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Center for Primary Care Research
Staff in the Center for Primary Care Research (CPCR), along with interested staff for the Center for Outcomes and Effectiveness Research and the Center for Practice and Technology Assessment, have participated in a collaborative process to develop a research agenda for CPCR. This agenda spans both intramural research conducted by staff and extramural research which the Agency funds through grants associated with the Center. This process included input from all staff members and reflected discussions of primary care from the Institute of Medicine's 1996 report, Primary Care: America's Health in a New Era, and Starfield's 1995 book, Primary Care: Concept Evaluation, and Policy. Working from definitions of primary care and primary care research, we identified core attributes relevant to the research we conduct and sponsor. Following this, we developed a list of relevant topic areas for each concept and prioritized the topics. We intend this to be a "living document" and expect it to evolve over time in response to changes in research knowledge, current issues in primary care practice and policy, and staff and investigator interests.
"Primary Care: Where Research and Practice Meet"
CPCR's broadest vision is to support and conduct research that will improve the access, effectiveness, and quality of primary health care services in the U.S. Designated by Congress as "the principal source of funding for primary care practice research in the Department of Health and Human Services", the Center also seeks to be known nationally as a major source of information on primary care practice and recognized internationally for the excellence of the research we support and conduct. This vision includes a commitment to building capacity within the primary care research community, and to forming productive, sustained partnerships with private and professional groups as well as other government organizations that share the goal of improved primary care services.
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Definition (modified from IOM and Starfield)
Primary care is the provision of integrated, high-quality, accessible health care services by clinicians who are accountable for addressing a full range of personal health and health care needs, developing a sustained partnership with patients, practicing in the context of family and community, and working to minimize disparities across population sub-groups.
Core attributes (modified from IOM and Starfield)
- Primary care serves as a point of first contact for the patient, playing a key role both in access to care and in the coordination of care for patients who use multiple providers or specialists.
- Primary care is holistic and comprehensive, focusing on the whole person and taking into account his or her social context.
- Uncertainty is a common attribute of clinical decisionmaking in primary care.
- Primary care practice is information intensive.
- Opportunities to promote health and prevent disease are intrinsic to primary care.
- A sustained personal relationship between patient and clinician is a key aspect of primary health care, emphasizing the importance of compassion, continuity, and communication between provider and patient.
Definition (from AHRQ's Reauthorizing legislation, 12/99) "[P]rimary care research focuses on the first contact when illness or health concerns arise, the diagnosis, treatment or referral to specialty care, preventive care, and the relationship between the clinician and the patient in the context of the family and community . . . [including] . . . the nature and characteristics of primary care practice . . . the management of commonly occurring clinical problems . . . the management of undifferentiated clinical problems; . . . [and] the continuity and coordination of health services."
Core attributes Primary care research:
- Is grounded in both clinical and social sciences.
- Emphasizes the complexities of conducting research in real-world settings and using secondary data.
- Focuses on disseminating key research findings back into real-world practice and policy, and encouraging their implementation.
- Addresses services that are often ignored in other medical or health services research, including mental health, dental, social, and enabling (e.g., outreach) services.
- May emphasize chronic care, acute care, or preventive care.
- Includes studies of lifestyles and risk factors, as well as ways to change health behaviors.
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- Conducting rigorous, methodologically-sound research in primary care practices can be challenging, due in part to the difficulty of collecting research data in busy practice settings.
- The limited availability of secondary data sources appropriate to primary care research poses a challenge for researchers. Data may be drawn from surveys of patients or providers, from patient records, or from other administrative data sources. Many of these were not primarily designed to support primary care research, and adapting them by adding new components or linking to other databases to increase their relevance poses unique challenges. In addition, gaining access to some of these data sources may be problematic due to the potentially confidential or proprietary nature of the data.
- Information technology (IT) may transform data collection in primary care practices. While IT may increase the capacity for conducting primary care research, it may also increase the gap in knowledge for non-computerized practices, and concurrently may increase disparities among the populations served by these practices.
- Primary care research has a strong foundation in both quantitative and qualitative methods, and encourages familiarity with and use of a wide variety of analytic techniques.
