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Publications

2012 | 2011 | 2010 | 2009 | 2008 | 2007 | 2006 | 2005 | 2004 | 2003 | 2002 | 2001 | 2000 | 1999
Articles -- Abstracts of manuscripts submitted to and published in peer-reviewed journals.
One-Pagers -- Research summaries pertinent to family practice advocacy.
Commentaries and Editorials -- References to editorials by Graham Center staff that have been published in peer-reviewed journals.
Monographs & Books -- Comprehensive studies, syntheses of evidence and compilations of conversations on the history and future of family medicine.
Presentations -- Given by Graham Center staff at various events.

The Value of Primary Care

2012

Primary care in the ACO: The role of primary care in the future healthcare system - November 2012
Erica Brode, MD MPH; Andrew Bazemore, MD, MPH; Kevin Grumbach, MD. University of California, San Francisco & The Robert Graham Center. (Presentations)

Improving America's Health Requires Community-Level Solutions: Folsom Revisited - August 2012
Amidst sweeping changes to health care in the 1960s, the broadly influential Folsom Commission report, “Health is a Community Affair,” never fully achieved its vision of galvanizing the creation of Communities of Solution, which were empowered to improve health at the local level. Passage of health care reform, and persistent concern over poor health outcomes despite runaway spending, contemporizes Folsom’s call for nationally supported and evaluated, but community-driven, solutions to the nation’s health care challenges. (One-Pagers)

A re-emerging political space for linking person and community through primary health care - June 2012
Current efforts to reform primary care are only intermediate steps toward a system with a greater focus on community and population health. Transformed and policy-enabled primary care is an essential link between personalized care and population health. (Articles)

Communities of solution: The Folsom Report revisited - May 2012
The 21st century primary care physician must be a true public health professional, forming partnerships and assisting data sharing with community organizations to facilitate healthy changes. We propose an updated vision of the Folsom Report for integrated and effective services, incorporating the principles of community-oriented primary care. (Articles)

The next phase of Title VII funding for training primary care physicians for America's health care needs - March 2012
Congress should act on the Council on Graduate Medical Education's recommendation to increase funding for Title VII, Section 747 roughly 14-fold to $560 million annually. This amount represents a small investment in light of the billions that Medicare currently spends to support graduate medical education, and both should be held to account for meeting physician workforce needs. Expansion of Title VII, Section 747 with the goal of improving access to primary care would be an important part of a needed, broader effort to counter the decline of primary care. Failure to launch such a national primary care workforce revitalization program will put the health and economic viability of our nation at risk. (Articles)

2011

Research Productivity of Senior General Practice Academicians in Australia, Canada, England/Wales, New Zealand, Scotland, and the U.S. - November 2011
Susan Dovey, PhD; Andrew W. Bazemore, MD, MPH; Winston Liaw, MD, MPH; Robert L. Phillips, Jr., MD, MSPH; NAPCRG Annual Meeting (Presentations)

Where the United States Falls Down and How We Might Stand Up - November 2011
(Commentaries and Editorials)

Better integration of mental health care improves depression screening and treatment in primary care - November 2011
Improving screening and treatment for depression in primary care will require better mental health care integration. Depression is common in primary care, yet screening for the condition remains low. Enhanced, coordinated financial support for the integration of mental health care into primary care could improve identification and treatment of depression. (One-Pagers)

Calling all scholars to the Council of Academic Family Medicine Educational Research Alliance (CERA) - July 2011
The mission of CERA is to set within family medicine a standard for medical education research that is rigorous and generalizable, to provide mentoring and education to junior researchers, to facilitate collaboration between medical education researchers, and to guide the specialty by providing leadership and vision in the arena of medical education research. (Articles)

An international health track is associated with care for underserved US populations in subsequent clinical practice - June 2011
Presence of an international health track (IHT) was associated with increased care of underserved populations. After the institution of an IHT track, this association was seen among IHT participants and nonparticipants and was not associated with increased long-term service abroad. (Articles)

Evidence and Tools for Advocacy from The Robert Graham Center - May 2011
Jennifer Rankin, PhD; AAFP Annual Leadership Forum (Presentations)

Evidence About Your Value (and the return on investment) - May 2011
Robert L. Phillips, Jr., MD, MSPH; Family Medicine Congressional Conference (Presentations)

Primary Care Physician Workforce and Outcomes - May 2011
(Commentaries and Editorials)

