As of mid-1997, PROS has grown to include over 1,300 practitioners
in more than 450 practices and is currently the largest primary
care research network in the US. Our members comprise approximately
4% of all AAP primary care pediatricians. Simply stated, PROS is
one of the largest research collaborations in the world. One might
ask, why should PROS need or want to collaborate with other groups?
The answer involves the nature of child health care delivery in
the US, the composition of the AAP, and the limitations of a national
network.
By definition, PROS is a network of pediatric practitioners.
Ninety percent of PROS members are pediatricians and the remaining
10% are nurse practitioners, physician assistants, and family physicians
who practice with pediatricians. But although pediatricians and
their practice colleagues provide health care for the majority of
infants, toddlers, and preschoolers, family physicians see a steadily
increasing proportion of children during school age and adolescence.
Thus when a potential project involves a problem common in older
children, PROS can be challenged regarding its ability to study
the situation and recruit sufficient patients and, most of all,
to represent all patients. Such a situation led to a successful
collaboration with the Ambulatory Sentinel Practice Network (ASPN)
of family physicians on the Child Behavior Study, which has managed
to furnish a complete picture of primary care child mental health
in office-based practice.
What about pediatrics -- is there a need for collaborations within
pediatrics? The answer is a decided "Yes." Since PROS is
an AAP program, PROS Rules of Governance stipulate that at least
one member of a PROS practice must be an AAP member. However, the
AAP membership does not include all those practicing pediatrics
in the US.
Importantly, non-AAP pediatricians include disproportionate numbers
of minority pediatricians and those working in the inner city. This
in part accounts for our difficulty in recruiting minority and urban
pediatricians.
As a result, PROS has lacked input from minority and urban pediatricians.
A second consequence has been under-representation of minority and
inner-city children and a resulting difficulty in addressing research
questions and issues (eg, asthma, immunizations) that are critical
for those groups. For this reason, PROS is now collaborating with
the Pediatric Section of the National Medical Association (NMA --
the 100-year-old African-American physicians organization) in a
CDC-funded study of the impact of recent recommendations for widespread
use of inactivated polio vaccine. Just as many PROS practitioners
have been concerned about unintended negative effects of giving
additional shots to the very young patients in their practices,
NMA physicians have been concerned about potential adverse effect
of the recommended change on immunization rates and immunity of
patients in the inner-city, the population that is arguably the
most vulnerable to an outbreak of wild polio virus. All parties
(CDC, PROS study team, NMA section leadership) agree that the collaboration
will address this research question in a uniquely valuable way.
You will be hearing more about the study this fall.
The final potential PROS collaborators are the growing number of
regional pediatric practice-based research networks (PBRNs). As
many of you know, the very first pediatric PBRN was the Chicago-based
Pediatric Practice Research Group (PPRG). There are now also pediatric
PBRNs in Columbus, Ohio, Washington, DC, Hanover, New Hampshire,
Seattle, and Cincinnati. The regional PBRNs and PROS have complementary
strengths (eg, regional PBRNs can do elaborate studies by actually
sending research assistants into offices -- PROS can generate large,
national samples). Leaders of PROS and the regional pediatric PBRNs
have met and agreed to develop one or more studies to take advantage
of their respective strengths.
In summary, PROS is taking collaboration in practice-based research
to new lengths in order to meet new challenges and conduct better
studies. We fully expect that these collaborations will result in
better research on primary care pediatrics and ultimately, better
health care for children.
From The Steering Committee Chair
By Thomas McInerny, MD
This, sadly, is the last column from me as chair of the Steering
Committee. An extremely exciting four years has passed all too quickly.
As documented in Mort's article in the Winter 1995-1996 Network
News, the network has grown dramatically in size, the number and
quality of studies increased significantly, with several published
papers and many more accepted for publication or in preparation,
and PROS has gained respected recognition among the pediatric and
scientific communities.
All of these wonderful events occurred because PROS practitioners,
coordinators, and staff are dedicated, hard-working, innovative
individuals willing to cooperate with each other and make the sacrifices
necessary to accomplish our goals. In all of my activities with
AAP members and staff, I have always been impressed with their kind,
caring willingness to work to improve the health of children in
diverse ways. PROS exemplifies that attitude!
As I review the network's growth over the years and contemplate
what lies ahead for the network, I, as a pediatrician, am naturally
drawn to the analogy of the maturation of children from infants
to adults. PROS is entering its twelfth year -- Ah adolescence!
What major changes will take place over the next several years as
the organization reshapes itself and emerges as a fully grown and
differentiated adult?
Fortunately, there is a growing recognition among the scientific
community at large of the need for greatly increased efforts to
expand the field of child health services research. This area of
inquiry attempts to answer questions about how to provide care to
children that improves the health of the entire population of children
in the most efficient manner. Examples include: which preventive
measures at what ages lead to the best outcomes; or how best to
provide disease management services to children with chronic illnesses
such as asthma and diabetes to minimize morbidity and maximize functional
status.
PROS is perfectly positioned to act as the "laboratory" in which
to carry out such studies. Indeed the Improving Asthma Care Study
currently in development is a perfect example of this type of investigation.
These studies will often be interventional in nature. That is, pediatricians
will be asked to change the way they deliver care, not merely document
how they provide care. Like adolescence this will not be an easy
transition, but I am sure that the network will successfully accomplish
the tasks necessary to mature and realize its full potential.
It indeed has been a privilege and a pleasure to work with all
of you over these past ten years as a coordinator and member of
the Steering Committee. Special praise goes to Mort and his very
able staff who "go the extra mile" to ensure that projects are successfully
completed. And, of course, a truly heartfelt thanks to the coordinators
and pediatricians who volunteer so generously of their time and
efforts in conducting the studies. I sincerely hope to stay involved
in PROS in some capacity to observe its continued exciting maturation.
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