An innovative clinical research network

RIOSNet logoIn 2000, researchers at the University of New Mexico and a statewide network of practices primarily in community health centers and in the Indian Health Service, created an innovative form of Practice-Based Research Network (PBRN). Unique among PBRNs, the purpose of Research Involving Outpatient Settings Network (RIOS Net) is to study the health and healthcare of the largely Hispanic and American Indian communities of the Southwestern United States, with a focus on the clinical research needs of populations that are generally underrepresented in the research enterprise. RIOS Net was thusly formed as a laboratory for clinical and effectiveness research in these traditionally underrepresented communities. 

Within the first year of its organization, RIOS Net became one of only 19 PBRNs selected by the Agency for Healthcare Research and Quality (AHRQ) for a national research collaborative. RIOS Net was also nationally selected by the NIH as one of only 12 clinical research networks (and one of only three in primary care) to explore expansion of translational research in communities, as part of the Roadmap Initiative (this NIH contract led to the formation of PRIME Net in 2004).

More recently, on behalf of PRIME Net, RIOS Net was selected as one of 10 Master Contractors for the AHRQ PBRN Task Order program. RIOS Net has also received continued support from several foundation, state, and federal funders (e.g., NCI, NCRR, NCCAM, NIMHD, HRSA, legislative, ADA, etc.) while conducting a broad range of clinical research.

RIOS Net members

Map of RIOSNet members

From an initial group of approximately 30 clinicians, RIOS Net has grown steadily over the last 12 years. These clinicians are located in some 65 locations across the state of New Mexico (see figure).  The members of RIOS Net are primarily affiliated with the U.S. Indian Health Service, community health centers across the state, or academic primary care practice sites.

Data collected as part of the national PRINS study (and still reflective of the membership) showed 57 percent of the members are family physicians, 26 percent pediatricians, 9 percent internists, and 8 percent nurse practitioners/physician assistants. The median age grouping of RIOS Net members is 40-49 years old and 48 percent of our members are female. All members of RIOS Net participate on a voluntary basis; they do so out of a commitment to the clinical research effort and from an interest in improving the care that they deliver.

Uniqueness of RIOS Net patient population

RIOS Net collected Primary Care Network Survey (PRINS) data to describe the patients seen in the network. Data from this study show that patients seen by RIOS Net members are predominantly female (62 percent) and are of all ages. Approximately 300,000 persons are cared for by the members of RIOS Net. These persons are approximately 43 percent Hispanic, 33 percent American Indian, 1 percent African American, 4 percent Asian American, and 20 percent non-Hispanic White.

RIOS Net direction

RIOS Net is led by a Board of Directors composed primarily of network members. Other members of the Board include representatives of the largely Hispanic and American Indian communities served by the clinician members, scientific/ technical support persons (biostatistician, epidemiologist, clinical researchers), and the network directors.

The Board sets the overall direction for the network and establishes priority clinical research topics based on member and community representative input, as well as reviewing and approving plans for research projects to be conducted in the network. The Board receives community input not only from its community representatives but also from its Community Advisory Board, which is composed largely of residents from the communities where RIOS Net members practice and leading health experts in the state. The Community Advisory Board meets regularly to discuss the needs for research in their communities and to review proposed network clinical research.

RIOS Net areas of research interest

Based on member and community representative feedback, the RIOS Net Board of Directors initially established a set of priority clinical topics that have been the basis for research planning to date: 

RIOS Net scientific accomplishments

RIOS Net research has focused on the health topic areas defined as priorities by its clinicians and community members. The attached list of references provides an overview of this research. Broadly speaking, in addition to work on specific topic areas, RIOS Net research has become known for several cross-cutting themes: 1) application of community-based participatory research methods to PBRNs; 2) factors influencing the dynamics of the clinician-patient primary care encounter; and 3) important contributions of PBRNs to primary care practice beyond research. Several RIOS Net publications touch on each of these broad themes. 

RIOS Net and PRIME Net

RIOS Net formed PRIME Net as part of the NIH Roadmap contract awarded in 2004, creating a unique collaboration among PBRNs dedicated to improving care of unserved and underserved populations. RIOS Net continued to lead the consortium as it expanded from its initial three-network membership (including CaReNet and SERCN), to five networks in 2007 (SPUR-Net, SFBayCRN), to its current eight networks (Metro-Net, SOAR-Net, LA Net). RIOS Net led the development of the consortium’s Memorandum of Agreement, specifying decision-making and research processes first implemented in 2005, and has organized meetings of the consortium networks (generally held 2-4/year over the last 7 years).

RIOS Net investigators have been lead authors on 6 PRIME Net peer-reviewed publications to date. RIOS Net has also taken the lead on several PRIME Net projects, including: 1) a multi-method study of the prevalence of acanthosis nigricans regarding its relationship to metabolic parameters, the risk of diabetes, and of the influence of participation in PBRN research on clinician behavior; 2) a study regarding the management of hepatitis C in underserved communities; and 3) a study regarding the management of chronic non-cancer pain in underserved communities.

RIOS Net also participated in the PRIME Net project (led by Metro-Net) on recruitment and retention of underrepresented populations in primary care. Moreover, as the AHRQ Master Contract holder, RIOS Net has supported SPUR-Net in its AHRQ task order work on after-visit summaries.

» Visit the RIOS Net website