Accounting for Graduate Medical Education production of primary care physicians and general surgeons: Timing of measurement matters - May 2011
Residency expansion thresholds that do not account for production at least two to four years after completion of first residency overestimate eligibility. The overall primary care production rate from GME will not sustain the current physician workforce composition. (Articles)

FPs lower hospital readmission rates and costs - May 2011
Hospital readmission after discharge is often a costly failing of the U.S. health care system to adequately manage patients who are ill. Increasing the number of family physicians (FPs) is associated with significant reductions in hospital readmissions and substantial cost savings. (One-Pagers)

I LIVE PC: International Learning on Increasing the Value and Effectiveness of Primary Care - April 2011
(Monographs & Books)

Primary Care Present and Future - April 2011
Robert L. Phillips, Jr., MD, MSPH; Paul Ambrose Spring Forum (Presentations)

A new Journal of the American Board of Family Medicine feature: The American Board of Family Medicine–Robert Graham Center Policy Brief - March 2011
(Commentaries and Editorials)

Case study of a primary care-based accountable care system approach to medical home transformation - February 2011
Over 20 years, WellMed Inc. (San Antonio, Texas) implemented many patient-centered services, experimenting to find which belong within clinics and which operate best as system functions. The adjusted mortality rate is half that of the state for people older than 65 years. Hospitalization and readmission rates and emergency department visits have not changed over time, but preventive services have improved. Phased implementation across the network makes it difficult to link improvements to specific processes but they seem to have improved outcomes collectively. (Articles)

2010

Primary Care and Health Reform - September 2010
Kevin Burke and Andrew Bazemore; AAFP Scientific Assembly (Presentations)

Income disparities shape medical student specialty choice - September 2010
Currently, a gap of more than $135,000 separates the median annual subspecialist income from that of a primary care physician, yielding a $3.5 million difference in expected income over a lifetime. These income disparities dissuade medical students from selecting primary care and should be addressed to ensure sufficient patient access to primary care. (One-Pagers)

Illinois Health Connect and Your Healthcare Plus Case Statement - August 2010
(Monographs & Books)

Loss of primary care residency positions amidst growth in other specialties - July 2010
Since the 1997 Balanced Budget Act capped funding for graduate medical education (GME) programs, overall growth in GME has continued (+7.8 percent), but primary care specialties have experienced a substantial decline in their number of programs and residency positions. This decline will further exacerbate the current primary care shortage and severely affect future projections of primary care shortage. (One-Pagers)

Primary care and why it matters for U.S. health system reform - May 2010
We discuss the evidence for primary care's important functions and international experiences with primary care. We also describe how and why the United States has deviated from this fuller realization of primary care, as well as the steps needed to achieve primary care and health outcomes on a par with those of other developed countries. (Articles)

Measuring primary care expenses - May 2010
It is feasible to systematically collect intervention-specific expenses in primary care using formal expenditure methods. However, most practices and researchers lack the knowledge, expertise, and resources to collect such data independently. Further assistance and education is necessary to obtain reliable information about the expenses to transform and improve primary care. (Articles)

Greater family medicine presence at NIH could improve research relevance and reach - May 2010
Advisory committees perform pivotal tasks at the National Institutes of Health (NIH), informing funding decisions, helping establish research priorities, and contributing to the vision for the nation's biomedical research agenda. Family medicine has not had a substantial role on these committees, but could, helping the NIH make research more patient centered and informing translational efforts to improve population health. (One-Pagers)

Greater NIH investment in Family Medicine would help both achieve their missions - March 2010
Family medicine is the predominant provider of primary health care in the United States, yet it receives relatively little research funding from the National Institutes of Health (NIH). Family medicine can help the NIH speed research discovery and improve research relevance; the NIH can help family medicine build its research capacity, and such mutual benefit could mean improvement in public health. (One-Pagers)

Does graduate medical education also follow green? - February 2010
Our findings support the concern expressed by the COGME that instead of responding to policy aims to correct shortage in the primary care pipeline, hospitals are instead training to meet hospital goals. (Articles)

2009

Global choices: international health and medical student residency preferences - November 2009
(Commentaries and Editorials)

Family physicians' present and future role in caring for the elderly - November 2009
The population of patients older than 65 years is projected to increase substantially in the coming years, particularly in rural areas. Family physicians are essential providers of geriatric care, especially in rural areas, but need payment reform to improve their capacity to meet the needs of older patients. (One-Pagers)

Title VII's decline: Shrinking investment in the primary care training pipeline - October 2009
Title VII, Section 747 is a source of federal funding intended to strengthen the primary care workforce. Despite evidence that Title VII has been successful, its funding has declined over the past three decades, threatening the production of primary care physicians. (One-Pagers)

