Frontier Rural Research Network

From Practice, For Practice, Into Practice


FRRN is the Frontier Rural Research Network, established in the Montana Family Medicine Residency Program as a Practice-Based Research Network (PBRN) for Frontier and Rural Primary Care Clinics

Principal Investigator: Renée Crichlow MD

Who is FRRN?

Eventually X number of primary care clinics in X number of Western states all in designated Frontier or Rural health service areas (here after abbreviated as Rural). We will start with 7-10 clinics in Montana. FRRN clinic members will    have as active participants the MDs, D.O.s, RNs, NPs, PAs, and office managers  of each respective clinic. We have over 400 potential primary care providers in the initial area of concern. 


Why FRRN?  

In 2000, rural America contained 56.1 million residents, or about 20-percent of the total U.S. population. Over seventy percent of Montana communities qualify as rural by every government definition of that designation; in addition a significant amount of Montana qualifies as frontier having less than 6 people per square mile with vast distances between population centers. Primary care practice in these geographically isolated environments has unique demands, considerations and challenges not often addressed by the University initiated research projects.


Developing and implementing evidence based care must meet these unique rural challenges in order to address and decrease the disparities facing health care in rural America.



       Research questions generated from rural practices, collecting pertinent  data from these practices, evaluating the data for patient oriented outcomes, i.e. Generating Research from Rural Practices (GRP)

       Translating Research into Practice (TRP) in a more efficient manner because the Clinics are stakeholders in the GRP and TRP

       Creating an Information Technologies based network wide Continual Quality Improvement (CQI) with the goal of improving rural patient outcomes

       Creating, providing and monitoring usage of web-based Continual Medical Education (CME) based directly on the GRP and CQI data generated. This CME would be for all FRRN members including the Clinics and individual clinic members MDs, D.O.s, RNs, NPs, PAs, and office managers.


Methods will be very Information Technology (IT) robust and interactive:


The FRRN web site will be a nexus unifying TRP, GRP, CME and aggregated CQI. Not only will it be a point of care question generator for GRP and gateway to point of care health care information for TRP and CME, the web site will facilitate the network sharing CQI data generated through the respective Electronic Health Records (EHR) to allow Benchmarking on Protocols of Care (PCs).


“The Curbside” will be a collegial list serve of the respective individual members where discussion groups may, in a HIPPA approve manner and level of encryption, discuss questions, concerns, and challenges facing either their clinic, patients, or FRRN.


GRP is a FRRN priority the research questions will be submitted through the web site by a nominating member and voted on by the participating the Clinic Members (CMs). CME will be an important part of diffusing the ability to generate the testable research questions originating from CMs.


Research questions chosen by the network CMs will then enter the project generating and execution cycle of FRRN.  Clinics and CMs volunteers may participate at many and multiple levels. The FRRN clinics will provide the necessary data and FRRN will have a centralized technical research support for the research design, analysis and dissemination of outcomes.


In Summary:

FRRN as a PBRN is patient care oriented learning collaborative using continual quality improvement as a practical science facilitated by information technology with the mission of using real world rural health care questions to design, implement and continually evaluate best practices in a practical setting.


FRRN will aim to reduce the lag that has arisen around transferring research with beneficial outcomes into clinician care with practical effect. The dissemination, diffusion and implementation of research with pertinent impact on rural patient outcomes will be the facilitated by the processes of the FRRN primarily because the research questions and answers will be generated from the stakeholders of interest in both the question input and patient oriented outcomes.


The Frontier Rural Research Network, FRRN is meant to generate the real world research and research questions that will help address maintaining quality care and best practices when appropriate and finding and evaluating innovative methods to address the significant health care disparities that exist in rural America.


We have the full support of the home agency the Montana Family Medicine Residency program (MFMR) which supplies a significant number of their graduates to eventually practice in the clinics of interest for the FRRN. The Montana Family Medicine Residency is a freestanding not-for-profit 501(c)(3).  This is the first and only residency training program in the state of Montana, established to provide training in the state for Family Practitioners, specifically for physicians intending to practice in rural or frontier areas.


The Residency is governed by a Board of Directors that employs a Program Director to administratively oversee the Residency Program.  The Residency is a member of the Washington Wyoming Alaska Montana Idaho, (WWAMI) network of residencies and Dr. Crichlow has an appointment as an Assistant Professor through the University Of Washington School Of Medicine, Department of Family Medicine. The MFMR residency is financially supported through a combination of Graduate Medical Education (GME) funding passed through from our two affiliated hospital (St. Vincent Hospital and Health Care and Deaconess Billings Clinic), contract monies paid to support faculty clinical activities in the Community Health Clinic, and legislatively appropriated funding from the State of Montana. 


The MFMR provides both on site and University of Washington based didactics, seminars and research support. The facilities to house, develop, and support the FRRN are available and sufficient. Fax, computers, information technology and IT support are on site. Full access and internet facilities are available for complete online full text, access to the University of Washington Health Science Libraries and Librarians. Administrative Assistance supports including a dedicated Research Assistant position are in place.

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