Primary Care

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

The Effect of Primary Care Provider Turnover on Patient Experience of Care and Ambulatory Quality of Care

Aug. 27, 2015

Ashok Reddy, Craig E. Pollack, David A. Asch, Anne Canamucio, Rachel M. Werner

In JAMA Internal Medicine, Ashok Reddy and colleagues, including David Asch and Rachel Werner, measure the effect of primary care provider (PCP) turnover on patient experiences of care and ambulatory care quality. For the study, the authors used a nationwide sample of primary care patients in the Veterans Health Administration (VHA). They assessed how many patients experienced PCP turnover and looked at five patient care experience measures and 11 measures of quality of ambulatory care. They find that 9% of patients experienced PCP turnover. Those who’d experienced turnover were...

Does Philadelphia Have Primary Care Deserts?

May. 19, 2015

Cross-posted with the Field Clinic blog

Over the past two years, one of the top health care priorities in Philadelphia has been getting people signed up for health insurance. That is still a huge, unfinished task, but alongside it we need to make sure we have enough doctors in the right places to deliver care. For health care reform to deliver on its promise, people need good access to primary care.

Perceptions of High-Risk Patients and Their Providers on the Patient-Centered Medical Home

Apr. 1, 2015

Shreya Kangovi, Katherine Kellom, Christopher Sha, Sarah Johnson, Casey Chanton, Tamala Carter, Judith A. Long, David Grande

In the Journal of Ambulatory Care Management, Shreya Kangovi and colleagues, including Judith Long and David Grande, analyze patient and primary care practice staff perceptions of patient-centered medical homes (PCMH). Through a multi-state qualitative survey, the authors explore areas of agreement and tension between the perceptions of chronically ill, low-income patients and their primary care practice staff on PCMH principles and implementation strategies. PCMH are a team-based delivery model that emphasize continuity of care and health outcomes. Kangovi and colleagues’ conclude some...

Adoption of Electronic Medical Record-Based Decision Support for Otitis Media in Children

Apr. 1, 2015

Alexander G. Fiks, Peixin Zhang, A. Russell Localio, Saira Khan, Robert W. Grundmeier, Dean J. Karavite, Charles Bailey, Evaline A. Alessandrini, Christopher B. Forrest

In Health Services Research, Alexander Fiks and colleagues, including Christopher Forrest, analyze the impact of feedback in improving adoption of clinical decision support (CDS). The work is part of a larger trial of the effectiveness of CDS for diagnosing and treating ear infections in children. While substantial investment in electronic health records (EHRs) has provided an unprecedented opportunity to use CDS, the impact of feedback on clinician use of CDS systems has not been well studied. The authors looked at EHR-based CDS adoption during 41,391 ear infection visits, and...

Medicaid Fee Bump: Gone Too Soon?

Feb. 4, 2015

The story of the Medicaid fee bump is, first and foremost, a story of a policy to improve access to primary care for Medicaid recipients, by paying physicians more to see them. But it is also a story of how research can answer an important policy question, and how it can affect policy as it is being made. That's the story we tell here:

Primary Care Appointment Availability and Preventive Care Utilization: Evidence From an Audit Study

Jan. 17, 2015

Brendan Saloner, Daniel Polsky, Ari Friedman, Karin Rhodes

In Medical Care Research and Review, Brendan Saloner (Johns Hopkins University), and Penn colleagues Dan Polsky, Ari Friedman and Karin Rhodes, analyzes adult preventive care utilization and primary care appointment availability. The authors link individual-level, cross-sectional data on adult preventive care utilization from the 2011-2012 Behavioral Risk Factor Surveillance System to novel county-level measures of primary care appointment availability collected from an experimental audit study conducted in 10 states in 2012 to 2013 and other county-level health service and...

The Affordable Care Act and Minority Health: Part IV (Workforce Diversity)

Jan. 15, 2015

As the Affordable Care Act’s health insurance marketplaces begin their second year of open enrollment, LDI examines the current and potential impact of the ACA on the health of minority populations. This fourth post of a five-part series describes the current initiatives to diversify the health care workforce with greater minority participation.

Healthcare System Supports for Young Adult Patients with Pediatric Onset Chronic Conditions: A Qualitative Study

Jan. 11, 2015

Dava E. Szalda, Manuel E. Jimenez, Jeremiah E. Long, Amelia Ni, Judy A. Shea, Sophia Jan

In the Journal of Pediatric Nursing, Dava Szalda and colleagues examine how adult primary care teams can facilitate the transition and ongoing care of adults with pediatric onset chronic illness. Currently, over 90% of pediatric patients with chronic medical conditions are living into adulthood. For some pediatric onset chronic conditions there are more adults living with an illness than children. This qualitative study explores practice supports and barriers to care for this population, comparing them to other patients with chronic illness in order to identify facilitators that...

Primary Care Shortages: More Than a Head Count

Issue Brief
Nov. 21, 2014

The existence of a primary care physician shortage, even prior to the ACA, is not universally accepted. A new report by the Institute on Medicine found “no credible evidence” that the nation faces a looming physician shortage in primary care specialties. There is greater consensus about a maldistribution of physicians, in terms of specialty, geography, and practice settings. 

Primary Care Shortages: More Than Just a Head Count

Nov. 21, 2014

A new LDI/INQRI Research Brief, written by Mark Pauly, PhD, Mary Naylor, RN, PhD, and me, reviews the evidence of an existing or looming primary care shortage in the wake of the ACA. Will the combined effects of an aging population, an increase in coverage and demand for care, and a decrease in the number of physicians going into primary care create widespread gaps in access? Who will treat the newly insured, and will this exacerbate existing workforce shortages?

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