Medical school expansion, primary care, and policy: Engaging primary care educators in evidence-based advocacy - April 2009
Andrew Bazemore, Julie Phillips, Amy McGaha, Hope Wittenberg; STFM Annual Spring Conference (Presentations)

Is Colorado ready for a primary care-based health care system? - April 2009
Bob Phillips, MD MSPH and Andrew Bazemore, MD MPH; University of Colorado Levitt Distinguished Speaker Series (Presentations)

Usual source of care: An important source of variation in health care spending - March 2009
Based on analyses of data from the 2001–2004 Medical Expenditure Panel Surveys, we found significant differences in annual spending, especially for adults. Use of and spending for subspecialists were similar to those for general internists, and both were significantly higher than those for family physicians. Variation in spending might be the result of training differences among primary care specialties. (Articles)

Family medicine, the NIH, and the medical-research roadmap: Perspectives from inside the NIH - March 2009
NIH key informants generally appreciated family medicine clinically but viewed family medicine research as underdeveloped. Some identified opportunities for family medicine to lead, particularly CTSAs. Greater self-advocacy, research training,and developing areas of expertise may improve family medicine’s engagement with NIH. (Articles)

Primary care's ecologic impact on obesity - March 2009
With a costly obesity epidemic, policy makers must recognize factors that may influence obesity not only for each person, but also across communities. Increased primary care physician density on the county level is associated with decreased obesity rates. As we move to restructure the primary care workforce and engage our patients and communities in behavior change, the implications of this association merit closer investigation. (One-Pagers)

Arranging generalism in the 2020 primary care team - February 2009
(Monographs & Books)

2008

Off the roadmap? Family medicine's grant funding and committee representation at NIH - November 2008
Departments of family medicine, and family physicians in particular, receive a miniscule proportion of NIH grant funding and have correspondingly minimal representation on standing NIH advisory committees. Family medicine's engagement at the NIH remains near well-documented historic lows, undermining family medicine's potential for translating medical knowledge into community practice, and advancing knowledge to improve health care and health for the US population as a whole. (Articles)

Navigating general practice. The use of geographic information systems - October 2008
Geographic information systems (GIS) are powerful tools for managing, analysing and mapping geographical and associated data. In the health care setting, GIS can be used to map and graph health care provider and social and environmental data. (Articles)

Changing patient health-risk behavior requires new investment in primary care - October 2008
Evidence supports the effectiveness of primary care interventions to improve nutrition, increase physical activity levels, reduce alcohol intake, and stop tobacco use. However, implementing these interventions requires considerable practice expense. If we hope to change behavior to reduce chronic illness, the way we pay for primary care services must be modified to incorporate these expenses. (One-Pagers)

Primary care's eroding earnings: is congress concerned? - September 2008
Issues in primary care are not high on the congressional agenda, and Medicare's Sustainable Growth Rate (SGR) is the physician-payment issue on the minds of congressional staff members. Attempts to solve primary care's reimbursement difficulties should be tied to SGR reform. (Articles)

2007

Seeking a replacement for the Medicare physician services payment method: A new approach improves health outcomes and achieves budgetary savings - July 2007
Key findings are that the single-payment rate is relatively inelastic to the Sustained Growth Rate (SGR) and expenditure levels and that the proposed service-specific payment rate promotes primary care, controls spending, and saves money. (Articles)

Democratizing and displaying health data: Introducing HealthLandscape.org - June 2007
A collaborative effort of the American Academy of Family Physicians, the Robert Graham Center for Policy Studies, the Health Foundation of Greater Cincinnati, and the University of Cincinnati, this site has three components: 1) Community Health View, 2) the Primary Care Atlas, and 3) the Health Center Mapping Tool. We describe the development and applications of this innovative platform, and how HealthLandscape helps its users to understand health and health needs in their community, evaluate programs, and influence policy. (Articles)

2006

Recent studies of the family physician workforce: Implications for education and training - May 2006
Bob Phillips, MD, MSPH; Andrew Bazemore, MD, MPH; Martey Dodoo, PhD; and Perry Pugno, MD; STFM Spring Conference (Presentations)

Family medicine training: Time to be counterculture, again - April 2006
Bob Phillips, MD, MSPH; Thomas L. Stern Lecture (Presentations)

2005

Primary care in the United States: problems and possibilities - December 2005
(Commentaries and Editorials)

