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/^((02([-\/])29\3(\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00)))|((((0[1-9]|1[012])([-\/])(0[1-9]|1\d|2[0-8]))|((0[13-9]|1[012])([-\/])(29|30))|((0[13578]|1[02])([-\/])31))(\11|\15|\19)\d{4}))$/

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GtoUC46hGDARWJvzTJ5tU6JduF4BaWKFKZA9eCcjHUxgmyXegsdZ7w2

West Virginia Practice-Based Research Network Study Proposal Application

Guidelines:

1. To utilize all WVPBRN available resources, potential research projects are formally proposed to the WVPBRN Protocol Review Committee via this application process. We strongly encourage you to consult with WVPBRN staff before application as needed to help with resources and questions and review the capabilities of the Network.

2. A proposal must be approved by a majority of the Protocol Review Committee to become a WVPBRN project. Voting may take place via the web, at in-person committee meetings, or a combination thereof. Committee members are generally given a two-week time frame by which to review the proposal and respond with their decision. A non-response from a Committee member is recorded as no objections to the study proposal.

3. All partners leading or highly involved in WVPBRN research projects must complete Human Subjects Training (i.e., Collaborative Institutional Training Initiative [CITI Program]).

4. When possible, the Principal Investigator(s) of the research project should submit a summary of any grant applications which intends to involve the WVPBRN as a partner before submitting the grant.

For assistance with your research proposal or for more information regarding the WVPBRN, please contact one of the following:

Jen Lukas, Network Manager-WVPBRN, at 304-293-7015 or jg0138@hsc.wvu.edu

Stacey Whanger, Assistant Director-WVPBRN, at 304-591-1821 or swhanger@hsc.wvu.edu

Name:

* must provide value

Phone:

* must provide value

Email:

* must provide value

Clinic or Institution:

Department (if applicable):

* must provide value

Address:

* must provide value

Preferred contact method

call

text

either

other

What stage is your project currently?

* must provide value

I am just thinking through an idea(s).

I have an idea, ready to start putting a plan together.

I have a project idea written up and ready to move forward.

I am preparing to submit my project for funding.

I have received funding and now ready to start the project.

I am working on the project implementation.

I am in the middle of this project

I have finished a project

I'm unsure

Other

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If other, please describe here:

* must provide value

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Title:
(final or working title)

* must provide value

Estimated start date:

* must provide value

Estimated project length:

Is this project currently funded?

Yes

reset

Are you currently either looking or applying for funding?

Yes

reset

Please list funding source(s) or potential funding source(s):

* must provide value

Grant Submission date (if applicable):

What services can the WVPBRN provide to be helpful to you?
Please check all that apply.

* must provide value

Study design feedback/guidance

Grant writing/submitting

Community engagement

Targeted site recruitment (sites that fit criteria best)

Open recruitment among all WVPBRN sites

Discuss the project at a Design Studio session

Provider recruitment

Patient recruitment

Access library resources and literature review support

Help with the Institutional Review Board process and/or Human Subjects Training

Dissemination

Clinical data support

Other resources

Unsure, but would like to learn more

Briefly describe your past experience (if any) working with communities in research.

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Do you have Institutional Review Board (IRB) approval for your study? If yes, please provide documentation to network staff prior to implementation.
(Note: If you would like guidance on the IRB process, please note that in the question below.)

* must provide value

Yes

In progress

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Is this project idea a clinical trial as defined by the National Institutes of Health?

For more information on the definition of a clinical trial, visit https://grants.nih.gov/ct-decision/index.htm.

* must provide value

Yes

Unsure

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Rationale & Specific objectives:
Please describe your objectives for the study and how these objectives contribute to improving health outcomes in WV.

* must provide value

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What groups are this project interested in recruiting and/or engaging in the project with the WVPBRN?

* must provide value

Patients

Providers

Patients and providers

Clinical teams/health systems

Speciality providers

Community organizations

Local health depts

Other

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How many are you planning or needing to recruit in your study?

(Please give an approximate if you are unsure at this point).

* must provide value

What would be the roles and responsibilities of the sites would play throughout the project?

* must provide value

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What is the benefit to any clinical partners, community organizations, or patients participating in this study?

* must provide value

Patient identification for treatment/prevention

Quality of care improvement

Patient referral processes

Access to resources

Other

Approach: Please include your approach as it relates to the primary care sites. If study reimbursement applies to sites, providers, or patients, please note here when applicable.

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Dissemination plans, potential impact of the research, and sustainability:
Please describe how information would be disseminated directly back to PBRN membership, in addition to scholarly presentations and publications.

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Please briefly explain the potential impact and expected outcomes for patients with health disparities.

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References:
Please provide any references used for your study application.

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Please list the other resources that are needed for your study:

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Please attach any project documents that you would like to share with the WVPBRN review committee.

Upload file

Thank you for your submission. The WVPBRN staff will be in touch soon.

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