ACORN: a PBRN project

A Brief Overview of the ACORN Practice-Based Research Network (PBRN) Design

Chiropractor demonstrating the human spine to a patient.

The Agency for Healthcare Research and Quality (AHRQ) defines a practice-based research network (PBRN) as a group with at least 15 ambulatory practices and/or 15 clinicians devoted principally to the primary care of patients, affiliated with each other (and often with an academic or professional organization) in order to investigate questions related to community based practice. A PBRN helps address issues of disconnect between research activity and practice reality sometimes experienced in health care research and the ACORN PBRN has been designed to ensure the research questions and analyses produced are grounded in and are therefore sensitive to the realities of daily routine care.

 

The ACORN Project is built upon a Sub-Study Model of PBRN design whereby initial recruitment and data collection focuses upon the practitioner population. The PBRN practitioner database then acts as a sustainable resource providing a platform (national in the case of ACORN) for further research investigations. This Sub-Study Model provides excellent flexibility helping facilitate coordinated ongoing research and capacity building.

Male patient at the chiropractor for a neck injury

The Agency for Healthcare Research and Quality (AHRQ) defines a practice-based research network (PBRN) as a group with at least 15 ambulatory practices and/or 15 clinicians devoted principally to the primary care of patients, affiliated with each other (and often with an academic or professional organization) in order to investigate questions related to community based practice.

 

The defining characteristics of a PBRN include:

        •  A mission and statement of purpose including an ongoing commitment to research;
        • Channels for communication among network participants;
        • A director with responsibility for administration of the network and at least one support staff;
        • An advisory board that solicits input from communities of patients served by the PBRN clinicians.

A PBRN design such as that employed by the ACORN project is ideally matched to the current research needs of Australian chiropractic. In particular, the PBRN design of ACORN affords a  broad focus essential to establishing a national, coordinated platform of evidence critical to informing further detailed, specific sub-studies. This is particularly important for Australian chiropractic given the current lack of information around daily care, clinical activity and other important issues. Significantly, such coordinated platform evidence is also vital to contextualising and strengthening the impact of clinically-focused investigations, effectively helping bridge the gap between findings from clinical trials and other related designs and the realities of practitioners’ everyday care.

acornThe broad research focus of a PBRN design allows the ACORN project to accommodate and address investigation of a vast number of issues important to chiropractors, the profession, patients and the Australian health care system more generally. The ACORN project design will accommodate both qualitative and quantitative research and examination of the efficacy, effectiveness, safety and cost evaluation of aspects of chiropractic.

PBRNs have been employed to help build an evidence-base in a number of health care fields around the world. Here we provide a link to a paper which will help further explain this approach to research design.

Rindal D, Flottemesch T, Durand E, Godlevsky O, Schmidt A, Gilbert G, et al. Practice change toward better adherence to evidence-based treatment for early dental decay in the National Dental PBRN. Implementation Science 2014, 9:117.
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For more information from AHRQ on PBRN design and issues please click here