UK lessons for US primary care - November 2005
(Commentaries and Editorials)

Excess, shortage, or sufficient physician workforce: How could we know? - November 2005
At least three models have been used to project the future physician workforce, and each produces different results. No physician workforce predictions can be relied on until there is more consideration of and agreement on desired health outcomes and what physicians must do to achieve them. (One-Pagers)

The family physician workforce: The special case of rural populations - July 2005
People living outside metropolitan areas, especially those living in rural counties, depend on family physicians. Resolving the disparities in physician distribution nationwide will require solutions to make rural practice a viable option for more health care workers. (One-Pagers)

The family physician workforce: Quality not quantity - June 2005
(Commentaries and Editorials)

Family physicians and the primary care physician workforce in 2004 - June 2005
In 2004, there were 91,600 family physicians (FPs) and general practitioners (GPs) and 222,000 primary care physicians actively caring for patients, one for every 1,321 persons. These primary care physicians represent the largest and best-trained primary care physician workforce that has ever existed in the United States. (One-Pagers)

Adding more specialists is not likely to improve population health: Is anybody listening? - March 2005
(Commentaries and Editorials)

2004

Follow-up on family practice residents' perspectives on length and content of training - September 2004
Although most surveyed residents favored a 3-year residency program, a substantial minority still supported extending training to 4 years, and the majority would still choose to enter family mdicine programs if theyr were extended. Given a lack of consensus about specific content areas, family medicine should consider a period of experimentation to determine how to best prepare future family physicians. (Articles)

How family physicians are funded in the United States - July 2004
(Commentaries and Editorials)

Annals of Family Medicine is 1 year old: So what and who cares? - June 2004
(Commentaries and Editorials)

Future of family medicine recommendations confirm need for increased research from family physicians - June 2004
No abstract available. (Articles)

The research domain of family medicine - May 2004
The domain of family medicine research is important and ripe for fuller discovery, and it invites the thinking and imagination of the best investigators. It seems unlikely that medical research can ever be complete without a robust family medicine research enterprise. As the domain of family medicine research is explored, not a few, but billions of people will benefit. (Articles)

Specialist physicians providing primary care services in Colorado - April 2004
The contribution of specialists should be considered in future primary care needs assessments, and specialists who experience low demand for their particular specialties may be especially inclined to provide primary care services. (Articles)

Is primary care worthy of physicians? An ecological perspective - January 2004
(Monographs & Books)

The nature of primary care - January 2004
(Monographs & Books)

The Balanced Budget Act of 1997 and the financial health of teaching hospitals - January 2004
Teaching hospitals realized deep cuts in profitability between 1996 and 1999; however, these cuts were not entirely attributable to the Balanced Budget Act of 1997. The role of Medicare in supporting GME has been substantially reduced and needs special attention in the overall debate. (Articles)

2003

A study of closure of family practice residency programs - November 2003
The rate of program closure is increasing, affecting programs that meet most measures of high quality. Quality programs are being lost, and the ultimate impact is yet to be seen. Program directors offer warning signs and advice that is generally applicable to other family practice residency programs. (Articles)

Exploring residency match violations in family practice - November 2003
Real and potential Match violations did occur, but there is also considerable confusion about what constitutes a violation. There are opportunities to investigate violations, train students to recognize and deal with violations, and clarify actual violation definitions and for programs to avoid the real and perceived violations that affect their recruiting. (Articles)

Why does a U.S. primary care physician workforce crisis matter? - October 2003
(Commentaries and Editorials)

The need for research in primary care - October 2003
The knowledge base for family practice must be expanded by integration of multiple methods of comprehension, so we can bridge the gap between evidence and practice. (Articles)

The U.S. primary care physician workforce: Undervalued service - October 2003
Primary care physicians work hard, but their compensation is not correlated to their work effort when compared with physicians in other specialties. This disparity contributes to student disinterest in primary care specialties. (One-Pagers)

The U.S. primary care physician workforce: Persistently declining interest in primary care medical specialties - October 2003
A persistent, six-year trend in the choice of specialty training by U.S. medical students threatens the adequacy of the physician workforce of the United States. This pattern should be reversed and requires the attention of policy makers and medical educators. (One-Pagers)

