ORPRN founder Dr. Lyle “L.J.” Fagnan retires

Sept. 18, 2018

On the frontier of improving health care for rural Oregonians, L.J. Fagnan, M.D., is a pioneer. In 2002, this veteran family medicine doctor and OHSU faculty member since 1993 founded the Oregon Rural Practice-based Research Network (ORPRN).

Now this independent research center, which enhances the health of rural Oregonians by pairing primary care physicians with researchers to improve and evaluate processes of care and practice culture, has reached a new chapter. Dr. Fagnan is retiring, ORPRN has officially become a program of the School of Medicine and the ORPRN Steering Committee has selected Nancy Elder, M.D., M.S.P.H., will succeed Dr. Fagnan as director Oct. 1.

Dr. Elder will have an appointment of professor, provisional, in family medicine, OHSU School of Medicine. Dr. Fagnan has earned faculty emeritus status to continue work on select projects as director of the Meta-LARC consortium.

"Over the years, ORPRN has become a trusted resource for disseminating best practices and facilitating practice transformation throughout Oregon," said Dr. Fagnan. "I'm excited Nancy is coming on board; she's highly experienced in working with practices. She'll take ORPRN to the next level."

"With ORPRN becoming a part of OHSU School of Medicine, I have had the privilege of working with Dr. Fagnan and the ORPRN team. I am confident that Dr. Elder will build upon L.J.'s legacy and further ORPRN's influence throughout the region," said Atif Zaman, M.D., senior associate dean for clinical and faculty affairs, OHSU School of Medicine.

Expertise in practice-based research

Dr. Elder, a family physician for 30 years, has more than 20 years of experience in primary care practice-based research. From 1992 to 1999, she held a clinical faculty position at OHSU in the Department of Family Medicine, teaching medical students and residents and providing clinical care.

In 2001, she joined the faculty at the University of Cincinnati as a clinician-researcher, ultimately directing research at the University of Cincinnati Department of Family and Community Medicine for eight years. For 15 years, her clinical practice was caring for homeless individuals, and she maintains an interest in caring for the underserved. She founded and directed the Cincinnati Area Research and Improvement Group (CARInG) Practice-Based Research Network. Her research interests include patient safety, quality of care, the management of chronic pain and the opioid epidemic. Earlier this year, she retired as a professor emeritus from the University of Cincinnati.

In returning to OHSU as ORPRN director, she says she's excited to be back in the Pacific Northwest and is thrilled to be working with ORPRN's talented team of researchers and clinicians.

"Dr. Fagnan has created one of the most productive and well-respected practice-based research networks around, and I'm honored to be selected for the directorship on his retirement," said Dr. Elder.

Her goal in the role, she says, is to maintain ORPRN's excellent reputation with Oregon's rural physicians, while working with other rural research endeavors at OHSU to expand and coordinate rural health research. Another component of the position, she says, will be training the researchers of tomorrow in the importance of practice-based research. 

"Primary care is the backbone of health care in rural Oregon, and no one knows that like the ORPRN physicians and their practice teams," said Dr. Elder.

Growth of ORPRN

ORPRN founder Dr. L.J. Fagnan began rural Oregon practice in 1977 as a family physician in Reedsport, Ore., where he started the successful clinic Dunes Family Health Care, before joining the OHSU Department of Family Medicine in 1993 and becoming the founding medical director of the OHSU Family Health Center at Gabriel Park.

But he missed rural practice and soon found a way to maintain those roots. With support from The Oregon Opportunity, a state-funded, public-private partnership to advance OHSU biomedical research, and the U.S. Agency for Healthcare Research and Quality, he launched ORPRN, an Oregon practice-based research network (PBRN) in 2002. ORPRN's mission is to improve the health of rural Oregonians by promoting knowledge transfer between communities and clinicians.

The research center, which employs community-based Practice Enhancement and Research Coordinators (PERCs) to conduct research and support member clinics, participates in a number of national initiatives. In 2015, in partnership with the MacColl Center for Health Care Innovation at the Kaiser Permanente Washington Health Research Institute, ORPRN led Oregon's work with the $112 million national EvidenceNOW effort to build quality improvement structures in primary care practices across the country while improving heart health in patients.

And last fall, ORPRN was awarded $8 million by the Patient-Centered Outcomes Research Institute to develop strategies that better align health care with patient preferences through advance care planning.

Under Dr. Fagnan's leadership, ORPRN has grown from 12 primary care practices to 281 practices serving more than 700 physicians across Oregon. It is overseen by an 11-member steering committee. 

Steering committee member Robert "Robbie" Law, M.D. '88, a family physician practicing in Astoria, has known Dr. Fagnan since he was recruited by Dr. Fagnan to the Dunes clinic out of residency. "One of L.J.'s biggest talents is his ability to make connections with people and build teams," said Dr. Law. "He's really good at getting people together and encouraging them. One of the greatest things about ORPRN is not just being connected to a big academic center like OHSU but being connected to practices all across the state where we can get together and feel like we have something in common. L.J. has built a great ORPRN team that is recognized nationally and internationally."

Built on relationships

Back when he founded ORPRN, Dr. Fagnan bought a car to travel to practices across the state. Today, the car, a 2002 Honda Pilot, has more than 250,000 miles on it, he says, the result of "showing up" to build and maintain relationships with ORPRN's physicians and researchers.

"I enjoy the landscape of Oregon," said Dr. Fagnan. "And the story of ORPRN is the story of relationships. When I'm traveling, I stop and see practices even if they aren't doing any current projects with ORPRN, just to see how they're doing. I enjoy that."

In addition to a leadership transition, ORPRN has also undergone administrative changes this year. It is now housed within the School of Medicine organization, and Melissent Zumwalt joined as ORPRN manager earlier this year.

"Practice-based research networks are the antidote to burnout for community practitioners," said Dr. Fagnan. "They are making a difference beyond day-to-day routine of a busy practice by participating in practice-based research, improving the quality of care for their patients and generating new knowledge that improves the lives of Oregon's rural citizens," said Dr. Fagnan. "I'm proud to have played a role and proud of all the relationships I've developed with rural communities over the years."

At its annual PBRN conference in June 2018, the North American Primary Care Research Group awarded Dr. Fagnan the "Pioneer in Practice-Based Research Network Research Award" for lifetime achievement as founding Director of the Oregon Rural Practice-based Research Network and the Meta Learning and Research Consortium (Meta-LARC). In 2005, the Oregon Academy of Family Physicians named Dr. Fagnan its 2005 Oregon Family Doctor of the Year.

Pictured, top to bottom: Dr. Nancy Elder (left) with Dr. L.J. Fagnan in front of a map in which the red dots represent the ORPRN network across Oregon; Drs. Fagnan and Elder  with ORPRN's "lucky shrine," comprised of objects collected from ORPRN travels around the state. ORPRN team members gather around the shrine and touch it before submitting a grant for research funding.