Problem Statement

Although the vast majority of health care is rendered in primary care practices, most research is carried out in subspecialty settings, largely in tertiary care centers. To help alleviate this disparity between research and practice settings, it has been increasingly recommended that “various types of practice laboratories, or centers of excellence” in primary care research be established. To date, efforts to develop a primary care research infrastructure have largely focused on establishing practice-based research networks (PBRNs)—groups of practices that affiliate to carry out practice-relevant research.

The growth of PBRNs has served a valuable role in promoting and carrying out primary care research. However, PBRNs have several limitations. Membership has largely been solicited through personal networks, leading to selection bias and underrepresentation of racial and ethnic minorities in PBRN-sponsored studies. Further, because PBRNs are physician and practice centered, their research has tended to focus more on physicians and physician services (eg, office function, quality of care, and health services research) than on patients and health behavior. Finally, PBRNs have tended to be costly, inefficient, and demanding of participating practitioners, factors that have become particularly problematic in the increasingly stressful primary care environment.

This (project) describes the development of a different type of primary care research laboratory—a cohort of adult patients recruited from a representative sample of primary care offices and maintained for use on mul- tiple projects. The cohort, the North Carolina Health Project (NCHP) research cohort, was developed by faculty of the University of North Carolina (UNC), in collaboration with the North Carolina Academy of Family Physicians, for the purpose of facilitating research on chronic disease and related health care problems commonly addressed in primary care settings. As such, it may represent a new model of primary care research infrastructure development—different from, and complementary to, traditional PBRNs.

(reprinted from Philip D. Sloane, MD, MPH; Leigh Callahan, PhD; Leila Kahwati, MD, MPH; C. Madeline Mitchell, MURP, Development of a Practice-based Patient Cohort for Primary Care Research,(Fam Med 2006;38(1):50-8.) http://nc-e-care.com/NC_FM_RN_Cohort_Development_Paper.pdf