Oral Vitamin D3 decreases fracture risk in the elderly - June 2003
The 5-year overall, age-adjusted fracture risk was lower for the patients receiving vitamin D (relative risk [RR]=0.78; 95% confidence interval [CI]=0.61–0.99). Important fractures were also significantly lower—that is, those occurring at the hip, wrist, forearm, or vertebrae (RR=0.67; 95% CI=0.48–0.93) Hip fractures, a known cause of severe morbidity in the elderly, were not significantly lower in the treated group; again, the study was probably too small or too brief to find a difference if one existed. With respect to secondary outcomes, the vitamin D group, compared with the placebo group, had no statistically significant difference in self-reported health and falls, or mortality from cardiovascular disease, cancer, or all causes. (Articles)

The effects of the 1997 Balanced Budget Act on family practice residency training programs - February 2003
The 1997 BBA did not have an immediate significant negative impact on family practice residency programs. However, there is a worrisome increase in the rate of family practice residency closures since 1997. A mechanism needs to be established to monitor all primary care program closures to give an early warning should this trend continue. (Articles)

2002

GME financing reform: The saga continues - August 2002
(Commentaries and Editorials)

First morning back - June 2002
This diary-based report documented the increasing difficulty of practicing in primary care settings. Medical knowledge and skills are, in general, the easy part; getting into a position to apply them is the challenge. (Articles)

The delicate task of workforce determination - March 2002
(Commentaries and Editorials)

Length and content of family practice residency training - March 2002
Most respondents support the current three year model of training. There is considerable interest in changing both the length and content of family practice training. Lack of consensus suggests a period of elective experimentation may be needed to assure that family physicians are prepared to meet the needs and expectations of their patients. (Articles)

Does career dissatisfaction affect the ability of family physicians to deliver high-quality patient care? - March 2002
An inability to care for patients is significantly associated with career dissatisfaction. This relationship has implications for the achievement of policy objectives related to access, having a usual source of care and quality. (Articles)

The role of family practice in different health care systems: A comparison of reasons for encounter, diagnoses, and interventions in primary care populations in the Netherlands, Japan, Poland, and the United States - January 2002
Even under different conditions there was substantial overlap in the top 30 symptom/complaint reasons for encounter, incidence rates, and encounters per diagnosis in the 4 countries we studied. This striking resemblance supports the concept of the reason for encounter as a core element of the consultation with a family physician. Similarities between the databases are much better reflected by the way patients formulate their demand for care than in the diagnoses by the family physician. US patients also see providers other than family physicians for common problems; it remains unclear whether a limited group brings most of their health problems to a family physician or whether most people visit a series of primary care physicians. Possibilities to further develop episode-oriented epidemiology in family practice have considerably increased with this study. The potential for comparative studies has also increased with the introduction of complete electronic patient records based on the documentation of episodes of care with the ICPC and with its mapping to International Classification of Disease-10th revision (or the 9th revision clinical modification.) (Articles)

2001

Role conflicts of physicians and their family members: Rules but no rulebook - October 2001
Conflicting rules of appropriate conduct, compounded by the inadequacies of modern health care, make the role of physician-family member especially challenging. The medical profession needs a clearer, more trenchant understanding of this role. (Articles)

The contemporary ecology of US medical care confirms the importance of primary care - September 2001
More women, men and children receive medical care each month in the offices of primary care physicians than any other professional setting. There is an urgent need for health policies that encourage further innovation and implementation of first-rate primary care for everyone. (One-Pagers)

Direct graduate medical education payments to teaching hospitals by Medicare: Unexplained variation and public policy contradictions - May 2001
Inherent inequities in DME funding seriously undermine the current Medicare GME payment system's capacity to contribute to US physician workforce reform and to improve access to care. There is actually a financial incentive to train residents in areas in which there is relatively less need for their services. (Articles)

Keystone III: The role of family medicine in a changing health care environment - April 2001
A dialogue conference proceedings (Monographs & Books)

Practice based primary care research networks - March 2001
(Commentaries and Editorials)

2000

Putting practice into research - June 2000
(Commentaries and Editorials)

Primary care research - March 2000
(Commentaries and Editorials)

1999

Rhetoric, reality and revolution in family practice and primary care - December 1999
(Commentaries and Editorials)

The development and goals of the AAFP Center for Policy Studies in Family Practice and Primary Care - November 1999
In this article we describe the creation and role of the Center for Policy Studies in Family Practice and Primary Care established by the American Academy of Family Physicians in Washington, DC, this year. We recount the events leading to the decision to implement the Center, list its guiding assumptions, and explain its initial structure and function. We also identify the three themes that will guide the early work of the Center: sustaining the functional domain of family practice and primary care; investing in key infrastructures; and securing universal health coverage. (Articles)