- Developing and refining relevant measures, including measures of access to and quality of care, pose challenges for primary care researchers.
- Protecting the privacy and confidentiality of patient and provider information, as well as gaining clearance from institutional review boards, are prominent concerns in conducting primary care research.
This initiative examines the clinical training and ability of front-line medical staff, including primary care providers, emergency departments, and hospitals, to detect and respond to a bioterrorist threat. This research also focuses on the use of information and decision support systems to enhance clinical preparedness in the event of a bioterrorist threat, and assesses linkages between the health system, local and state public health departments, and emergency preparedness units.
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Staff have a wide range of primary care research interests, and actively collaborate with colleagues within and outside of AHRQ to produce peer-reviewed manuscripts and agency publications, as well as to fund relevant grants. Unless otherwise noted, all staff are with the Center for Primary Care Research.
Joy Basu, Ph.D.
Dr. Basu's research interests include supply and demand issues in primary care, preventable hospitalization, racial and ethnic disparities, managed care, hospital location, geographic barriers to access, and risk adjustment methods.
Helen Burstin, M.D., M.P.H.
Dr. Burstin has served as Director of the Center since January 2000. Her research focuses on primary care topics such as patient-provider communication; disparities in access and quality for vulnerable populations; safety and quality of ambulatory care; and patient satisfaction
Ms. Dillard is interested in working with investigators who study access to and quality of care issues; disparities in health care delivery; rural health research; methods development and evaluation; the scope of primary care delivery systems; and patient behavior issues.
Peter Gergen, M.D.
Dr. Gergen's research interests are in child health, focusing on the impact of source of care, socioeconomic status, and race/ethnicity on diagnosis, severity, and treatment of disease; cost of care; and utilization patterns, using respiratory diseases as a model. He is also interested in the impact of level and type of staffing on patient outcomes.
Ronda Hughes, Ph.D., R.N.
Dr. Hughes' research interests include access to and use of quality health care, particularly for low-income populations, measuring the quality of health care, health care disparities, child health and women's health, and the use of evidence-based medicine, including effective preventive care services.
Lynn Kazemekas, Ed.D., R.N.
Dr. Kazemekas' interests involve the complexities of clinical decisionmaking in primary care with a focus on how the roles and skills of clinicians affect the quality of care, and the relationships between patient self care skills, culture, and health literacy.
David Lanier, M.D.
Dr. Lanier's current research interest is in medical symptoms and how the interpretation of those symptoms (by symptomatic individuals themselves or their family or friends) affects the decision to seek, or not seek, health care. The secondary data sources that could shed light on this issue are very limited, but he intends to collaborate with the American Academy of Family Physicians and others to enhance primary data collection in this area.
Eduardo Ortiz, M.D., M.P.H.
Dr. Ortiz's research interests are in the area of computerized decision support to improve clinical outcomes and quality of care. He is interested in both provider and patient decision support, which can facilitate evidence-based, shared decisionmaking—taking into account outcomes, costs, preferences, etc. He is also interested in quality of care measures and changing physician and patient behavior.
Sari Siegel, M.A.
Ms. Siegel's research interests include access for at-risk communities, health disparities and cultural competency, and Medicaid managed care viability.
Robin Weinick, Ph.D.
Dr. Weinick's research agenda focuses on the access to and use of health care services in the U.S., with a particular emphasis on racial and ethnic disparities, children, and the impact of managed care gate keeping. She is also interested in the provision of health care services to low-income populations and the status of the health care safety net.
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- Coordination of services across providers and sites of care.
- Appropriateness of referrals to specialty care.
- Quality and outcomes of multidisciplinary care teams.
- Methods of communication and information transfer, including the role of information technology.
- The role of shared decisionmaking in the provision of primary care services.
- The integration of multiple sources and systems of care, including school-based services, complementary and alternative medicine, and telehealth; the integration of medical, public health, mental health, and oral health services.
- The effect of comprehensive/collaborative care models on quality and outcomes.
- The role of hospitalists and their integration with primary care providers.
