®® Practice based research networks (PBRN) have developed rapidly in the US in response to the pressing needs for research in routine clinical care. 1 Practice based research provides the setting for observation studies, physician and patient surveys, secondary data analysis and qualitative research. 2 Clinicians and researchers benefit through this process. Clinicians obtain rapid feedback that can incorporate in their practice. Researchers have access to large number of patients and data that can be used in pilot studies. There are over 100 regional and national Primary Care networks in addition to those developed in Pediatrics, Nursing, Dental and Mental Health care. 3,4 Within the VA system, we are aware of a Dental PBRN, a recently formed Women's Health PBRN and a Primary Care PBRN in South Texas. The VA Mental Health PBRN is a network of clinicians in the South Texas Veterans Health Care System (STVHCS) dedicated to improving mental health care through multidisciplinary practice-based research. The PBRN-VA stems from a collaboration of STVHCS mental health providers with an existing psychiatric PBRN at the affiliated University of Texas Health Science Center at San Antonio (UTHSCSA). Figure 1. Introduction THE MENTAL HEALTH PRACTICE BASED RESEARCH NETWORK AT THE VA (PBRN-VA) Conclusions Methods and Results An introductory flyer about the PBRN-VA initiative was sent to all clinicians at the Mental Health Outpatient Services (MHOS) and the Post Traumatic Stress Disorder (PTSD) Clinical Team. This flyer described the PBRN concept, types of questions that could be addressed, benefits of participation and clinical applications. As figure 1 shows, clinicians are key in this process as they provide input in generating the questions. Representatives from various disciplines as well as a clinician serving as liaison between the Mental Health PBRN-VA and the University PBRN joined in at the first meeting. Over the initial sessions a mission statement, goals and structure of the network were agreed upon. The structure included a Steering Committee, a research subcommittee and general membership. Our Health Services Research Program volunteered ongoing study design and statistical support. The significant interest among participating clinicians for this practice-based research network is encouraging, particularly considering that establishing a research culture in clinical practice is challenging. The first projects will serve as testing ground for development of future studies. References 1. Niebauar, L and Nutting, P: Practice Based research networks: the view from the office. Journal of Family Practice, 38, 4 :409-(6), Westfall,J; Mold, J: Practice-Based Research: "Blue Highways" on the NIH Roadmap. JAMA 2007; 297: J Am Board Fam Med June Special issue on PBRNs. 4.Lindbloom,EJ; Ewigman,BG et al: Practice-Based Research Networks. The laboratories of Primary Care Research. Medical Care , 4: III45-III-49 5.Zeber,J; Pearson, D et al. Primary Health Care : With the input from general members, the Steering committee voted on addressing the issue of No-Shows 5 first, focusing on both the providers' and the patients' perspectives. For the providers' perspective a small card containing questions about primary diagnosis, extent of concern for No-Show for future appointments and primary reasons for that belief were distributed. Providers were to fill a card after each clinical encounter for one-week period. Information on 263 encounters were obtained from the19 providers that participated in this card study. Clinicians reported high concerns for future No-Shows in 24% of the patients. 25% of the patients with PTSD and 25% of the patients with depression were identified of high concern for future No-Shows. Among the 64 patients identified as High Concern, the top five reasons for that perception were: History of No-Shows, Poor insight into illness, Comorbid alcohol/substance abuse, Comorbid personality disorder and transportation problems. Among the 199 patients identified as of Low Concern, the most common reasons for that perception were: Good therapeutic alliance, Strong motivation to stay in treatment, Good insight into illness, Good social support. At this time the patients' survey is underway. Specific goals for the PBRN-VA are: 1)to develop ideas for research projects that are relevant to the clinicians and veterans; 2)provide rapid feedback to clinicians about questions, methods and results; 3)serve as "a community of learning" to draw upon the experience and expertise of mental health providers to improve the care of the veterans. Albana Dassori, MD 1, John Zeber, PhD, 2 Laurel Copeland, PhD 2, Holly Hayes, MSPH 3, Stephanie Reyes BA 3 1 Psychiatry Services and 2 Health Services Research and Development, South Texas Veterans Health Care System, 3 Institute for Integration of Medicine & Science, University of Texas Health Science Center San Antonio