The Cost of Primary Care Research

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Commentary

The Cost of Primary Care Research

J Fam Pract. 2000 November;49(11):985-989

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The Research Process After the Receipt of Grant Funding

Phase 5: Recruit the Practice Sites, Clinicians, and Patients. The larger, more complex, and more intrusive the research project, the more difficult this stage of operation is. The expenses of this phase have recently been described^25-27 and quantified.²⁸
Phase 6: Train the Researchers, Clinicians, and Staff. It may prove necessary to provide training for the personnel involved in the project. They may include research project staff, clinicians, and clinical staff at multiple or remote sites.
Phase 7: Collect the Data. Data need to be collected at several steps along the way. If the trial is an interventional trial, pre- and postintervention data will be needed. Other types of research will require the tracking of patients over time. Data about physician-patient interactions may be difficult to collect, often requiring intensive qualitative methods.
Phase 8: Intervention. Conducting the intervention will require clinician and patient time, staff time, materials, travel, and communication costs.
Phase 9: Data Entry and Analysis. Database design and management and data entry are required. Data analysis is needed.
Phase 10: Disseminate Results. The dissemination of study results must include feedback to practices, the preparation of grant reports, publication, and presentations. In addition, primary care research projects should include arrangements for the translation of the research results into practice.

The costs related to each phase of operation must be funded (directly or indirectly) by one or more of 3 sources: (1) the academic or network infrastructure; (2) the practice site infrastructure, including the physician and patient; and (3) an extramural funding source.

The proportion of costs incurred by the various organizations or the extramural funding source will vary over time for any project. There is considerable overlap in how the costs of the various phases of research are distributed among the 3 types of sources. However, any extramural funding source will help support the research costs only in phase 5 and beyond.

Discussion

We have outlined the phases of research in a way that allows for some itemization of project expenses. The importance of the development and maintenance of a robust and well-funded support infrastructure is demonstrated by the fact that all activities up to and including those in phase 4 are performed before receiving grant funding.

Limitations

The limitations of this work include the lack of external validation of our model. Nonetheless, the basic outline provides one way to look at the costs of initiating and conducting research projects. We encourage other researchers to build on these ideas. In future work we intend to attach costs to the phases and activities outlined in this paper.

Conclusions

We hope that we have articulated the need for capital investment in the primary care research process, with special attention to practice-based research. This investment, which has paid great dividends in other areas of medicine, will help primary care investigators meet the challenge of developing a robust research enterprise. Such an investment will help us to ensure that the questions asked are important ones for primary care clinicians and that the answers will ultimately pay dividends in the health of our population in the same way research in other areas of medicine has.