Implementing community-based provider participation in research: an empirical study

Randall Teal,Dawn M Bergmire,Matthew Johnston,Bryan J Weiner

doi:10.1186/1748-5908-7-41

Randall Teal, Dawn M Bergmire + Show 2 more

Open Access

https://doi.org/10.1186/1748-5908-7-41

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Abstract

BackgroundSince 2003, the United States National Institutes of Health (NIH) has sought to restructure the clinical research enterprise in the United States by promoting collaborative research partnerships between academically-based investigators and community-based physicians. By increasing community-based provider participation in research (CBPPR), the NIH seeks to advance the science of discovery by conducting research in clinical settings where most people get their care, and accelerate the translation of research results into everyday clinical practice. Although CBPPR is seen as a promising strategy for promoting the use of evidence-based clinical services in community practice settings, few empirical studies have examined the organizational factors that facilitate or hinder the implementation of CBPPR. The purpose of this study is to explore the organizational start-up and early implementation of CBPPR in community-based practice.MethodsWe used longitudinal, case study research methods and an organizational model of innovation implementation to theoretically guide our study. Our sample consisted of three community practice settings that recently joined the National Cancer Institute’s (NCI) Community Clinical Oncology Program (CCOP) in the United States. Data were gathered through site visits, telephone interviews, and archival documents from January 2008 to May 2011.ResultsThe organizational model for innovation implementation was useful in identifying and investigating the organizational factors influencing start-up and early implementation of CBPPR in CCOP organizations. In general, the three CCOP organizations varied in the extent to which they achieved consistency in CBPPR over time and across physicians. All three CCOP organizations demonstrated mixed levels of organizational readiness for change. Hospital management support and resource availability were limited across CCOP organizations early on, although they improved in one CCOP organization. As a result of weak IPPs, all three CCOPs created a weak implementation climate. Patient accrual became concentrated over time among those groups of physicians for whom CBPPR exhibited a strong innovation-values fit. Several external factors influenced innovation use, complicating and enriching our intra-organizational model of innovation implementation.ConclusionOur results contribute to the limited body of research on the implementation of CBPPR. They inform policy discussions about increasing and sustaining community clinician involvement in clinical research and expand on theory about organizational determinants of implementation effectiveness.

Highlights

In 2003, the United States National Institutes of Health (NIH) embarked on a fundamental restructuring of the national clinical research enterprise [1]
Using case study research methods and implementation theory, we identify the organizational factors associated with the effective implementation of community-based provider participation in research (CBPPR) in three community practice settings that joined the National Cancer Institute’s (NCI) Community Clinical Oncology Program (CCOP) in the United States, a federally funded provider-based research network with a 28-year history of translating research into practice [12]
Some constructs exhibited less salience than others, as measured by the number of text units coded for that construct, either because interview questions pertinent to that construct were asked only in specific years or because interview participants had less to say about the issue or because the construct proved difficult to identify in the natural language responses of interview participants (e.g., Innovation-values fit (IVF))

Summary

Introduction

In 2003, the United States National Institutes of Health (NIH) embarked on a fundamental restructuring of the national clinical research enterprise [1]. The Roadmap has spurred discussion of the potential benefits of CBPPR [6,7,8], infrastructure and workforce training needs for CBPPR [4,9], common barriers to increasing CBPPR [7,10,11], and strategies for overcoming those barriers [7,10] Missing from this discussion, though, is an empirical investigation of the organizational factors that facilitate or hinder the implementation of CBPPR. Since 2003, the United States National Institutes of Health (NIH) has sought to restructure the clinical research enterprise in the United States by promoting collaborative research partnerships between academicallybased investigators and community-based physicians. The purpose of this study is to explore the organizational start-up and early implementation of CBPPR in community-based practice

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