title: Sustaining Research Networks: the Twenty-Year Experience of the HMO Research Network.
abstract: OBJECTIVE
  As multi-institutional research networks assume a central role in clinical research, they must address the challenge of sustainability. Despite its importance, the concept of network sustainability has received little attention in the literature, and the sustainability strategies of durable scientific networks have not been described.
  
  
  METHODS
  The Health Maintenance Organization Research Network (HMORN) is a consortium of 18 research departments in integrated health care delivery systems with over 15 million members in the United States and Israel. The HMORN has coordinated federally funded scientific networks and studies since 1994. This case study describes the HMORN approach to sustainability, proposes an operational definition of network sustainability, and identifies 10 essential elements that can enhance sustainability.
  
  
  METHODS
  The sustainability framework proposed here is drawn from prior publications on organizational issues by HMORN investigators and from the experience of recent HMORN leaders and senior staff.
  
  
  CONCLUSIONS
  Network sustainability can be defined as (1) the development and enhancement of shared research assets to facilitate a sequence of research studies in a specific content area or multiple areas, and (2) a community of researchers and other stakeholders who reuse and develop those assets. Essential elements needed to develop the shared assets of a network include: network governance; trustworthy data and processes for sharing data; shared knowledge about research tools; administrative efficiency; physical infrastructure; and infrastructure funding. The community of researchers within a network is enhanced by: a clearly defined mission, vision and values; protection of human subjects; a culture of collaboration; and strong relationships with host organizations. While the importance of these elements varies based on the membership and goals of a network, this framework for sustainability can enhance strategic planning within the network and can guide relationships with external stakeholders.
authors.affiliation: Kaiser Permanente Colorado Institute for Health Research.
authors.forename: John F
authors.initials: JF
authors.lastname: Steiner
authors.affiliation: Kaiser Permanente Colorado Institute for Health Research.
authors.forename: Andrea R
authors.initials: AR
authors.lastname: Paolino
authors.affiliation: Group Health Research Institute.
authors.forename: Ella E
authors.initials: EE
authors.lastname: Thompson
authors.affiliation: Group Health Research Institute.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Larson
references.citation: Ann Epidemiol. 2006 Apr;16(4):275-8
references.pmid: 16005245
references.citation: Pharmacoepidemiol Drug Saf. 2001 Aug-Sep;10(5):373-7
references.pmid: 11802579
references.citation: Chest. 2011 Sep;140(3):764-7
references.pmid: 21896519
references.citation: J Natl Cancer Inst Monogr. 2005;(35):12-25
references.pmid: 16287881
references.citation: Prev Chronic Dis. 2012;9:E110
references.pmid: 22677160
references.citation: Clin Med Res. 2010 Dec;8(3-4):126-30
references.pmid: 20682758
references.citation: N Engl J Med. 2005 Oct 13;353(15):1621-3
references.pmid: 16221788
references.citation: Acad Med. 2012 Dec;87(12):1710-4
references.pmid: 23095928
references.citation: BMJ. 2014 Jan 28;348:g368
references.pmid: 24472779
references.citation: BMC Med Genomics. 2011 Jan 26;4:13
references.pmid: 21269473
references.citation: JAMA. 2012 Dec 12;308(22):2341-2
references.pmid: 23240142
references.citation: Thorax. 2012 May;67(5):450-5
references.pmid: 22514237
references.citation: Am J Prev Med. 2009 Dec;37(6):552-5
references.pmid: 19944924
references.citation: Pediatrics. 2011 May;127 Suppl 1:S45-53
references.pmid: 21502240
references.citation: J Am Med Inform Assoc. 2012 Jun;19(e1):e60-7
references.pmid: 21873473
references.citation: EGEMS (Wash DC). 2014 Apr 16;2(1):1058
references.pmid: 25821838
references.citation: N Engl J Med. 2011 Mar 3;364(9):818-28
references.pmid: 21366473
references.citation: EGEMS (Wash DC). 2013 Jan 17;1(1):1005
references.pmid: 25848557
references.citation: Med Care. 2009 Oct;47(10):1091-7
references.pmid: 19648826
references.citation: J Natl Cancer Inst Monogr. 2005;(35):3-11
references.pmid: 16287880
references.citation: Med Care. 2013 Aug;51(8 Suppl 3):S30-7
references.pmid: 23774517
references.citation: Pharmacoepidemiol Drug Saf. 2009 Jul;18(7):554-61
references.pmid: 19402030
references.citation: Perm J. 2005 Fall;9(4):33-5
references.pmid: 22811643
references.citation: Contemp Clin Trials. 2012 Jan;33(1):46-54
references.pmid: 21986391
references.citation: Inflamm Bowel Dis. 2007 Apr;13(4):451-61
