Looking back to move forward: Future horizons for PBRNS extending learnings from the first 40 years of ASPN-NRN

<h3>Context:</h3> The directors and original staff of the Ambulatory Sentinel Practice Network/National Research Network united to review the establishment and operation of the first US national primary care practice based research network during its first 40 years. <h3>Objective:</h3> Capture and organize the reflections and recommendations of the PBRN leaders who were “in the room” as decisions and commitments were made to identify important issues and possible future horizons for PBRNs going forward. <h3>Study Design:</h3> A written survey in 2020 followed by iterative 90 minute virtual group conversations from 2021-2023 recalling and distilling experiences and conclusions, reaching consensus opinions. <h3>Analysis:</h3> Careful review with an independent evaluator of recursive conversations and debate articulated into era’s, archetypal dilemmas, and future horizons. <h3>Population studied:</h3> A national primary care practice based research network in continuous operation for 4 decades. <h3>Intervention:</h3> None. <h3>Outcome measures:</h3> Distinct periods of development and implementation; challenges and responses to them; important future possibilities for primary care PBRNs. <h3>Results:</h3> Three eras featuring Launch, Expansion, and Scaling. Six archetypal dilemmas: 1.Tension between what practices want and what funding agencies want. 2. Sustaining sufficient and consistent network infrastructure funding. 3.Sustaining network relationships in increasingly centralized and business-oriented systems. 4.Adapting to ongoing shifts in the technology, business, and practice environment. 5.Gradual evolution of what counts as a worthy question and publishable evidence. 6.Translating study findings to accepted changes in practice. Eight possible future horizons and responses to dilemmas: 1.Adapt core PBRN ideas that are durable and flexible. 2.But take up new ideas, skills, and challenges. 3.Seek systemic upstream knowledge of particularly complex phenomena. 4.At the same time, question what we habitually do in practices. 5.Address large emerging societal issues. 6.Expand collaboration beyond practice networks themselves. 7.Disseminate with greater reach and power: appeal to what matters to all who care about health and care. 8.Let PBRNs help improve joy of practice and camaraderie. <h3>Conclusion:</h3> A call to service awaits future PBRN leaders. “Sail forth—steer for the deep waters only, reckless O Soul, exploring, I with thee and thou with me, for we are bound where mariner has not yet dared to go.” (Walt Whitman)