The authors, led by Ryan M. Kane of Tufts University School of Medicine and the Duke Clinical Research Institute, describe primary care as the “first and last mile” of the US healthcare system. It is where patients first present with symptoms, where prevention and screening happen, and where long-term relationships between patients and trusted clinicians accumulate over years. That structural position, the article contends, makes primary care uniquely suited to generate real-world evidence that reflects the diversity of the population rather than the narrow, highly selected cohorts typical of specialty clinics and academic hospitals. Because care is delivered by general internists, family physicians, pediatricians, and med-peds clinicians across in-person, urgent, and telehealth settings, the patient pool available for research is both enormous and representative.

Recruitment is one of the most concrete advantages the Think Tank identified. Clinical trials frequently stall because they cannot enroll participants quickly enough; recruitment failures and delays are behind an estimated 80% of premature trial discontinuations. Research on trial participation suggests that personalized outreach from trusted recruiters substantially increases patients’ willingness to enroll, and patients consistently report deep trust in their primary care teams—physicians, advanced-practice providers, nurses, and staff. Similarly, physicians are more likely to refer patients to studies when they trust the research team. Embedding recruitment in primary care could therefore shrink timelines and costs while producing cohorts that generalize far beyond a single specialty population.

Primary care also offers scientific opportunities unavailable elsewhere. Because it is the frontline for diagnosis, researchers can study new screening and diagnostic tests in clinically “naïve” patients before specialist referral changes the picture. The setting supports a wide methodological spectrum: pragmatic observational cohorts, implementation science, quality improvement initiatives, phase 4 post-marketing surveillance, and target trial emulation studies that mimic randomized controlled trials through careful patient matching. As demand grows for real-world evidence generated in ordinary care environments rather than artificial experimental conditions, the authors argue that primary care is arguably the most powerful laboratory medicine has yet failed to fully exploit.

Yet the barriers are formidable. The United States has only 67.2 primary care physicians per 100,000 people, compared with 133 in Canada and 114 in Switzerland—countries that achieve better population health outcomes at lower national expenditure. The workforce shortage is driven by high educational debt, lower salaries than subspecialties, burnout from excessive documentation and short visits, and an aging physician population. The arithmetic is stark: one widely cited analysis estimates that fully delivering guideline-recommended care to a typical adult panel would require 27 hours per day. Clinicians operating at that level of overload have little capacity to participate in research, and the pipeline of new primary care researchers is dwindling accordingly.

Infrastructure and money compound the workforce problem. Effective primary care research requires trained clinical and non-clinical staff to handle regulatory documentation, recruitment, data collection, and participant navigation, along with sustained bidirectional communication between research teams and practices. Systematic reviews cite missing dedicated time, limited research training and confidence, and weak administrative support as recurring obstacles. Funding has grown more precarious, not less: federal freezes and workforce reductions have hit agencies with a historic commitment to primary care research, notably the Agency for Healthcare Research and Quality, whose grant function analysts have described as collapsing under impoundments. Incentives add another layer of misalignment—fee-for-service reimbursement rewards clinical throughput, and with roughly four out of five physicians now employed by hospitals, health systems, or corporations, practice consolidation prioritizes revenue over research participation.

The Think Tank’s first proposed solution is to scale up practice-based research networks, or PBRNs. These networks embed longitudinal research infrastructure into community-based primary care by connecting clinics to an operational hub, often based at an academic medical center, that supplies onsite research staff, training, and facilitation. In their foundational description, Westfall and colleagues argued that PBRNs can identify the gaps between recommended and actual care, test whether efficacious treatments remain effective in real ambulatory settings, and serve as laboratories for system improvement. Evidence suggests PBRNs improve recruitment, reduce clinician burden, and generate more generalizable evidence, while community-based participatory approaches build durable relationships among researchers, clinicians, staff, and patients.

