epidemiologist and geriatrician. Ann Nguyen, is director of the New Jersey Practice-Based Research Network at the Rutgers Institute for Health, Health Care Policy and Aging Research. She is an assistant research professor and implementation scientist at the Rutgers Center for State Health Policy.