Portal de Periódicos da CAPES

The Continuity Research Network (CORNET): What's in it for You?

2019; Elsevier BV; Volume: 212; Linguagem: Inglês

10.1016/j.jpeds.2019.07.002

1097-6833

Iman Sharif, Hollyce Tyrrell,

Childhood Cancer Survivors' Quality of Life

Often, platform or poster presentations at regional or national pediatric meetings end with a limitations slide citing the "single site" as a threat to generalizability. Regional and national research networks are a solution to overcome this constraint; however, for a variety of reasons including time, expertise, and mentorship, junior researchers (eg, residents, fellows, and junior faculty) often do not access such networks for their studies. The Continuity Research Network (CORNET) is the Academic Pediatric Association's (APA) primary resource for junior and senior researchers at academic pediatric institutions across the country. Founded in 2001 by members of the APA Continuity special interest group, CORNET is a practice-based research network of now more than 170 pediatric resident continuity practices representing more than 120 pediatric residency programs (∼60% of US pediatric residency programs). The network reaches more than 6000 pediatric residents and 1 million children across the country (Figure; available at www.jpeds.com). CORNET not only has the capacity to conduct research that improves the health and well-being of underserved children in the US, but also to foster the careers of young researchers and the future pediatric workforce. CORNET is led by a steering and executive committee. The steering committee consists of the network director, founding director, research and network coordinator, stakeholder representatives, the APA's research chair, 3 evaluators of clinical and educational research, and a network membership chair. Stakeholder representatives include parents and general pediatrics trainees. The executive committee includes all steering committee members in addition to regional research chairs, 1 from each of the 10 geographic regions of the APA. Together, the committees cultivate and provide oversight of network studies and, with membership engagement, set research priorities. CORNET's mission is to advance children's health by partnering with key stakeholders to conduct rigorous research in primary care, health care delivery, improvement science, and medical education. With the guiding principles of academic integrity, mentorship, stakeholder engagement, innovation, value, collaboration, inclusion, and respect, CORNET has the following goals: (1) to study health, healthcare, and disparities among children and families, particularly those most vulnerable and at risk, (2) to study and improve resident education in pediatric continuity practices, and (3) to engage residents in pediatric primary care research. Prior CORNET studies (http://academicpeds.org/research/CORNETPublication.cfm) have included integration of mental health services in primary care, Bright Futures, defining the resident continuity experience, obesity, oral health, and asthma management. Over the past few years, CORNET has been engaged in multiyear, nationally funded research focused on quality improvement of immunization delivery in primary care. More recently, the network has implemented quick, network-wide surveys to gather data in preparation for larger grant submissions on topics such as screening for social determinants of health, implementation of Reach Out and Read, and perceptions of adolescent vaccines. In 2016, with an eye toward community engagement, CORNET formed a new partnership with the national family-led nonprofit, Family Voices (http://familyvoices.org/), an organization of families and friends of children and youth with special health care needs, including physical, developmental, and behavioral health needs. Through Health Resources & Services Administration–funded Family 2 Family information centers, Family Voices provides information and education to parents about their child's condition and available resources in their state. CORNET's Executive Committee collaborates with at least 1 Family Voice's representative from each of the APA's 10 geographic regions. This important partnership guides CORNET investigators toward relevance in research, advises on intervention and evaluation design, and provides essential strategies for the dissemination of research results to inform patients, policy, and practice. Over the past few years, CORNET has collaborated closely with the American Academy of Pediatrics' Pediatric Research in Office Settings (PROS), to understand the differences between the study of care delivery in academic vs nonacademic pediatric practices. Currently, CORNET and PROS are engaged in the first large-scale, National Institutes of Health–funded randomized controlled trial across the 2 networks, to study the feasibility and real-world effectiveness of screening for social determinants of health in pediatric primary care. CORNET, PROS, and the APA's Pediatric Research in Inpatient Settings have been discussing strategies to study transitions of care and hand-off communication for children with and without special health care needs. Similarly, conversations with Better Outcomes through Research for Newborns, the APA's network focused on neonatology research) continue about studies on transition from newborn to primary care. As a direct product of the APA Continuity special interest group, CORNET and its leadership are passionate about engaging pediatric residents in national-level research. Each CORNET research project aims to engage at least 1 resident champion from every participating practice. With the knowledge that traditional grant-funded research engages at most 20-30 practices at a time, CORNET's new "card studies" offer a chance for wider resident engagement throughout the network. Card studies were first used by practice-based research networks about 30 years ago, as a way to collect observational data on patients at the point of care.1Green L.A. The weekly return as a practical instrument for data collection in office based research.Fam Med. 1988; 20: 182-184PubMed Google Scholar Participating clinicians were given a physical pocket-sized card on which they recorded data on eligible patients and cards were mailed back to the investigator at the end of the week. In CORNET, card studies are electronic RedCap surveys following the similar principle of quick data collection at the point of care. Card studies offer a chance for quick unfunded research studies that answer interesting and important questions posed by residents, fellows, and junior or senior faculty. These brief electronic surveys spread rapidly through the network, asking participants (residents and faculty) to collect data on a consecutive series of a small number of patients (with the most recent CARD STUDY requesting only 5). Very quickly, the strategy yields a large sample size that is nationally representative. Using CARD STUDIES, early stage researchers may collect preliminary data that provides background for successful grant proposals. A major goal of CORNET is to mentor budding researchers toward successful projects. Each proposal that comes to CORNET is reviewed by 2 members of the CORNET Steering Committee and, through several telephone conversations, is refined to a form to be presented to the executive committee for a vote. Most research proposals submitted to CORNET are eventually approved and implemented. Only projects with a goal that is clearly not relevant to the CORNET mission are rejected; this has happened only once over the past 2 years. With mentorship, time to implementation depends on the rigor of the original proposal; most recently, a fellow's project conceptualized at the 2018 Pediatric Academic Societies meeting resulted in a manuscript submission by the time of the 2019 meeting. This year, CORNET is implementing a new strategy to engage pediatric residents and fellows in the network by offering a 1-year competitive "internship" to 1 resident and 1 academic general pediatrics fellow annually. The successful candidate will attend CORNET's annual meeting at the conclusion of the larger Pediatric Academic Societies meeting and will participate in monthly steering/executive committee calls to learn how the network selects, guides, reviews, and implements research studies. A formal call for nominations for the internship will be released this summer; information about CORNET activities, contact information, and Listserv enrollment is available on the website (www.academicpeds.org/research/research_CORNET.cfm). The APA's current strategic plan (http://academicpeds.org/aboutUs/pdfs/APAStrategicPlan2017-2012.pdf) seeks to streamline the 4 main pillars of the organization, including a focus on connecting the multiple research programs available to its members. Under the guidance of the APA Research Chair, leaders of CORNET, Better Outcomes through Research for Newborns, Pediatric Research in Inpatient Settings, the Research Scholars Program, the Young Investigator Awards Program, and Research in Academic Pediatrics Initiative on Diversity meet regularly via the APA Research Executive Committee to maintain open communication across programs about ongoing and developing activities. This new path of transparency creates a direct pipeline for early stage pediatric researchers to learn basic research principles and strategies, submit proposals for small grant awards (simulating the process of submitting to larger scale funders), run national-level research studies, and eventually take on leadership positions all while receiving mentorship from senior APA members.