1. Pediatric Research in Office Settings (PROS) How PROS Has Changed Practice

2. MISSION STATEMENT T he mission of PROS is to improve the health of children and enhance primary care practice by conducting national collaborative practice-based research.

3. Objectives 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

4. PROS 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

5. 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

6. How PROS Works

7. 5/27/2016 Practices (N= 738) by AAP Chapter 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 - AB NA ON PQ Canada 1 1 4 2

8. PROS Practices

9. How PROS Works

10. PROS Primary Investigators

11. How PROS Works

12. PROS at Work

13. How PROS Works

14. PROS Staff

15. How PROS Works

16. How Has New Knowledge from PROS 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

17. Example of PROS in Action

18. 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

20. 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

21. How PROS Works

22. 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 (BMI 2 ) –Clinical Effort Against Secondhand Smoke Exposure (CEASE)

23. Summary: How 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

24. http://www.aap.org/pros/