Existing national networks demonstrate the model’s scale. PCORnet, the Patient-Centered Clinical Research Network funded by the Patient-Centered Outcomes Research Institute, links more than 75 health systems through thousands of academic, community, and federally qualified health centers, with standardized electronic health record data on over 45 million patients seen in the past year. That combination of rural and urban representation and standardized data makes such networks suitable for everything from large multisite pragmatic trials to rare disease studies. The Think Tank also emphasized a second lever: technology. Interoperable EHRs with built-in artificial intelligence, secure patient portals for identifying and contacting eligible participants, digital consent and randomization platforms, EHR-embedded interventions, and remote collection of patient-reported outcomes and wearable data can all engage participants asynchronously and minimize disruption to busy practices. The authors caution, however, that digital approaches risk worsening technology-related health disparities, particularly in rural areas, and must be deployed deliberately.

The third pillar is investment. Because primary care practices are pressured by high daily clinical throughput, financial remuneration is needed to offset research-related losses in clinical revenue, along with resources for health information technology, laboratory processing, and startup costs. The authors call for expanded public, private, and nonprofit funding for research training at every career stage—fellowships comparable to those routinely funded in specialty medicine, training for non-clinician researchers, and short-term or asynchronous programs for practicing clinicians—so that research can be embedded without destabilizing patient care.

The article’s conclusion is blunt: strengthening primary care research is a scientific imperative, not an optional reform. With chronic disease at the center of national health policy debates, the setting best positioned to deliver prevention, coordinate care, and reach the whole population remains almost entirely disconnected from the machinery of evidence generation. Research networks, digital tools, and sustained funding, the authors argue, are the three levers that can close the gap between where Americans receive care and where knowledge is made. If the enterprise takes that prescription seriously, the waiting room may become one of the most productive research spaces in medicine.

Subject of Research: Integrating clinical research into primary care through practice-based research networks, digital health technology, and increased funding

Article Title: Rewiring the Research Enterprise: Why Primary Care Is the Next Frontier

Article References: Kane, R. M., Jackman, J. G., Henningfield, M. F., Hester, C. M., Cherrington, A. L., Sanchez, K., Tapp, H., Hornik, C. P., Hernandez, A. F., Dolor, R. J., & Rothman, R. L. (2026). Rewiring the Research Enterprise: Why Primary Care Is the Next Frontier. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10760-5

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10760-5

Keywords: primary care, clinical research, practice-based research networks, real-world evidence, clinical trials, PCORnet, digital health, workforce shortage, research funding, learning healthcare system, chronic disease, implementation science

In this study, the authors conducted extensive qualitative research, collecting insights from key stakeholders involved in PBRNs. The goal was to understand the complexities surrounding the sustainability of these networks, especially as they strive to remain relevant in a rapidly changing healthcare landscape. The findings revealed a rich tapestry of experiences, showcasing both common obstacles and unique advantages encountered by different PBRNs across the globe.

One of the primary themes emerging from the research was the pivotal role of leadership within PBRNs. Effective leadership can galvanize participation, foster collaboration among diverse stakeholders, and drive innovation. The study highlighted that PBRNs led by visionary individuals tend to be more successful in attracting funding, engaging practitioners, and generating impactful research outcomes. Additionally, leaders who promote a culture of trust and open communication are better positioned to sustain their networks in the long term.

Funding remains a critical factor influencing the sustainability of PBRNs. The study indicates that diverse funding sources — be they government grants, academic partnerships, or private sector support — are essential for maintaining the operational capabilities of these networks. However, reliance on a single funding stream can pose significant risks. Networks that successfully diversify their funding sources are often more resilient and capable of adapting to the financial uncertainties characteristic of the contemporary research landscape.

Another intriguing insight from the research focused on the role of community engagement in sustaining PBRNs. Networks that actively involve community members in the research process are more likely to produce relevant findings that resonate with local populations. By fostering collaboration between researchers and community stakeholders, PBRNs can address the pressing health needs identified by the communities themselves. Moreover, such engagement enhances the credibility and impact of the research, thereby attracting additional support and resources.