- Appropriateness and timeliness of care, including overuse, underuse, and identifying preventable illnesses.
- Role of information technology and decision support in improving quality.
- Monitoring racial, ethnic, socioeconomic, and geographic disparities in quality of care; understanding these disparities and factors which can reduce them.
- Translating evidence into primary care practice and assessing the impact on outcomes.
- Assessment and improvement of primary care quality, including assessment from the patient's perspective.
- Developing and refining measures of primary care quality.
- Role of primary care attributes, including sustained partnerships between providers and patients, coordination and continuity of care, on quality and outcomes.
- Improving care for patients at the end of life, including addressing chronic pain.
- Measuring and improving the quality of care for the elderly and patients with special health care needs, including chronic conditions, multiple comorbidities, and disabilities.
- Measuring and improving patient safety in ambulatory care settings.
Accessible Health Care Services
- Barriers to obtaining needed care, including geographic, racial/ethnic, financial, health status, and socioeconomic disparities in access to and use of services.
- The effect of enabling services and local resources on access to care.
- The role of financing, systems, delivery mechanisms, and supply of primary care providers on access.
- The impact of having a usual source of care on the use of primary and specialty care; evaluating different models of providing access to primary care and usual sources of care.
- Patients' perceptions of the availability of services and the actual availability of services.
- Patients' perceptions of access, discrimination, and stigma; patients' willingness to use services.
- Assessing cultural competency and its impact on primary care.
- Language ability and language barriers, including work with translators and interpreters.
- The role of telehealth and electronic communication in improving access.
- Issues of the growing digital divide and differential access to new technologies .
- Effect of alternative sites of care on the provision of primary care services.
- The role of the safety net in access to care.
- Developing and refining measures of access to primary care.
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- Role of generalists and specialists in the delivery of health care services; issues of workforce planning.
- Characteristics and core competencies of primary care providers.
- Racial/ethnic distribution of the health care workforce, including relationship to patients' race/ethnicity..
- Geographic maldistribution of the health care workforce.
- Organization of primary care practices, including staffing and systems.
- The impact of changing information technology on primary care practices.
- The impact of provider time constraints on quality of care.
- How the organization of care and health care working conditions affects primary care providers and in turn influence the care they provide.
- Role of community health and lay health workers.
- Changing roles and responsibilities of providers.
- Effect of primary care clinician education on performance and outcomes.
Accountable for Addressing the Full Range of Personal Health Needs
- Health services access and utilization.
- Curative and preventive treatment and wellness care.
- Historically understudied areas.
- Health education.
- Social services.
- Eating habits, nutrition, and access to food.
- Complementary and alternative medicine.
- Injuries and accidents.
- School-based services.
- Environmental health issues (e.g., lead exposure).
- Foster care.
- Mental health.
- Dental services.
- Family-based interventions.
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Developing Sustained Partnerships with Patients
- Effect of sustained relationships on prevention, acute and chronic care, and well-being.
- How to facilitate ongoing, longitudinal relationships so that patients' health and health care can be placed in their personal and social contexts.
- The role of electronic communication in developing sustained partnerships.
- Effect of ongoing relationships to facilitate shared decisionmaking.
- Communication and information transfer between patients and providers, including patient education, language ability, health literacy, information technology, and culturally and linguistically appropriate services.
- Impact of communication on health-seeking behaviors and outcomes.
Family and Community
- How social support, networks, and social capital influence health care.
- Role of family and culture in health-seeking activities and clinical decisionmaking.
- Impact of health status, knowledge, attitudes, and practices of parents on children's health and health services.
- Role of community-based organizations and institutions on access to care.
- Impact of health status, knowledge, attitudes, and practices of care givers on dependent's health and health services.
- Role of integration and collaboration between primary care and public health to improve the health of the individual and the community.
- Role of the safety net in health of the community.
- The effect of providing community-based services, including ensuring their financial viability and sustainability, on access to and quality of care.
- Influence of media and marketing on patients, providers, and communities.
- The burden of care giving on care givers' health and well-being.
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Current as of April 2001