The Pediatric Investigators Collaborative Network on Infections in Canada: A model for multicentre research collaboration

Abstract

The Pediatric Investigators Collaborative Network on Infections in Canada (PICNIC), a collaborative research network, has been held up as a model of successful multicentre research. A description of the elements promoting the success of this network has been published (1). The present article summarizes PICNIC components relevant to the Canadian research environment. PICNIC came into existence at a retreat of the Canadian Infectious Disease Society in 1989. Under the PICNIC umbrella, numerous epidemiological investigations of respiratory syncytial virus illness have been presented and published (2–6), a network for studying infections in the neonate has developed and a multicentre clinical trial designed to examine antibiotic treatment of pertussis is underway. Initial studies consisted of retrospective chart reviews, which were performed with minimal external funding. This provided pilot data and established the group’s credibility, thereby facilitating funding for subsequent studies. The main impetus for the development of a collaborative network was Canada’s small population relative to its large geographic area. This makes it nearly impossible for a single centre to have the sample numbers necessary to answer many significant questions in a timely manner. The size of the country also requires novel ways to overcome problems of communication and data transfer between investigators at centres separated by large distances. In this regard, PICNIC’s success depended on the concurrent availability of modern communication tools, ie, faxes, electronic mail and conference calls. A number of principles were discussed and adopted early in the PICNIC collaboration process. These principles are listed below and should be adapted to reflect specific circumstances. The question is the key to success. The question must be clearly delineated, relevant to child health and scientifically valid, and the population needed for the study must be large enough that the question cannot be answered by a single centre study. Equity before efficiency. Small centres must have equal access to study participation even though they may enroll fewer participants. The principal investigator on a PICNIC study must be a PICNIC member. PICNIC must be in the title or authorship of a study to increase name recognition for future funding and publication. Authorship should be discussed at the inception of each study. In addition to core members, ad hoc membership should be included to ensure wider content expertise for specific studies. An advantage of multicentre participation in studies is the reduction in referral bias. Furthermore, population-based estimates of disease incidence can be obtained at some of the study centres, which serve as the only paediatric referral centre for a region. However, networks differ from multicentre studies in several important aspects. In multicentre studies, centres are assembled after a core group of investigators has established a study question and the protocol design. In networks, study questions are often determined after discussion with members who are also involved in the protocol design. Although initial study development may be prolonged in a network, it enhances subsequent study participation because coinvestigators feel ownership of the study. Furthermore, the existence of PICNIC (or groups in general) beyond a single study allows experience gained in one study to be applied to another. For example, methods standardized for one study can be used subsequently. The changing role from coinvestigator to principal investigator in different studies also encourages individual researchers from PICNIC or groups in general to be committed to all studies. A number of factors unique to the specialty of paediatric infectious diseases also contributed to the success of PICNIC. PICNIC members already had a high level of collegiality before the network was established. A number of investigators had previous links with industry sponsors, making it easier to obtain funding from this source. Finally, the conscious decision of several senior investigators to assume coinvestigator rather than principal investigator roles set examples for others. Many of the issues that have been described in the context of research networks do not differ from those of single centre studies. However, the participation of a larger number of individuals in networks increases the complexity of conducting studies. Nevertheless, the broader discussion promoted by networks enhances the breadth and quality of investigations. In summary, the benefits of collaboration in such networks outweigh the obstacles, and are a logical next step for clinical research.