Primary Care

The entry point into the health system for most individuals, through a provider that delivers non-specialized, continuous, and coordinated care.

Educating Health Professionals on Social Determinants of Health

Apr. 6, 2016

Health professionals are ill-prepared to address social factors that contribute to poor health, because these factors often lie beyond the scope of medical education. But just as addressing social determinants of health (SDH) involves stretching beyond traditional medical practices, educating health professionals involves stretching beyond traditional medical education.

Retainer-Based Medicine: Where is the Research?

Feb. 8, 2016

About 10 years ago, my primary care physician decided that she would no longer take insurance, and left the practice.  Patients could pay directly to continue in her care in her new practice, or see another physician in the existing practice.  I chose to stay in the practice with another physician.

Effect of Financial Incentives to Physicians, Patients, or Both on Lipid Levels: A Randomized Clinical Trial

Research Brief
Jan. 15, 2016

To whom should financial incentives be targeted to achieve a desired clinical or health outcome—physicians or patients? Using insight from behavioral economics, a research team led by LDI Senior Fellows David Asch and Kevin Volpp sought to determine whether physician financial incentives, patient incentives, or shared physician and patient incentives are more effective in promoting medication adherence and reducing cholesterol levels of patients at high risk for cardiovascular disease. Though physician and patient incentives are becoming more common, they are rarely combined, and effectiveness of these approaches is not well-established. This study offers insight into what incentive structure leads to the greatest impact on health promotion. 

Preterm Infant Attendance at Health Supervision Visits

Oct. 29, 2015

Jo Ann D’Agostino, Molly Passarella, Philip Saynisch, Ashley Martin, Michelle Macheras, Scott Lorch

In Pediatrics, Jo Ann D’Agostino and colleagues, including Scott Lorch, evaluate to what extent premature infants adhere to the American Academy of Pediatric’s (AAP) health supervision visit schedule, what factors affect adherence, and how adherence associates with receiving suggested preventive care. The AAP recommends periodic health supervision visits throughout childhood to monitor growth and development, and to screen for illnesses.  Using data from a 30-site primary care network, the authors find less than half of the infants received all expected health supervision visits....

Influence of provider mix and regulation on primary care services supplied to US patients

Oct. 15, 2015

Michael Richards, Daniel Polsky

In Health Economics, Policy and Law, Michael Richards and Daniel Polsky explore the link between provider mix and access for different patient types. The authors use data from a field study spanning 10 states where trained audit callers were randomly assigned an insurance status and then contacted primary care physician practices seeking new patient appointments. Clinics with more non-physician clinicians are associated with better access for Medicaid patients and lower prices for office visits. However, the authors only find this association in states granting full practice...

Asking the Patient About Patient-Centered Medical Homes: A Qualitative Analysis

Sep. 21, 2015

Jaya Aysola, Rachel M. Werner, Shimrit Keddem, Richard SoRelle, and Judy A. Shea

In the Journal of General Internal Medicine, Jaya Aysola and colleagues, including Rachel Werner and Judy Shea, assess patients’ perspectives of the patient-centered medical home (PCMH) model and compare responses by degree of practice-level PCMH adoption and patient race/ethnicity. The authors interviewed 48 patients with diabetes and/or hypertension enrolled in PCMHs within the University of Pennsylvania Health System. They purposively sampled minority and non-minority patients from the four highest-ranked and four lowest-ranked PCMH-adopting practices to determine whether...

Impact of the Patient-Centered Medical Home on Veterans’ Experience of Care

Sep. 14, 2015

Ashok Reddy, Anne Canamucio, Rachel Werner

In the American Journal of Managed Care, Ashok Reddy and colleagues, including Rachel Werner, assess whether the adoption of patient-centered medical homes improves patient experiences of care. Using a linear probability model they tested whether the adoption of the medical home model is associated with changes in patient experiences of care, looking at primary care sites in one region of the Veterans Health Administration. Despite a significant increase in medical home implementation, the authors find no association between medical home adoption and five domains of patient...

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