Pediatric Research in Office Settings Pediatric Research in Office Settings (PROS) (PROS)
How PROS Has Changed Practice
MISSION STATEMENT
The mission of PROS is to improve the health of children and enhance primary
care practice by conducting national collaborative practice-based research.
ObjectivesObjectives
• Provide a very brief history of Pediatric Research in Office Settings (PROS)
• Describe how PROS works, and how it aims to improve child health
• Provide examples of the ways PROS has changed practice
• Describe how PROS will continue to change practice
PROS BeginningsPROS Beginnings
• 1985: AAP President Dr. Robert Haggerty commissioned a Task Force on Collaborative Research (chaired by Dr. Evan Charney)
• 1986: AAP Board approved the formation of an academy-sponsored practice-based research network (PBRN)
• 1988: PROS launched its first study, and since that time has conducted over two dozen research projects
What Makes PROS PROS?What Makes PROS PROS?
• PROS consists of– An infrastructure supported by the HRSA
Maternal and Child Health Bureau and the AAP– Many, many people – A process
How PROS WorksHow PROS Works
04/21/23
Practices (N= 738) by AAP Chapter
8
4
13
NY I - NY II - NY III -
CA I -
CA II -
CA IV -
CA III -
VT -
MD -
DE -
NJ -
CT -
RI -
MA -
NH -
E. Military Chapter – W. Military Chapter -Puerto Rico –
DC -
3
7
20
28
26
9
45
1110
4
2
1
15
22
5
18
75
5 6
7
12
7
317
82
2
24
23
7
23
1823
34
13
14
5
27
2
6
5
2
14
1217
19
16
30
9
1
3
12
2
30
8
AB
NA
ON
PQ
Canada 1
1
4
2
PROS Practices
How PROS WorksHow PROS Works
PROS Primary
Investigators
How PROS WorksHow PROS Works
PROS at Work
How PROS WorksHow PROS Works
PROS Staff
How PROS WorksHow PROS Works
How Has New Knowledge from PROSHow Has New Knowledge from PROS Changed Practice? Changed Practice?
• Two examples from our first decade• In each case, the study idea was suggested by one
or more practitioners• In one, it resulted in a change in policy and
practice• In the second the change in practice has likely
occurred while the change in policy is still taking place
Example of PROS in Action
• Girls mature earlier than stated in text books, with African American girls maturing earlier than white girls• Earlier maturity only partially accounted for by increased BMI• Change in policy by the Lawson Wilkins Pediatric Endocrine Society
Example of PROS in Action
Example of PROS in Action
• Very young febrile infants presenting to practice settings can be managed less aggressively than recommended in published guidelines, by employing close follow-up, and achieve good outcomes• New guideline being developed, based in part on these findings – the principal investigator chairs the guideline committee and PROS pediatricians are on the guideline committee
Example of PROS in Action
How PROS WorksHow PROS Works
How Will PROS Change Practice?How Will PROS Change Practice?• Developing and testing innovations in primary
care practice
• Two cluster randomized controlled trials aimed at changing the way pediatricians practice– Brief Motivational Interviewing to Reduce Child
BMI (BMI2)– Clinical Effort Against Secondhand Smoke
Exposure (CEASE)
Summary:Summary:How PROS Has Changed PracticeHow PROS Has Changed Practice
• PROS is a process allowing many hundreds of people to collaborate in generating new knowledge about the best ways to care for children and families
• The PROS system is embedded in the larger context of the AAP, which allows PROS results to be effectively disseminated so as to improve pediatric practice
• This improved pediatric practice will lead to better health for our nation’s children
http://www.aap.org/pros/