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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.

Healthcare Quality and Safety


Engagement of family physicians in Maintenance of Certification remains high - December 2012
Maintenance of Certification for Family Physicians was created to enhance the quality of care delivered by family physicians but risked decreasing their engagement due to the increased burden of meeting additional requirements to remain board-certified. Participation by family physicians in Maintenance of Certification remains higher than predicted. (Articles)


EHR implementation without meaningful use can lead to worse health outcomes - December 2011
Defying expectations, typical electronic health record (EHR) use in practices belonging to a primary care network has been associated with poorer diabetes care quality and outcomes. Current expansion of primary care EHR implementation must focus on use that improves care. (One-Pagers)

Evidence about the Role of the PCMH and ACOs in Improving Quality and Safety - May 2011
Robert L. Phillips, Jr., MD, MSPH; Georgetown University Department of Family Medicine Grand Rounds (Presentations)

Family physician participation in maintenance of certification - May 2011
Large numbers of family physicians are participating in MOC. The significant association between practicing in underserved areas and lapsed board certification, however, warrants more research examining causes of differential participation. The penetrance of MOC engagement shows that MOC has the potential to convey substantial practice-relevant medical information to physicians. Thus, it offers a potential channel through which to improve health care knowledge and medical practice. (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)

Seeking ethical approval for an international study in primary care patient safety - April 2011
Seeking ethics committee approval for research can be challenging even for relatively simple studies occurring in single settings. Complicating factors such as multicentre studies and/or contentious research issues can challenge review processes, and conducting such studies internationally adds a further layer of complexity. This paper draws on the experiences of the LINNAEUS Collaboration, an international group of primary care researchers, in obtaining ethics approval to conduct an international study investigating medical error in general practice in six countries. (Articles)

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)

Establishing a baseline: Health information technology adoption among family medicine diplomates - March 2011
A majority of board-certified family physicians in the United States now use EHRs. The most rural of family physicians lag slightly behind the national adoption frequency, but 4-year trends suggest similar rates of uptake. Though board-certified family physicians may differ from those who do not maintain certification, understanding uptake among this cohort is critical because Maintenance of Certification (MOC) and the adoption of health information technology both are essential elements of quality improvement in primary care. Although further monitoring of adoption trends is important, the mounting challenge will not be adoption but the sufficiency of EHRs to help family physicians take better care of their patients. (Articles)

Comparison between U.S. Preventive Services Task Force recommendations and Medicare coverage - January 2011
Medicare coverage for preventive services needs to be reassessed, with special focus on preventive coordination. Continuing previous practices will likely promote both inadequate and excessive delivery of preventive services. The new health care reform law has the potential to improve the provision of preventive services to Medicare beneficiaries. (Articles)


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

State tort reforms and hospital malpractice costs - March 2010
This study explored the relation between state medical liability reform measures, hospital malpractice costs, and hospital solvency. It suggests that state malpractice caps are desirable but not essential for improved hospital financial solvency or viability. (Articles)


A comparison of chronic illness care quality in US and UK family medicine practices prior to pay-for-performance initiatives - December 2009
Following National Health Service (NHS) investment in primary care preparedness, but prior to the QOF, UK practices provided more standardized care but did not achieve better intermediate outcomes than a sample of typical US practices. US policymakers should focus on reducing variation in care documentation to ensure the effectiveness of P4P efforts while the NHS should focus on moving from process documentation to better patient outcomes. (Articles)

Universal Primary Care -- Shovel Ready Health Care Reform - March 2009
Michael Fine, MD and Shannon Brownlee, MS; Primary Care Roundtable Dialogue Series (Presentations)

How can primary care cross the quality chasm? - March 2009
The chasm between knowledge and practice decried by the Institute of Medicine (IOM) is the result of other chasms that have not been addressed. If we are to facilitate the production and use of the knowledge needed for primary care to cross IOM’s chasm, major changes are needed. (Articles)


Characterizing breast symptoms in family practice - November 2008
Of patients with breast symptoms only a small subset is subsequently given a diagnosis of breast cancer (3.2%); however, the presence of a breast mass is associated with an elevated likelihood of breast cancer. These data illustrate the use of systematic data collection and classification from primary care offices to extract information regarding disease symptoms and diagnoses. (Articles)

Testing process errors and their harms and consequences reported from family medicine practices - June 2008
Errors occur throughout the testing process, most commonly involving test implementation and reporting results to clinicians. While significant physical harm was rare, adverse consequences for patients were common. The higher prevalence of harm and adverse consequences for minority patients is a troubling disparity needing further investigation. (Articles)


Congruent satisfaction: Is there geographic correlation between patient and physician satisfaction? - January 2007
Despite geographic variation, there is a strong correlation between physician and patient satisfaction living in similar geographic locations. Further analysis of this congruence and examination of areas of incongruence between patient and physician satisfaction may aid in improving the healthcare system. (Articles)

How well do family physicians manage skin lesions? - January 2007
This study demonstrates that most skin lesions seen by office-based family physicians resolve within three months, patients are generally satisfied with the care they receive, and the diagnostic and treatment decisions made by primary care physicians are not significantly different from those of their dermatologic colleagues. (Articles)


Training on the clock: Family medicine residency directors' responses to resident duty hours reform - December 2006
Many FMPDs cited increased faculty burden and the risk of lower-quality educational experiences for their trainees. Innovations for increasing the effectiveness of teaching may ultimately compensate for lost educational time. If not, alternatives such as extending the length of residency must be considered. (Articles)

