title: Reengineering the clinical research enterprise to involve more community clinicians.
abstract: BACKGROUND
  The National Institutes of Health has called for expansion of practice-based research to improve the clinical research enterprise.
  
  
  METHODS
  This paper presents a model for the reorganization of clinical research to foster long-term participation by community clinicians.Based on the literature and interviews with clinicians and other stakeholders, we posited a model, conducted further interviews to test the viability of the model, and further adapted it.
  
  
  RESULTS
  We propose a three-dimensional system of checks and balances to support community clinicians using research support organizations, community outreach, a web-based registry of clinicians and studies, web-based training services, quality audits, and a feedback mechanism for clinicians engaged in research.
  
  
  CONCLUSIONS
  The proposed model is designed to offer a systemic mechanism to address current barriers that prevent clinicians from participation in research. Transparent mechanisms to guarantee the safety of patients and the integrity of the research enterprise paired with efficiencies and economies of scale are maintained by centralizing some of the functions. Assigning other responsibilities to more local levels assures flexibility with respect to the size of the clinician networks and the changing needs of researchers.
authors.affiliation: RAND Health, Santa Monica, CA, USA.
authors.forename: Gery
authors.initials: G
authors.lastname: Ryan
authors.forename: Claude
authors.initials: C
authors.lastname: Berrebi
authors.forename: Megan
authors.initials: M
authors.lastname: Beckett
authors.forename: Stephanie
authors.initials: S
authors.lastname: Taylor
authors.forename: Elaine
authors.initials: E
authors.lastname: Quiter
authors.forename: Michelle
authors.initials: M
authors.lastname: Cho
authors.forename: Harold
authors.initials: H
authors.lastname: Pincus
authors.forename: Katherine
authors.initials: K
authors.lastname: Kahn
mesh_terms: D035843:Biomedical Research / Q000193:education / Q000458:organization & administration* / Q000592:standards; D003159:Community-Institutional Relations; D006801:Humans; D010820:Physicians / Q000458:organization & administration; D015397:Program Evaluation; D012042:Registries; D012108:Research Personnel / Q000193:education / Q000458:organization & administration / Q000600:supply & distribution; D057170:Translational Research, Biomedical / Q000193:education / Q000458:organization & administration / Q000592:standards; D014481:United States; D000078329:Workforce