Pediatric Research in Office Settings (PROS)

Emalee G. Flaherty, M.D.

Improving Children's Health Through Health Services Research was a special 1-day meeting held June 26, 1999, in Chicago. The state of the science in children's health services research was explored, including public and private funding opportunities, networks for conducting research, and uses of research in policy and practice. The meeting was co-sponsored by the National Association of Children's Hospitals and Related Institutions (NACHRI), with the Agency for Health Care Policy and Research (AHCPR), the American Academy of Pediatrics (AAP), the David and Lucille Packard Foundation, the Association for Health Services Research (AHSR), the Robert Wood Johnson Foundation, and Data Harbor, Inc.

The mission of PROS is to improve the health of children by conducting collaborative, practice-based research in the delivery of primary care services. PROS, founded in 1986 by the American Academy of Pediatrics (AAP), is supported, in part, by a grant from the Health Resources and Services Administration, Maternal Child Health Bureau, U.S. Department of Health and Human Services. Additional funding comes from a variety of public and private sector sources.

PROS involves more than 1,450 pediatric practitioners from over 500 practices in 57 "networks" organized at the State level. Each State has a Chapter Coordinator who recruits practices, oversees research activities, and attends two meetings annually with PROS research staff and consultants.

The practitioners involved in PROS are physicians (89 percent), nurse practitioners (10 percent), and physician's assistants (1 percent). Ninety-three percent of those involved report patient care as their primary professional activity with approximately 90 percent of their time spent in general pediatrics. The demographics of PROS practitioners are similar to those of the membership of the AAP—49 percent are female with an average age of 45.

PROS practices differ from the membership of the AAP in that these practices are more likely to be located in suburban rather than urban settings. According to race, the patients served by PROS are 75 percent white, 17 percent African-American, and 8 percent other. The ethnicity of patients is 13 percent Hispanic. All ages (birth to 21 years) are served by PROS with declining percentages of patients in the older age groups.

With their expertise in primary care practice, PROS practitioners and researchers work together to:

• Generate research questions.
• Design and conduct studies.
• Obtain research funding.
• Disseminate research findings.

Current PROS studies include:

• Life Around Newborn Discharge: Assess the judgments of pediatricians, obstetricians, and mothers about readiness for hospital discharge and their relationships to mother and newborn health outcomes.
• Helping Improve Pediatric Practice Outcomes: Develop and test "tool kits" of materials and techniques to improve quality in the management of children with asthma.

PROS has completed a number of studies:

• Polio immunization delivery.
• Assessment of febrile infants less than 2 years of age.
• Child behavior.
• Gastrointestinal outcomes.
• Management of acute asthma.
• Referral processes in primary care.
• Immunizations.
• Secondary sexual characteristics in young girls.
• Preschool vision screening.
• Respiratory illness management.
• Implementing research in pediatric office networks.

The advantages of practice-based research networks include:

• Non-referred study samples.
• Ability to conduct longitudinal studies.
• Larger samples.
• Variety of practitioners.
• Information from settings where applied.
• Samples which are diverse and geographically dispersed.

Challenges include:

• Office intrusiveness.
• Inter-observer and equipment variability.
• Imprecise data collection.
• Lack of a pediatric registry to follow patients.
• Maintaining practitioner involvement.
• Funding.

For additional information: PROS Web page is located on the AAP Web page at http://www.aap.org/pros/

Internet Citation:

Flaherty, E.G. Pediatric Research in Office Settings (PROS). Presentation Summary, Improving Children's Health Through Health Services Research, Chicago, June 26, 1999. http://www.ahrq.gov/research/chsrpros.htm