Technological advancements have also transformed PBRNs, enabling more efficient data collection, analysis, and dissemination of research findings. The study points to the growing importance of digital tools in facilitating communication among network participants and in conducting trials remotely. However, the authors caution that while technology can enhance operational efficiencies, it also brings challenges related to data security and privacy which must be diligently addressed.

The shifting dynamics of healthcare policy are another vital consideration for the sustainability of PBRNs. Health policies can significantly impact the priorities and funding available for research. The study emphasizes the need for PBRNs to remain agile in their approaches, adapting to new regulations and funding opportunities as they arise. Networks that take a proactive stance toward policy changes are better equipped to navigate the complexities inherent in the modern healthcare system.

Moreover, the findings underscore the significance of networking and collaboration among PBRNs themselves. By sharing best practices, lessons learned, and resources, these networks can bolster one another’s sustainability efforts. Collaborative initiatives, such as joint research projects and cross-network meetings, can lead to innovative solutions that benefit all participating organizations. The study calls for a more structured approach to facilitate such collaborations across geographic and disciplinary boundaries.

Training and capacity-building for PBRN members—including healthcare practitioners and researchers—are also crucial components of sustainability. This study outlines that equipping network members with necessary skills and knowledge can enhance research capabilities and participant engagement. Ongoing professional development and training opportunities not only ensure that individuals remain proficient in conducting research but also create a sense of ownership and commitment to the network’s objectives.

Challenging the status quo within PBRNs is essential for innovation. The study reveals that networks willing to explore unconventional research methodologies often yield groundbreaking results. By fostering an environment that encourages risk-taking and experimentation, PBRNs can discover new pathways to address long-standing healthcare issues. Creative solutions developed within these networks can serve as models for other organizations seeking to improve their own research efforts.

The implications of the research extend beyond academic discourse; they hold significant potential for practical applications in real-world healthcare settings. Policymakers and healthcare administrators can glean insights from the study’s findings to design better frameworks for supporting and sustaining PBRNs. By aligning incentives and resources with the unique challenges faced by these networks, stakeholders can foster environments conducive to impactful research.

The study’s conclusions advocate for a holistic perspective on sustaining PBRNs, suggesting that individual components—from leadership to funding strategies to community engagement—are interrelated. Each element plays a critical role in the overall sustainability equation, emphasizing that a multifaceted approach is most likely to yield success. This integrative framework may guide future research and policy initiatives aimed at bolstering the global landscape of practice-based research.

In summary, the sustainability of practice-based research networks is a critical issue that deserves urgent attention. The diverse insights gathered from this worldwide qualitative study illuminate the complexities of sustaining these essential networks. Understanding their multifaceted nature and the interconnected factors influencing their sustainability is vital for nurturing the future of healthcare research. As PBRNs continue to evolve, it is essential for all stakeholders to collaborate and innovate, ensuring that these networks thrive in their commitment to improving health systems globally.

As the pulse of healthcare research shifts, the findings of this study act as a clarion call. They underscore the significance of adaptable, resilient, and community-centered approaches to sustaining practice-based research initiatives. With ongoing commitment, ingenuity, and collaboration, PBRNs can emerge as beacons of innovation, paving the way for a healthier future for communities worldwide.

Subject of Research: Sustainability of practice-based research networks

Article Title: The sustainability of practice-based research networks across the globe – insights from a worldwide qualitative study.

Article References:

Dania, A., Nagykaldi, Z., Haaranen, A. et al. The sustainability of practice-based research networks across the globe – insights from a worldwide qualitative study. BMC Health Serv Res 25, 1287 (2025). https://doi.org/10.1186/s12913-025-13159-w

Image Credits: AI Generated

DOI: 10.1186/s12913-025-13159-w

Keywords: Practice-based research networks, sustainability, healthcare research, community engagement, funding strategies, technology integration, policy dynamics.