This is a list of articles by the Graham Center published in peer-reviewed journals. Please e-mail the Graham Center at policy@aafp.org, for more information.
Articles
Building the research culture of family medicine with fellowship training - August 2010
There are many fellowship and research training opportunities for family physicians. But in many programs, research training is tenuous, and support for researchers is low. We recommend expanding research advocacy efforts within family medicine, Congress, and funding institutions.
The social mission of medical education: ranking the schools - June 2010
Medical schools vary substantially in their contribution to the social mission of medical education. School rankings based on the social mission score differ from those that use research funding and subjective assessments of school reputation. These findings suggest that initiatives at the medical school level could increase the proportion of physicians who practice primary care, work in underserved areas, and are underrepresented minorities.
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.
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.
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.
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.
Avertable deaths associated with household income in Virginia - February 2010
If the mortality rates of the reference population had applied to the entire state, 24.3% of deaths in Virginia from 1990 through 2006 (range=21.8%–28.1%) would not have occurred. Further research must clarify the extent to which individual-level factors (e.g., earnings, education, race, health insurance) and community characteristics can improve health outcomes.
The impact of a clinic move on vulnerable patients with chronic disease: A geographic information systems (GIS) analysis - January 2010
Maps created from practice management data revealed a shift in patients when a clinic moved. Geographic information systems tools are valuable aids in defining changing service areas of primary health care clinics.
Harnessing Geographic Information Systems (GIS) to enable Community-Oriented Primary Care - January 2010
Analytic mapping was enthusiastically received and practically applied in the primary care setting, and was readily comprehended by clinic leaders for innovative purposes. This is a tool of particular relevance amid primary care safety-net expansion and increased funding of health information technology diffusion in these settings, particularly if the hurdles of cost and technological expertise are overcome by harnessing new advances in web-based mapping technology.
American Board of Family Medicine (ABFM) Maintenance of Certification: Variations in Self-Assessment Modules uptake within the 2006 cohort - January 2010
More than two-thirds of eligible, certified family physicians completed stage-one MC-FP requirements. Concerns that technical aspects of the new MC-FP paradigm would leave parts of a widely distributed, poorly resourced primary care workforce disadvantaged may hold true for providers in some underserved areas, but differential completion among rural and remote physicians was not found. Understanding barriers to uptake is essential if the specialty boards are to meet their obligations to the public to promote quality of care through Maintenance of Certification for all physicians.
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.
Race and ethnicity and rural mental health treatment - August 2009
Findings suggest that characteristics of the rural environment may disadvantage all residents with respect to mental health treatment. In more populated areas where mental health services are more plentiful, complex racial and service system factors may play a greater role in evident ethnic/racial treatment disparities.
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.
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.
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.
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.
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.
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.
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.
Impact of Title VII training programs on community health center staffing and national health service corps participation - September 2008
Continued federal support of Title VII training grant programs is consistent with federal efforts to increase participation in the NHSC and improve access to quality health care for underserved populations through expanded CHC capacity.
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.
Residency footprints: Assessing the impact of training programs on the local physician workforce and communities - May 2008
The effect of closing family medicine residency programs is likely to go undetected for many years. Decisions regarding the fate of family medicine programs are often made without benefit of a full assessment. Local and regional effects on physician access are often recognized only after the fact. Novel approaches to analysis and display of local effects of closures are essential for policy decisions concerning physician workforce training.
Nonemergency medicine-trained physician coverage in rural emergency departments - April 2008
Nonemergency physicians provide a significant portion of emergency department care, particularly in rural areas. Medical specialties must cooperate to ensure the availability of high-quality emergency department care to all Americans regardless of physician specialty.
Going global: Considerations for introducing global health into family medicine training programs - October 2007
Several hurdles can be anticipated in developing global health programs, including finances, meeting curricular and supervision requirements, and issues related to employment law, liability, and sustainability.
The Shoulder to Shoulder Model: Channeling medical volunteerism toward sustainable health change - October 2007
The Shoulder to Shoulder model allows health care professionals to channel short-term medical volunteerism into sustainable health partnerships with resource-poor communities. The resulting network of partnerships offers a powerful resource available to governments and foundations, poised to provide innovative interventions and cost-effective services directly to poor communities.
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.
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.
The Canadian contribution to the U.S. physician workforce - April 2007
Minimizing emigration, and perhaps recruiting physicians to return to Canada, could reduce physician shortages, particularly in subspecialties and rural areas. In light of competing physician shortages, it will be important to consider policy options that reduce emigration, improve access to care and reduce reliance on physicians from developing countries.
