title: Building a Governance Strategy for CER: The Patient Outcomes Research to Advance Learning (PORTAL) Network Experience.
abstract: BACKGROUND
  The Patient Outcomes Research to Advance Learning (PORTAL) Network was established with funding from the Patient-Centered Outcomes Research Institute (PCORI) in 2014. The PORTAL team adapted governance structures and processes from past research network collaborations. We will review and outline the structures and processes of the PORTAL governance approach and describe how proactively focusing on priority areas helped us to facilitate an ambitious research agenda.
  
  
  BACKGROUND
  For years a variety of funders have supported large-scale infrastructure grants to promote the use of clinical datasets to answer important comparative effectiveness research (CER) questions. These awards have provided the impetus for health care systems to join forces in creating clinical data research networks. Often, these scientific networks do not develop governance processes proactively or systematically, and address issues only as problems arise. Even if network leaders and collaborators foresee the need to develop governance approaches, they may underestimate the time and effort required to develop sound processes. The resulting delays can impede research progress.
  
  
  METHODS
  Because the PORTAL sites had built trust and a foundation of collaboration by participating with one another in past research networks, essential elements of effective governance such as guiding principles, decision making processes, project governance, data governance, and stakeholders in governance were familiar to PORTAL investigators. This trust and familiarity enabled the network to rapidly prioritize areas that required sound governance approaches: responding to new research opportunities, creating a culture of trust and collaboration, conducting individual studies, within the broader network, assigning responsibility and credit to scientific investigators, sharing data while protecting privacy/security, and allocating resources. The PORTAL Governance Document, complete with a Toolkit of Appendices is included for reference and for adaptation by other networks.
  
  
  METHODS
  As a result of identifying project-based governance priorities (IRB approval, subcontracting, selection of new research including lead PI and participating sites, and authorship) and data governance priorities (reciprocal data use agreement, analytic plan procedures, and other tools for data governance), PORTAL established most of its governance structure by Month 6 of the 18 month project. This allowed science to progress and collaborators to experience first-hand how the structures and procedures functioned in the remaining 12 months of the project, leaving ample time to refine them and to develop new structures or processes as necessary.
  
  
  CONCLUSIONS
  The use of procedures and processes with which participating investigators and their home institutions were already familiar allowed project and regulatory requirements to be established quickly to protect patients, their data, and the health care systems that act as stewards for both. As the project progressed, PORTAL was able to test and adjust the structures it put place, and to make substantive revisions by Month 17. As a result, priority processes have been predictable, transparent and effective.
  Strong governance practices are a stewardship responsibility of research networks to justify the trust of patients, health plan members, health care delivery organizations, and other stakeholders. Well-planned governance can reduce the time necessary to initiate the scientific activities of a network, a particular concern when the time frame to complete research is short. Effective network and data governance structures protect patient and institutional data as well as the interests of investigators and their institutions, and assures that the network has built an environment to meet the goals of the research.
authors.affiliation: Kaiser Permanente Colorado.
authors.forename: Andrea R
authors.initials: AR
authors.lastname: Paolino
authors.affiliation: Kaiser Permanente Southern California.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: McGlynn
authors.affiliation: Kaiser Permanente Northern California.
authors.forename: Tracy
authors.initials: T
authors.lastname: Lieu
authors.affiliation: HealthPartners Institute for Education and Research.
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Nelson
authors.affiliation: Kaiser Permanente Northern California.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Prausnitz
authors.affiliation: Kaiser Permanente Mid-Atlantic States.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Horberg
authors.affiliation: GroupHealth Research Institute.
authors.forename: David E
authors.initials: DE
authors.lastname: Arterburn
authors.affiliation: Kaiser Permanente Southern California.
authors.forename: Michael K
authors.initials: MK
authors.lastname: Gould
authors.affiliation: Kaiser Permanente Oakland.
authors.forename: Reesa L
authors.initials: RL
authors.lastname: Laws
authors.affiliation: Kaiser Permanente Colorado.
authors.forename: John F
authors.initials: JF
authors.lastname: Steiner
keywords: Comparative Effectiveness Research; Governance; Patient-Centered Outcomes Research; Research Networks