Background: The objective of this study was to determine the impact of the Wellness Portal-a novel, web-based patient portal that focuses on wellness, prevention, and longitudinal health-on the delivery of patient-centered preventive care by examining the behavior and experiences of both patients and primary care clinicians and the degree to which recommended services were individualized and provided.Methods: We conducted a 3-year, systematic portal development and testing study, which included a 6-month feasibility and acceptability pilot in 2 primary care practices followed by a 12-month cluster randomized controlled trial in 8 clinician practices (4 in each study group). Descriptive and bivariate analyses were conducted to compare service delivery between intervention and control arms.Results: Ninety percent of patients in the pilot study found the portal easy to use, 83% found it to be a valuable resource, and 80% said that it facilitated their participation in their own care. The cluster randomized controlled trial included 422 adults 40 to 75 years of age and the parents of 116 children 2 to 5 years of age. Seventy three percent of patients used the portal during the study. Both patient activation (measured via the 13-item Patient Activation Measure) and participants' perception of patient-centeredness of care (measured via the Consumer Assessment of Healthcare Providers and Systems instrument) increased significantly in the portal group compared with control (P ‫؍‬ .0014 and P ‫؍‬ .037, respectively). A greater proportion of portal users received all recommended preventive services (84.4% intervention vs 67.6% control; P < .0001); took low-dose aspirin, if indicated (78.6% intervention vs 52.3% control; P < .0001); and received Pneumovax because of chronic health conditions (82.5% vs 53.9%; P < .0001) and age (86.3% vs 44.6%; P < .0001), despite having fewer visits over the study period compared with those in the control group (average of 2.9 vs 4.3 visits; P < .0001). Children in the intervention group received 95.5% of all recommended immunizations compared with 87.2% in the control group (P ‫؍‬ .044).Conclusions: A comprehensive patient portal integrated into the regular process of primary care can increase the patient-centeredness of care, improve patient activation, enhance the delivery of both ageand risk factor-appropriate preventive services, and promote the utilization of web-based personal health records. (J Am Board Fam Med 2012;25:158 -167.)

IntroductionCOPD is a leading cause of morbidity and mortality. Self-management interventions are considered important in order to limit the progression of the disease. Computer-tailored interventions could be an effective tool to facilitate self-management.MethodsThis randomized controlled trial tested the effectiveness of a web-based, computer-tailored COPD self-management intervention on physical activity and smoking behavior. Participants were recruited from an online panel and through primary care practices. Those at risk for or diagnosed with COPD, between 40 and 70 years of age, proficient in Dutch, with access to the Internet, and with basic computer skills (n=1,325), were randomly assigned to either the intervention group (n=662) or control group (n=663). The intervention group received the web-based self-management application, while the control group received no intervention. Participants were not blinded to group assignment. After 6 months, the effect of the intervention was assessed for the primary outcomes, smoking cessation and physical activity, by self-reported 7-day point prevalence abstinence and the International Physical Activity Questionnaire – Short Form.ResultsOf the 1,325 participants, 1,071 (80.8%) completed the 6-month follow-up questionnaire. No significant treatment effect was found on either outcome. The application however, was used by only 36% of the participants in the experimental group.ConclusionA possible explanation for the nonsignificant effect on the primary outcomes, smoking cessation and physical activity, could be the low exposure to the application as engagement with the program has been shown to be crucial for the effectiveness of computer-tailored interventions. (Netherlands Trial Registry number: NTR3421.)

Practice facilitators (PFs) are health care professionals, who assist primary care practices in research and quality improvement activities. Their work goes beyond data collection and feedback and includes practice enhancement methods to facilitate system-level changes. PFs provide a framework for translating research into practice by building relationships, improving communication, facilitating change, and sharing resources in practice-based research networks (PBRNs). Scope/Range of ActivitiesWithin PBRNs, PFs participate most often in externally funded research projects initiated by an academic organization. Although network clinicians may have an active role in the planning and the completion of these projects, the activity of PFs is driven mostly by the study protocols. In these projects, PFs act as research assistants. However, the PF model underscores the importance of relationship building. Relationships developed between the PFs and a group of practices is essential to implement and sustain interventions in primary care. PFs also assist clinicians in local research and QI projects initiated by the practices. Clinicians may develop project ideas on their own, or PFs can help the practices initiate projects based on an assessment of the practice's needs and potential to implement interventions. Project ideas and solutions are often shared with other providers within a PBRN via the PFs (cross-pollination). 4,5 Relationships with PracticesBecause translational research projects often require the re-engineering of the practice, it is espe-

Introduction

Practice-based research networks (PBRNs) have developed dynamically across the world, paralleling the emergence of the primary care discipline. While this review focuses on the internal environment of PBRNs, the complete framework will be presented incrementally in future publications.Methods: We conducted a scoping review of the published and gray literature. Electronic databases, including MEDLINE (PubMed), OVID, CINAHL (EBSCOhost), Scopus, and SAGE Premier, were searched for publications between January 1, 1965 and December 31, 2020 for English-language articles. Rigorous inclusion/exclusion criteria were implemented to identify relevant publications, and inductive thematic analysis was applied to elucidate key elements, subthemes, and themes. Social network theory was used to synthesize findings.Results: A total of 229 publications described the establishment of 93 PBRNs in 15 countries that met the inclusion criteria. The overall framework yielded 3 main themes, 12 subthemes, and 57 key elements. Key PBRN activities included relationship building between academia and practitioners and development of a learning environment through multidirectional communication.Conclusions: PBRNs across many countries contributed significantly to shaping the landscape of primary health care and became an integral part of it. Many common features within the sphere of PBRNs can be identified that seem to promote their establishment across the world.