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Brigham and Women’s Primary Care Practice Based Research Network

Preliminary Proposal Application

Preliminary proposals are research ideas that are being explored for development into a full proposal, pending initial endorsement from the BWPC PBRN. Preliminary proposal review provides a mechanism for issuing letters of support to potential investigators. The BWPC PBRN reviewers and Steering Committee will consider a proposal’s significance; alignment with the Mission of the BWPC PBRN; relevance to our practice and patients; feasibility; potential to improve primary care practice or community health; approach; innovation; qualifications of the investigator(s); resources; and conflicts with other active projects. Priority will be given to projects that have a BWPC PBRN Clinician as a Co-Principal Investigator or Co-Investigator. Please allow a minimum of 3 weeks for review and Steering Committee initial endorsement.

Directions:

Please describe the proposed project as completely as possible by responding to the following questions. When completed, email this form to .

1.  Proposal Identification

Title of project: ______

Principal investigator: ______

Other investigators: ______

______

Home organization/practice site: ______

Phone/e-mail: ______

Topic: ______

Project start and end dates: ______

Potential Funding source: ______

Submission deadline (if applicable): ____/____/______

IRB/HRC Approval: Yes No

2. Purpose: What is the purpose of your study? Please state your principal questions and/or specific aims.

3. Background: Concisely describe the scientific background of your study.

4. Clinical Relevance: Why is this research important to primary care practices and the communities they serve?

5. Design and methods: include project design, target population, projected sample size, and other methods.

6. Patient Recruitment, Communication, and Impact: Describe how you are going to obtain PCP approval for contacting patients; contact patients; and communicate with patients throughout the life of your project. (NB: Use of a recruitment letter that is co-signed by the PCP and investigators is not acceptable. You must use separate letters signed by the PCP and investigator(s).)

7. Practice and PBRN Impact: Describe resources required to initiate, implement, and complete this project and how you plan on supporting these resources. We strongly encourage the engagement and participation of PBRN clinicians as co-investigators.

PBRN Resource / Brief Justification / % FTE or number of hours for Personnel / Other Resource Description (item, location, number) / Duration of Projected Resource Need / Amount of Funding Request in Proposal
PBRN Staff
PBRN Investigator
Data Management
Practice Administrative Staff
Practice Clinician(s)
Practice Nursing
Other Personnel
Practice Equipment
Practice Space
Other Practice Resource

8. Significance of your project: How will this project contribute to primary care practice?

9. Other information: What other information should reviewers know about this proposal?

______

Principal Investigator Date

Proposals must not exceed 4 pages in (11 point Times New Roman or Arial)

Last updated: April 2016