Infrastructure building for primary care research in safety net institutions

Background: A strong primary care system that provides evidence-based, patient-centered care is critical to the US health care system. Safety net providers require a robust base of research to achieve their potential as high performing systems of care. This is especially true following the implementation of the Affordable Care Act and the transformation of primary care systems to medical homes and accountable care organizations. Yet community health centers and public hospitals have typically been less involved in research due to lack of “in house” investigators, lack of structures for collaboration with outside investigators, and inadequate research management infrastructure. Methods; To correct this deficiency, members of the community engagement initiative at Harvard's Clinical and Translational Science Award (CTSA) used a participatory approach to build capacity for primary care research at a safety net hospital Cambridge Health Alliance (CHA). This public health integrated system provides primary care to a diverse and largely disadvantaged population in urban communities surrounding Boston. CHA physicians and representatives were involved in every aspect of the work. The components of the intervention included a provider survey, administrator interviews, the development of physician champions, and provider community meetings. Results: The survey of 72 primary care physicians found that 66% of providers were interested in research, but most lacked research skills and time to engage in these activities. Physician champions representing the three primary care specialties (medicine, pediatrics, family medicine) successfully initiated research collaborations and served as departmental resources. A plan for improved data access was developed and an educational series for providers on primary care research was initiated (e.g. differences between quality improvement and research, use of the electronic medical record for research purposes, qualitative methods). The important domains critical for research infrastructure included priority setting that ties research endeavors to institutional mission, leadership/organizational support, needs assessment of clinical staff, linking interested clinicians with experienced researchers, developing new ways to utilize electronic health information, and making research methods training available. Conclusion: Partnerships between CTSAs and safety net institutions can help enhance research infrastructure in safety net settings. A strong research capacity has the potential to bridge the gaps between research and practice for traditionally underserved patients in the US.