Structure and Function of Emergency Care Research Networks: Strengths, Weaknesses, and Challenges

Authors

  • Linda Papa MD, MSc,

    1. From the Department of Emergency Medicine, Orlando Regional Medical Center (LP), Orlando, FL; the Departments of Emergency Medicine and Pediatrics, UC Davis Health System (NK), Sacramento, CA; the Department of Emergency Medicine, University of Pennsylvania School of Medicine (KL), Philadelphia, PA; the Department of Emergency Medicine, University of Michigan (WB), Ann Arbor, MI; Harvard Medical School and the Department of Emergency Medicine, Massachusetts General Hospital (CAC), Boston, MA; the Department of Emergency Medicine, Virginia Commonwealth University Health System (JPO), Richmond, VA; the Department of Emergency Medicine, University of Ottawa and the Ottawa Health Research Institute (IS), Ottawa, Ontario, Canada; and the Department of Emergency Medicine, Olive View–UCLA (DAT), Los Angeles, CA.
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  • Nathan Kuppermann MD, MPH,

    1. From the Department of Emergency Medicine, Orlando Regional Medical Center (LP), Orlando, FL; the Departments of Emergency Medicine and Pediatrics, UC Davis Health System (NK), Sacramento, CA; the Department of Emergency Medicine, University of Pennsylvania School of Medicine (KL), Philadelphia, PA; the Department of Emergency Medicine, University of Michigan (WB), Ann Arbor, MI; Harvard Medical School and the Department of Emergency Medicine, Massachusetts General Hospital (CAC), Boston, MA; the Department of Emergency Medicine, Virginia Commonwealth University Health System (JPO), Richmond, VA; the Department of Emergency Medicine, University of Ottawa and the Ottawa Health Research Institute (IS), Ottawa, Ontario, Canada; and the Department of Emergency Medicine, Olive View–UCLA (DAT), Los Angeles, CA.
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  • Katherine Lamond,

    1. From the Department of Emergency Medicine, Orlando Regional Medical Center (LP), Orlando, FL; the Departments of Emergency Medicine and Pediatrics, UC Davis Health System (NK), Sacramento, CA; the Department of Emergency Medicine, University of Pennsylvania School of Medicine (KL), Philadelphia, PA; the Department of Emergency Medicine, University of Michigan (WB), Ann Arbor, MI; Harvard Medical School and the Department of Emergency Medicine, Massachusetts General Hospital (CAC), Boston, MA; the Department of Emergency Medicine, Virginia Commonwealth University Health System (JPO), Richmond, VA; the Department of Emergency Medicine, University of Ottawa and the Ottawa Health Research Institute (IS), Ottawa, Ontario, Canada; and the Department of Emergency Medicine, Olive View–UCLA (DAT), Los Angeles, CA.
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  • William G. Barsan MD,

    1. From the Department of Emergency Medicine, Orlando Regional Medical Center (LP), Orlando, FL; the Departments of Emergency Medicine and Pediatrics, UC Davis Health System (NK), Sacramento, CA; the Department of Emergency Medicine, University of Pennsylvania School of Medicine (KL), Philadelphia, PA; the Department of Emergency Medicine, University of Michigan (WB), Ann Arbor, MI; Harvard Medical School and the Department of Emergency Medicine, Massachusetts General Hospital (CAC), Boston, MA; the Department of Emergency Medicine, Virginia Commonwealth University Health System (JPO), Richmond, VA; the Department of Emergency Medicine, University of Ottawa and the Ottawa Health Research Institute (IS), Ottawa, Ontario, Canada; and the Department of Emergency Medicine, Olive View–UCLA (DAT), Los Angeles, CA.
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  • Carlos A. Camargo Jr MD, DrPH,

    1. From the Department of Emergency Medicine, Orlando Regional Medical Center (LP), Orlando, FL; the Departments of Emergency Medicine and Pediatrics, UC Davis Health System (NK), Sacramento, CA; the Department of Emergency Medicine, University of Pennsylvania School of Medicine (KL), Philadelphia, PA; the Department of Emergency Medicine, University of Michigan (WB), Ann Arbor, MI; Harvard Medical School and the Department of Emergency Medicine, Massachusetts General Hospital (CAC), Boston, MA; the Department of Emergency Medicine, Virginia Commonwealth University Health System (JPO), Richmond, VA; the Department of Emergency Medicine, University of Ottawa and the Ottawa Health Research Institute (IS), Ottawa, Ontario, Canada; and the Department of Emergency Medicine, Olive View–UCLA (DAT), Los Angeles, CA.
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  • Joseph P. Ornato MD,

