REACH

Practice-based Research (PBR) is a type of research that asks questions that originate from day-to-day clinical practices and collects/analyzes data generated during the course of practice -- for the purposes of understanding and improving effectiveness, efficiency and quality.  PBR conducts pragmatic studies tied to the real (“messy”) world of practice, instead of highly structured controlled randomized trials, the results of which are often challenging to apply back to the real world.

The average number of questions that arise during a day in practice is upwards of 15-20. Compared to 20 years ago, many of these questions are now more answerable to a reasonable approximation from the current evidence base and literature. This is because that knowledge has been made more accessible to the clinician by advances like highly cross-linked and regularly updated “electronic texts” like “Up-to-Date”, and the more recent AI/LLM resources like “Open-Evidence” that can synthesize an answer to a complicated natural language clinical question.  Despite these tools, there are still many unanswered questions that PBR can help answer.

As with all research, PBR has required steps to optimize its practicality and impact. The first is defining the clinical question carefully. These arise directly from clinicians’ observations in practice about many aspects of care: what is the best way to screen for, diagnose or manage a given problem, how widespread is the challenge among all the patients in the practice or in the community, are there systemic approaches to preventing or affecting the outcomes for a particular challenge, etc. Such ideas of how to improve practice are often called Quality Improvement (QI).

The next step is to decide what data elements are needed to answer the question and planning data collection methods that least disturb day-to-day practice. The data are often collected with a mixed methods approach, that is they include both quantitative data directly from the EMR and qualitative elements obtained from patient reported outcomes or experiences often via questionnaires.  These data reflect the actual real-world events going on with patients in the course of their care.

A major requirement of PBR is that one must have the ability to extract data from the EMR, but also to be able to innovate the data capture in the EMR on the front end. This expertise is sometimes hard to come by and is not cheap. Some data collection in PBR can be done more simply and inexpensively, but if an increased scale is desired EMR-based data capabilities are required.

The final step is to analyze the data and design interventions to improve clinical practice. This is usually done over a short time frame, and the process can be repeated until one achieves an acceptable level of improvement. This process can be described as the “plan-do-study-act” or PDSA cycle.

PBR has several advantages: 1) it is designed to be a “byproduct” of the care being delivered so it can be done in parallel with ongoing practice; 2) it is a good beginning form of research because clinicians are motivated by their own practice needs and clinical curiosity, which helps them be and remain engaged; 3) the outcome is pragmatically useful as it can often actually improve practice in the short run.

Interested in partnering with UC San Diego clinician-scientists to work on practice-based research projects? With support from the Krupp Endowed Fund, the UC San Diego Centers for Integrative Health uses PBR to evaluate the impact of our integrative medicine clinical programs and services on a range of health conditions. These studies help generate evidence that directly informs patient care, advances best practices, and improves outcomes across our community. Pilot grants for in-kind research support are available each year.  Learn more at cih.ucsd.edu/research/practice-based-research/

Hemal Patel is a Professor in the Department of Anesthesiology at UC San Diego, a VA Research Career Scientist, and a Co-Investigator on the UCSD REACH Center. His research focuses on mitochondrial biology and translational science, with work spanning cardiovascular disease, aging, neurodegeneration, and meditation research related to whole-person health.

In His Own Words

What project or idea are you currently most excited about?
The project that most excites me right now is our multi-omic profiling of the relationship between mind and body. We are beginning to see a unique molecular and physiological signature of energetics as a core integrating feature. Having studied the relationship between plasma membranes and mitochondria in stress adaptation for many years as a basic science problem, it is fascinating to see how many common features connect a single cell to an animal to the whole human.

What originally drew you to work in integrative or whole-person health?
I grew up deeply contemplative — comfortable sitting in silence for hours. I was raised Hindu, though I never really practiced formally, but always felt a sense that something larger than myself existed in the universe. I met my wife in high school; she was raised Catholic and faith was central to her life. In college, I explored philosophy and religion alongside biology and classical studies, because faith was something I couldn’t piece together the way I could science. My theology was shaped by two Germans: one a Hindu who became my guru, the other a pastor and professor who introduced me to Western faith. These were defining moments that ultimately led to my conversion to Christianity as an adult. As a scientist living within a worldview shaped by both reason and faith, whole-person health is a cornerstone of that way of seeing the world. We are our bodies — but our minds and thoughts matter just as much.

What is one piece of advice you received that has stuck with you throughout your career?
Find a mentor who is interested in developing you as a colleague. These individuals will become your lifelong guides and champions.

Looking back, what is something you wish you had known earlier in your career?
Know your worth as an individual — and challenge those who do not see it or will not let you express it.

What book, podcast, or resource has influenced how you think about health or research?
I recently read Transformer by Nick Lane. It aligns closely with what we are thinking about in whole-person health: that energy is what connects us both internally and externally. At the core of this is metabolism — and DNA is, in some ways, a less central player than we’ve long assumed.

What is one small habit that improves your daily well-being?
Think before I speak and interact — and try to see the good inside the person on the other end. When I don’t do this, the day is invariably less productive. When I do, life seems remarkable.