Giving everyone the health of the educated: An examination of whether social change would save more lives than medical advances - April 2007
Higher mortality rates among individuals with inadequate education reflect a complex causal pathway and the influence of confounding variables. Formidable efforts at social change would be necessary to eliminate disparities, but the changes would save more lives than would society’s current heavy investment in medical advances. Spending large sums of money on such advances at the expense of social change may be jeopardizing public health.
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.
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.
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.
Family physicians in the child health care workforce: Opportunities for collaboration in improving the health of children - September 2006
More than 5 million children and adolescents live in counties with no pediatrician. Unmet need, addressing health in the context of families and communities, and tackling "millennial morbidities" represent common ground for both specialties that could lead to specific, collaborative training, research, intervention, and advocacy.
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.
National Health Service Corps staffing and the growth of the local rural non-NHSC primary care physician workforce - September 2006
These data suggest that the NHSC contributed positively to the non-NHSC primary care physician workforce in the rural underserved counties where its clinicians worked during the 1980s and 1990s.
International medical graduates in family medicine in the United States of America: An exploration of professional characteristics and attitudes - July 2006
There are significant differences between IMG and USMG family physicians' professional profiles and attitudes. These differences from 1997 merit further exploration and possible follow-up, given the increased proportion of family physicians who are IMGs in the United States.
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.
Overcoming obstacles in U.S. health care delivery with a new practice model for family practice - June 2005
This essay highlights some of the hurdles and obstacles that have hindered physicians and presents brief summaries of some proposals currently being discussed to overcome them.
Using the ecology model to describe the impact of asthma on patterns of health care - May 2005
The ecology model confirmed that having asthma changes the likelihood and pattern of care for Americans. More importantly, the ecology model identified a subgroup with asthma who sought only emergent or hospital services.
What if we were equal? A comparison of the black-white mortality gap in 1960 and 2000 - March 2005
Using 2002 data, an estimated 83,570 excess deaths each year could be prevented in the United States if this black-white mortality gap could be eliminated.
Changes in age-adjusted mortality rates and disparities for rural physician shortage areas staffed by the National Health Service Corps: 1984-1998 - March 2005
From the early 1980s through the mid-1990s, the National Health Service Corps's goal to see health improve in rural health professional shortage areas was met, but its goal to diminish geographical health disparities was not. Because age-adjusted mortality rates improved in all county groups, the authors conclude that improvement was likely due to a variety of factors, including decreasing poverty and unemployment rates and increasing primary care physician-to-population ratios, to which the National Health Service Corps may have contributed.
Patients' beliefs about racism, preferences for physician race, and satisfaction with care - March 2005
Many African Americans and Latinos perceive racism in the health care system, and those who do are more likely to prefer a physician of their own race or ethnicity. African Americans who have preferences are more often satisfied with their care when their own physicians match their preferences.
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.
The health impact of resolving racial disparities: An analysis of US mortality data - December 2004
Achieving equity may do more for health than perfecting the technology of care.
When do older patients change primary care physicians? - November 2004
Older patients, and particularly those who are older and have more education and income, tend to stay with their PCP until they are forced to change. The longer they stay in the relationship, the better they feel about the quality of the primary services they receive. Changes in the health care system may have increased the number of patients forced to change PCP.
Variation in participation in health care settings associated with race and ethnicity - October 2004
Fewer blacks and Hispanics than whites received healthcare in physicians’ offices, outpatient clinics, and emergency departments in contrast to hospitals and home care. Research and programs aimed at reducing disparities in receipt of care specifically in the outpatient setting may have an important role in the quest to reduce racial and ethnic disparities in health.
Modifiable determinants of healthcare utilization within the African-American population - September 2004
The three modifiable factors of poverty, uninsurance, and having a primary care medical home have a dramatic effect on patterns of care for African-American patients, and could be independently targeted for intervention
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.
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.
Future of family medicine recommendations confirm need for increased research from family physicians - June 2004
No abstract available.
Geographic retrofitting: A method of community definition in community-oriented primary care practices - June 2004
This paper describes a technique called "geographic retrofitting" that has proved useful in establishing a rigorous definition of a practice's community based on current patterns of health care by the community. It also demonstrates how this approach, used in conjunction with geographic information systems software, facilitates more-powerful capabilities in community characterization and intervention.
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.
Who are the uninsured elderly in the United States? - April 2004
This study reveals important gaps in the availability of health insurance for the elderly, gaps that are likely to affect an increasing number of older Americans in the coming decade.