    1. From the Department of Emergency Medicine, Orlando Regional Medical Center (LP), Orlando, FL; the Departments of Emergency Medicine and Pediatrics, UC Davis Health System (NK), Sacramento, CA; the Department of Emergency Medicine, University of Pennsylvania School of Medicine (KL), Philadelphia, PA; the Department of Emergency Medicine, University of Michigan (WB), Ann Arbor, MI; Harvard Medical School and the Department of Emergency Medicine, Massachusetts General Hospital (CAC), Boston, MA; the Department of Emergency Medicine, Virginia Commonwealth University Health System (JPO), Richmond, VA; the Department of Emergency Medicine, University of Ottawa and the Ottawa Health Research Institute (IS), Ottawa, Ontario, Canada; and the Department of Emergency Medicine, Olive View–UCLA (DAT), Los Angeles, CA.
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  • Ian G. Stiell MD, MSc,

    1. From the Department of Emergency Medicine, Orlando Regional Medical Center (LP), Orlando, FL; the Departments of Emergency Medicine and Pediatrics, UC Davis Health System (NK), Sacramento, CA; the Department of Emergency Medicine, University of Pennsylvania School of Medicine (KL), Philadelphia, PA; the Department of Emergency Medicine, University of Michigan (WB), Ann Arbor, MI; Harvard Medical School and the Department of Emergency Medicine, Massachusetts General Hospital (CAC), Boston, MA; the Department of Emergency Medicine, Virginia Commonwealth University Health System (JPO), Richmond, VA; the Department of Emergency Medicine, University of Ottawa and the Ottawa Health Research Institute (IS), Ottawa, Ontario, Canada; and the Department of Emergency Medicine, Olive View–UCLA (DAT), Los Angeles, CA.
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  • David A. Talan MD

    1. From the Department of Emergency Medicine, Orlando Regional Medical Center (LP), Orlando, FL; the Departments of Emergency Medicine and Pediatrics, UC Davis Health System (NK), Sacramento, CA; the Department of Emergency Medicine, University of Pennsylvania School of Medicine (KL), Philadelphia, PA; the Department of Emergency Medicine, University of Michigan (WB), Ann Arbor, MI; Harvard Medical School and the Department of Emergency Medicine, Massachusetts General Hospital (CAC), Boston, MA; the Department of Emergency Medicine, Virginia Commonwealth University Health System (JPO), Richmond, VA; the Department of Emergency Medicine, University of Ottawa and the Ottawa Health Research Institute (IS), Ottawa, Ontario, Canada; and the Department of Emergency Medicine, Olive View–UCLA (DAT), Los Angeles, CA.
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Address for correspondence and reprints: Linda Papa, MD, MSc; e-mail: lpstat@aol.com A related commentary appear on page 986.

Abstract

The ability of emergency care research (ECR) to produce meaningful improvements in the outcomes of acutely ill or injured patients depends on the optimal configuration, infrastructure, organization, and support of emergency care research networks (ECRNs). Through the experiences of existing ECRNs, we can learn how to best accomplish this. A meeting was organized in Washington, DC, on May 28, 2008, to discuss the present state and future directions of clinical research networks as they relate to emergency care. Prior to the conference, at the time of online registration, participants responded to a series of preconference questions addressing the relevant issues that would form the basis of the breakout session discussions. During the conference, representatives from a number of existing ECRNs participated in discussions with the attendees and provided a description of their respective networks, infrastructure, and challenges. Breakout sessions provided the opportunity to further discuss the strengths and weaknesses of these networks and patterns of success with respect to their formation, management, funding, best practices, and pitfalls. Discussions centered on identifying characteristics that promote or inhibit successful networks and their interactivity, productivity, and expansion. Here the authors describe the current state of ECRNs and identify the strengths, weaknesses, and potential pitfalls of research networks. The most commonly cited strengths of population- or disease-based research networks identified in the preconference survey were access to larger numbers of patients; involvement of physician experts in the field, contributing to high-level study content; and the collaboration among investigators. The most commonly cited weaknesses were studies with too narrow a focus and restrictive inclusion criteria, a vast organizational structure with a risk of either too much or too little central organization or control, and heterogeneity of institutional policies and procedures among sites. Through the survey and structured discussion process involving multiple stakeholders, the authors have identified strengths and weaknesses that are consistent across a number of existing ECRNs. By leveraging the strengths and addressing the weaknesses, strategies can be adopted to enhance the scientific value and productivity of these networks and give direction to future ECRNs.

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