Practice-Based Clinical Research Networks to Improve Health Care for Populations That Experience Health Disparities

Council Date: September 10, 2021

Objective

This initiative will support practice-based clinical research networks (PBRNs) to improve health care for populations that experience health disparities. Download full concept paper

Description of Initiative

This initiative will support disease-agnostic PBRNs with a health equity research lens to improve minority health and reduce disparities in care. The PBRNs will be both:

• Comprised of ambulatory primary care settings that serve patients from the NIH-designated United States populations experiencing health disparities (e.g., racial and ethnic minority populations, sexual and gender minority groups, underserved rural populations, and socioeconomically disadvantaged populations).
• Led by clinicians with representation from backgrounds that are underrepresented in health-related sciences on a national basis.

These PBRNs will develop and test disease agnostic interventions and service delivery strategies that are feasible, scalable, and sustainable to improve routine health care services for populations that experience health disparities. By having a rich diversity of patients and clinicians, these PBRNs will be able to examine the role of the patient-clinician relationship in care delivery, including cultural competence and conscious and unconscious bias that are implicated in health disparities.

NIMHD will prioritize primary care clinicians serving a higher-than-average proportion of patients with no insurance coverage, Medicaid, CHIP, or Medicare dual eligibility, but privately insured patients will also be included. Examples include health care settings such as:

• Tribal health clinics
• Academic health centers
• Federally Qualified Health Centers (FQHCs)
• Rural health clinics
• Accountable Care Organizations
• Staff model Health Maintenance Organizations

Furthermore, priority will be given to PBRN sites that provide ambulatory primary care in family medicine, general internal medicine, and general pediatrics, as well as cognitive subspecialties with a component of chronic diseases such as:

• Rheumatology
• Endocrinology (especially diabetes)
• General cardiology
• Asthma/chronic lung disease
• Geriatrics
• General gynecology (especially for younger women)

Research questions can address urgent health care priorities as well as disparities in access, quality, and outcomes of treatment and services.

Studies conducted through the PBRNs will be pragmatic and deployment-focused, incorporating stakeholder perspectives and criteria used for clinical decision-making with an emphasis on improving minority health and reducing disparities in care. These PBRNs will support a wide range of practice-based research, including:

• Pragmatic and comparative effectiveness trials.
• Optimization and testing of scalable preventive and therapeutic interventions.
• Health service and public health services research.

For example, a study might include comparative effectiveness research that tests clinical services interventions targeting patient-, provider-, or systems-level factors to improve service use, care delivery, and/or outcomes.

These PBRNs will also support implementation science approaches to encourage adoption, quality, scale-up, and sustainability of new innovations and existing best practices. It is expected that the PBRNs would be able to respond to requests to conduct real-world clinical trials of relevant treatments.

Page updated Jan. 12, 2024