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.
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.
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.
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.
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.
Disparities in health care in the United States apparent in the ecology of medical care - October 2003
No abstract available.
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.
Variation in the ecology of medical care - July 2003
Frequency and location of health care delivery varies substantially with sociodemographic characteristics, insurance, and having a usual source of care. Understanding this variation can inform public consideration of policy related to access to care.
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.
Receipt of preventive care among adults: Insurance status and usual source of care - May 2003
Having a usual source of care and health insurance are both important to achieving national prevention goals.
The ecology of medical care for children in the United States - May 2003
The ecology of children's medical care is similar to that of adults in the United States in that a substantial proportion of children receive health care each month, mostly in community-based, outpatient settings. In all settings except emergency departments, receipt of care varies significantly by children's age, race, ethnicity, income, health insurance status, and whether they have a usual source of care.
International medical graduates and the primary care workforce for rural underserved areas - March 2003
IMGS appear to have been no more likely than USMGs were to practice primary care in RUAs, but the distribution by specialty differs.
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.
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.
Can nurse practitioners and physicians beat parochialism into plowshares? - September 2002
The country can ill afford doctors and nurses who ignore one another's capabilities and fail to maximize each other's contributions cost-effectively. A collaborative, integrated health care workforce could improve patient care.
Family practice in the United States: A status report - September 2002
To reflect on and reconsider the role of family practice in US health care, this article reviews the development of the status of family medicine in the United States, and comments on issues that are of ongoing important to family practice.
Accounting for graduate medical education funding in family practice training - September 2002
More than half of family practice training programs do not know how much GME they receive. These findings call for improved accountability in the use of Medicare payments that are designated for medical education.
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.
Family practice in the United States: Position and prospects - August 2002
Family practice's mistakes include expending much effort on justification and less on assuring practical means to accomplish its work; permitting an erosion of public trust; failing to strengthen relationships with interfacing specialties and organizations; and neglecting research. Nonetheless, there are promising opportunities to improve health and health care through strengthening family practice that depend in part on redesigning the family practice setting, defining carefully critical interactions with other elements of the health care system, fostering discovery of family practice, and further differentiating family practice as a scientific and caring field. Another period of adaptation by family practice is already under way; this may be the first time in history that its ambitious aspirations are actually achievable.
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.
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.
The increase in international medical graduates in family practice residency programs - June 2002
Family practice is becoming increasingly reliant on IMGs to fill residency positions.
The association of Title VII funding to departments of family medicine with choice of physician specialty and practice location - June 2002
Title VII has been successful in achieving its stated goals and legislative intent and has had an important role in addressing US physician workforce policy issues.
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.
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.
Patients' rights in the United States: From 'down-under' the situation seems upside-down - February 2002
No abstract available. Free full text version available.
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.)
Taking necessary steps to position U.S. health care to be the best - November 2001
No abstract available. Full, free text available.
Using geographic information systems to understand health care access - November 2001
Given the relative universality of such data collection from CHCs nationwide and recent political commitment to doubling the capacity of CHCs over the next five years, we suggest options for developing centralized processes for evaluating CHC service areas and local unmet health care access needs.
The ecology of medical care revisited - October 2001
No abstract available.
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.
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.
Hispanic versus white, non-Hispanic physician medical practices in Colorado - August 2001
These findings argue for special provision to admit ethnic minorities to undergraduate and graduate medical education programs.
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.
The view from 2020: How family practice failed - April 2001
This article is part of a special issue of Family Medicine dedicated to The Keystone Papers: Formal Discussion Papers from Keystone III.
A preface concerning Keystone III - April 2001
This article is part of a special issue of Family Medicine dedicated to The Keystone Papers: Formal Discussion Papers from Keystone III.
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.
Educating doctors to provide counseling and preventive care: Turning 20th century professional values head over heels - March 2000
We draw on data from the National Ambulatory Medical Care Survey to compare roles of primary care physicians and other office-based medical specialties in delivering preventive health care. We also estimate the cost of providing preventive care in terms of physician time. Finally, we contemplate how medical education values must change in the US and other countries if 21st century physicians are to be prepared to meet the health care needs of their communities.
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.
Multi-method assessment of access to primary medical care in rural Colorado - March 1999
The results of simultaneous application of distance-to-care and provider-to-population techniques unrestricted by geographic boundaries, depict access to primary medical care and corresponding consumer difficulty more fully than previously done. Further combination of methods of needs assessment such as those used in this analysis may better inform the future efforts of organizations mandated to address health care underservice in rural areas.