Learning from different lenses: Reports of medical errors in primary care by clinicians, staff, and patients - September 2006
Clinicians and staff offer different and independently valuable lenses for understanding errors and their outcomes in primary care, but both predominantly reported process- or system-related errors. There is a clear need to find more effective ways to invite patients to report on errors or adverse events. These findings suggest that patient safety organizations authorized by recent legislation should invite reports from a variety of health care workers and staff. (Articles)

The US medical liability system: Evidence for legislative reform - June 2006
Significant reductions in malpractice payments could be realized if total or noneconomic damage caps were operating nationally. Hard noneconomic damage and total damage caps could yield lower premiums. If tied to a comprehensive plan for reform, the money saved could be diverted to implement alternative approaches to patient compensation or be used to achieve other systems reform benefiting patients, employers, physicians, and hospitals. (Articles)

HealthSTAT: Making America's health care more affordable - February 2006
R. Eric Hart, MD; Washington Primary Care Forum #47 (Presentations)


Avoiding and fixing medical errors in general practice: Prevention strategies reported in the Linnaeus Collaboration's Primary Care International Study of Medical Errors - January 2005
In general practitioners’ medical errors reports, a culture of individual blame is more evident than recognised need for systems design. A minority of reports contained specific, pragmatic suggestions for changing healthcare systems to protect patients’ safety. Error reporting systems may be a practical way to generate innovative solutions to potentially harmful problems facing general practice patients. (Articles)


A string of mistakes: The importance of cascade analysis in describing, counting, and preventing medical errors - August 2004
Cascade analysis of physicians’ error reports is helpful in understanding the precipitant chain of events, but physicians provide incomplete information about how patients are affected. Miscommunication appears to play an important role in propagating diagnostic and treatment mistakes. (Articles)

Learning from malpractice claims about negligent, adverse events in primary care in the United States - April 2004
Claims data identify conditions and processes where primary health care in the United States is prone to go awry. The burden of severe outcomes and death from malpractice claims made against primary care physicians was greater in primary care outpatient settings than in hospitals. Although these data enhance information about error-related negligent events in primary care, particularly when combined with other primary care data, there are many operating limitations. (Articles)


Family physicians' solutions to common medical errors - March 2003
In two U.S. studies about medical errors in 2000 and 2001, family physicians offered their ideas on how to prevent, avoid, or remedy the five most often reported medical errors. Almost all reports (94 percent) included at least one idea on how to overcome the reported error. These ideas ranged from “do not make errors” (34 percent of all solutions offered to these five error types) to more thoughtfully proposed solutions relating to improved communication mechanisms (30 percent) and ways to provide care differently (26 percent). More education (7 percent) and more resources such as time (2 percent) were other prevention ideas. (One-Pagers)

Types of medical errors commonly reported by family physicians - February 2003
In a group of studies about medical errors in family medicine, the five error types most often observed and reported by U.S. family physicians were: (1) errors in prescribing medications; (2) errors in getting the right laboratory test done for the right patient at the right time; (3) filing system errors; (4) errors in dispensing medications; and (5) errors in responding to abnormal laboratory test results. “Errors in prescribing medications” was the only one of these five error types that was also commonly reported by family physicians in other countries. (One-Pagers)


Classification of medical errors and preventable adverse events in primary care: A synthesis of the literature - November 2002
Original research on medical errors in the primary care setting consists of a limited number of small studies that offer a rich description of medical errors and preventable adverse events primarily from the physician's viewpoint. We describe a classification derived from these studies that is based on the actual practice of primary care and provides a starting point for future epidemiologic and interventional research. Missing are studies that have a patient, consumer, or other health care provider input. (Articles)

A preliminary taxonomy of medical errors in family practice - September 2002
This medical error taxonomy, developed from self-reports of errors observed by family physicians during their routine clinical practice, emphasizes problems in healthcare processes and acknowledges medical errors arising from shortfalls in clinical knowledge and skills. Patient safety strategies with most effect in primary care settings need to be broader than the current focus on medication errors. (Articles)

An international taxonomy for errors in general practice: A pilot study - July 2002
This pilot study indicates that errors are likely to affect primary care patients in similar ways in countries with similar primary healthcare systems. Further comparative studies are required to improve our understanding of general practice error differences between Australia and other countries. (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)

Patients' rights in the United States: From 'down-under' the situation seems upside-down - February 2002
No abstract available. Free full text version available. (Articles)


Family physicians' experiences of their fathers' health care - October 2001
Even patients with a knowledgeable physician family member face challenges in receiving optimal medical care. Patients might receive better treatment if health care systems reinforced the role of an accountable attending physician, encouraged continuity of care, and emphasized the value of knowing the patient as a person. (Articles)

The patient safety grid: Toxic cascades in health care settings - March 2001
The Patient Safety Grid shows the fields where action is necessary in a comprehensive national effort to reduce harm from medical errors. Each segment of the grid is important and connected to others, sometimes forming a toxic cascade. (One-Pagers)

Toxic cascades: A comprehensive way to think about medical errors - March 2001
Current thinking about threats to patient safety caused by medical errors is often focused in hospital on the immediate consequences of mistakes that affect specific aspects of care, such as testing procedures or medications. Some mistakes, however, become apparent distant from where they were committed and only after a lapse in time. The model of a toxic cascade organizes an approach to making U.S. health care safer for patients by locating upstream sources and downstream consequences of errors within a comprehensive, multilevel scheme. (One-Pagers)

Shortchanging adolescents: Room for improvement in preventive care by physicians - February 2001
Adolescents visit physicians infrequently. When they do, few receive counseling on critical adolescent health issues. Both family physicians and pediatricians have room for improvement. (Articles)