references.pmid: 17219403
references.citation: Expert Rev Cardiovasc Ther. 2008 Sep;6(8):1043-5
references.pmid: 18793105
references.citation: JAMA. 2003 Sep 24;290(12):1624-32
references.pmid: 14506122
references.citation: Am J Manag Care. 2004 Sep;10(9):643-8
references.pmid: 15515997
references.citation: Health Aff (Millwood). 2010 May;29(5):835-43
references.pmid: 20439869
references.citation: Arch Intern Med. 2008 Sep 22;168(17):1919-25
references.pmid: 18809820
references.citation: J Gen Intern Med. 2014 Feb;29(2):305-11
references.pmid: 24142119
references.citation: Clin Pharmacol Ther. 2011 Dec;90(6):883-7
references.pmid: 22030567
references.citation: Med Care. 2012 Jul;50 Suppl:S3-6
references.pmid: 22692255
references.citation: JAMA. 2002 Dec 18;288(23):2981-97
references.pmid: 12479763
references.citation: Med Care. 2007 Oct;45(10 Supl 2):S29-37
references.pmid: 17909379
references.citation: J Am Med Inform Assoc. 2009 Sep-Oct;16(5):624-30
references.pmid: 19567788
references.citation: Med Care. 2012 Jul;50 Suppl:S77-81
references.pmid: 22692264
references.citation: Am J Manag Care. 2005 Jul;11(7):413-21
references.pmid: 16044978
references.citation: Vaccine. 2009 Aug 27;27(39):5307-12
references.pmid: 19616500
references.citation: EGEMS (Wash DC). 2014 Mar 24;2(1):1049
references.pmid: 25848584
references.citation: Pharmacoepidemiol Drug Saf. 2012 Jan;21 Suppl 1:23-31
references.pmid: 22262590
references.citation: Health Aff (Millwood). 2007 Mar-Apr;26(2):w107-18
references.pmid: 17259191
references.citation: J Am Med Inform Assoc. 2012 Jun;19(e1):e119-24
references.pmid: 22437072
references.citation: Clin Med Res. 2013 Sep;11(3):120-2
references.pmid: 24085855
references.citation: Pharmacoepidemiol Drug Saf. 2005 Dec;14(12):829-36
references.pmid: 15800957
references.citation: Med Care. 2012 Jul;50 Suppl:S21-9
references.pmid: 22692254
references.citation: Circ Cardiovasc Qual Outcomes. 2013 Mar 1;6(2):157-63
references.pmid: 23463811
references.citation: Med Care. 2013 Oct;51(10):e67-73
references.pmid: 22531648
references.citation: Ethn Dis. 2002 Winter;12(1):135-40
references.pmid: 11913601
references.citation: J Healthc Manag. 2013 May-Jun;58(3):187-203; discussion 203-4
references.pmid: 23821898
references.citation: Med Care. 2010 Jun;48(6 Suppl):S45-51
references.pmid: 20473204
references.citation: Pediatrics. 1997 Jun;99(6):765-73
references.pmid: 9164767
references.citation: Eval Health Prof. 2002 Jun;25(2):169-84
references.pmid: 12026751
references.citation: Am J Epidemiol. 1999 Jan 15;149(2):186-94
references.pmid: 9921964
references.citation: Ann Oncol. 2011 Nov;22 Suppl 7:vii36-vii43
references.pmid: 22039143
references.citation: Med Care. 2012 Jul;50 Suppl:S49-59
references.pmid: 22692259
references.citation: Curr Oncol. 2011 Oct;18(5):e243-9
references.pmid: 21980256
references.citation: IRB. 2010 May-Jun;32(3):1-6
references.pmid: 20590050
references.citation: JAMA. 2013 May 8;309(18):1895-6
references.pmid: 23652519
references.citation: Pharmacoepidemiol Drug Saf. 2011 Nov;20(11):1168-76
references.pmid: 22020902
references.citation: Clin Transl Sci. 2011 Aug;4(4):259-65
references.pmid: 21884512
references.citation: BMC Health Serv Res. 2010 Nov 23;10:316
references.pmid: 21092309
references.citation: Hum Reprod. 2011 Nov;26(11):3163-8
references.pmid: 21911435
references.citation: Vaccine. 2011 Jul 12;29(31):4891-6
references.pmid: 21596088
references.citation: Epidemiology. 2011 May;22(3):302-4
references.pmid: 21464650
references.citation: J Am Med Inform Assoc. 2012 Jan-Feb;19(1):54-60
references.pmid: 22037893
references.citation: BMC Public Health. 2006 Sep 19;6:235
references.pmid: 16984658
references.citation: J Am Board Fam Med. 2012 Sep-Oct;25(5):577-81
references.pmid: 22956693
references.citation: Perm J. 2010 Fall;14(3):51-6
references.pmid: 20844705
references.citation: Med Care. 2013 Aug;51(8 Suppl 3):S1-3
references.pmid: 23793048
references.citation: J Am Med Inform Assoc. 2010 Mar-Apr;17(2):124-30
references.pmid: 20190053
references.citation: Clin Transl Sci. 2011 Aug;4(4):266-7
references.pmid: 21884513
references.citation: N Engl J Med. 2002 Feb 7;346(6):393-403
references.pmid: 11832527
references.citation: Am J Epidemiol. 2012 May 1;175(9):859-66
references.pmid: 22411865
references.citation: Contemp Clin Trials. 2008 Sep;29(5):646-53
references.pmid: 18397842
references.citation: JAMA. 2013 Nov 20;310(19):2037-8
references.pmid: 24240926
references.citation: Med Care. 2012 Jul;50 Suppl:S30-5
references.pmid: 22692256
references.citation: BMC Med Res Methodol. 2007 Jun 18;7:23
references.pmid: 17577410
references.citation: Ann Intern Med. 2009 Sep 1;151(5):341-4
references.pmid: 19638403
references.citation: J Investig Med. 2009 Oct;57(7):748-55
references.pmid: 19730130