Pediatric Research in Office Settings at 25: A Quarter Century of Network Research Toward the Betterment of Children's Health

Abstract

Twenty-five years ago, Robert Haggerty, MD, then newly elected as President of the American Academy of Pediatrics (AAP), made the formation of a national pediatric practice-based research network an integral part of his presidency. His reasons for promoting this idea were compelling. Family medicine already had begun recruiting and maintaining stable cohorts of practices to examine issues of importance in primary care. In pediatrics, however, primary care issues were being addressed largely by academic medical center investigators who did not have access to typical pediatric populations and who did their studies on samples drawn from the urban inner city environment. Inspired by the early work of a handful of family medicine networks, Dr Haggerty foresaw a stable network of pediatric practices to conduct research in “real world” settings, rather than in the academic settings where condition severity and comorbidity, as well as available technology and treatments, were atypical, limiting the generalizability of findings. 1 The envisioned end product was the generation of new, compelling, and generalizable research to improve the health of the nation’s children. From Dr Haggerty’s vision sprang Pediatric Research in Office Settings (PROS)—a network that began with a modest 100 practices, and 25 years later, includes over 700 practices, active in every state, as well as in the District of Columbia, 2 Canadian provinces, and the Commonwealth of Puerto Rico (Fig 1—PROS map). The mission of PROS is to improve the health of children by conducting collaborative practice-based research to enhance primary care practice. In the service of that mission, with core support from the AAP and the Health Resources and Services Administration Maternal and Child Health Bureau, PROS has conducted more than 30 national studies, changed policy and practice, and contributed to the betterment of children’s health. This article reviews the policy and practice changes realized, discusses key lessons learned along the way, and describes new horizons for the network, as it embarks on its next quarter century.