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/