The Agency for Healthcare Research and Quality (AHRQ) Practice-based Research Network (PBRN) relationship: Delivering on an opportunity, challenges, and future directions

Practice-based research networks (PBRNs) often lack sufficient funding to develop the underlying infrastructure necessary to conduct high-quality, pragmatic, policy-relevant studies. One mechanism introduced by the Agency for Healthcare Research and Quality (AHRQ) that held the potential to address this issue was the PBRN Master Contract Program. The program allows the AHRQ to fund tightly focused "research activities" and to create a partnership through the PBRN contracts. Although PBRNs expected Master Contracts to strengthen them, several issues limit the utility of these contracts. The funding levels are lower than that provided from other sources for comparable work. Although some Task Order Officers are diligent, responsive, and supportive, too frequently their zeal for specific results and heavy handed approaches have led to significant "scope creep" and unrealistic expectations. Finally, a mechanism to allow PBRNs and network clinicians to influence the direction of the research questions has not been well developed. We see value in a new approach that supports the ability of the AHRQ to (1) garner support from other government agencies to engage PBRNs in studies relevant to policymakers and PBRNs; (2) capitalize on the collaborative nature of PBRNs by developing projects that support collaboration; (3) provide modest funding for infrastructure; (4) avoid the unnecessary and costly regulatory oversight from OMB; and (5) develop sustained "lines of research" on a scale, currently unavailable through the Master Contract, that can meaningfully contribute to the shaping of health policy.