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      Association of Primary Care Physician Supply With Population Mortality in the United States, 2005-2015

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          Abstract

          Recent US health care reforms incentivize improved population health outcomes and primary care functions. It remains unclear how much improving primary care physician supply can improve population health, independent of other health care and socioeconomic factors.

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          Primary care: a critical review of the evidence on quality and costs of health care.

          Mark Friedberg, Peter S Hussey, Sophie Schneider (2010)
          Despite contentious debate over the new national health care reform law, there is an emerging consensus that strengthening primary care will improve health outcomes and restrain the growth of health care spending. Policy discussions imply three general definitions of primary care: a specialty of medical providers, a set of functions served by a usual source of care, and an orientation of health systems. We review the empirical evidence linking each definition of primary care to health care quality, outcomes, and costs. The available evidence most directly supports initiatives to increase providers' ability to serve primary care functions and to reorient health systems to emphasize delivery of primary care.
          Article 0 comments Cited 93 times – based on 0 reviews     Review now
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            GWmodel: AnRPackage for Exploring Spatial Heterogeneity Using Geographically Weighted Models

            Isabella Gollini, Paul B Harris, Martin Charlton … (2015)
            Article 0 comments Cited 60 times – based on 0 reviews     Review now
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              Primary care physician workforce and Medicare beneficiaries' health outcomes.

              Ann Barry Flood, Therese A Stukel, Hsiang-Hua Chang … (2011)
              Despite a widespread interest in increasing the numbers of primary care physicians to improve care and to moderate costs, the relationship of the primary care physician workforce to patient-level outcomes remains poorly understood. To measure the association between the adult primary care physician workforce and individual patient outcomes. A cross-sectional analysis of the outcomes of a 2007 20% sample of fee-for-service Medicare beneficiaries aged 65 years or older (N = 5,132,936), which used 2 measures of adult primary care physicians (general internists and family physicians) across Primary Care Service Areas (N = 6542): (1) American Medical Association (AMA) Masterfile nonfederal, office-based physicians per total population and (2) office-based primary care clinical full-time equivalents (FTEs) per Medicare beneficiary derived from Medicare claims. Annual individual-level outcomes (mortality, ambulatory care sensitive condition [ACSC] hospitalizations, and Medicare program spending), adjusted for individual patient characteristics and geographic area variables. Marked variation was observed in the primary care physician workforce across areas, but low correlation was observed between the 2 primary care workforce measures (Spearman r = 0.056; P < .001). Compared with areas with the lowest quintile of primary care physician measure using AMA Masterfile counts, beneficiaries in the highest quintile had fewer ACSC hospitalizations (74.90 vs 79.61 per 1000 beneficiaries; relative rate [RR], 0.94; 95% confidence interval [CI], 0.93-0.95), lower mortality (5.38 vs 5.47 per 100 beneficiaries; RR, 0.98; 95% CI, 0.97-0.997), and no significant difference in total Medicare spending ($8722 vs $8765 per beneficiary; RR, 1.00; 95% CI, 0.99-1.00). Beneficiaries residing in areas with the highest quintile of primary care clinician FTEs compared with those in the lowest quintile had lower mortality (5.19 vs 5.49 per 100 beneficiaries; RR, 0.95; 95% CI, 0.93-0.96), fewer ACSC hospitalizations (72.53 vs 79.48 per 1000 beneficiaries; RR, 0.91; 95% CI, 0.90-0.92), and higher overall Medicare spending ($8857 vs $8769 per beneficiary; RR, 1.01; 95% CI, 1.004-1.02). A higher level of primary care physician workforce, particularly with an FTE measure that may more accurately reflect ambulatory primary care, was generally associated with favorable patient outcomes.
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                Author and article information

                Journal
                Title: JAMA Internal Medicine
                Abbreviated Title: JAMA Intern Med
                Publisher: American Medical Association (AMA)
                ISSN (Print): 2168-6106
                Publication date (Electronic): February 18 2019
                Affiliations
                [1 ]Department of Medicine, Stanford University, Stanford, California
                [2 ]Department of Health Research and Policy, Stanford University, Stanford, California
                [3 ]Center for Primary Care, Harvard Medical School, Boston, Massachusetts
                [4 ]Division of General Medicine and Clinical Epidemiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill
                [5 ]American Board of Family Medicine Center for Professionalism and Value in Health Care, Lexington, Kentucky
                [6 ]Ariadne Labs, Brigham and Women’s Hospital, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
                [7 ]Division of General Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
                [8 ]Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
                [9 ]Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts
                Article
                DOI: 10.1001/jamainternmed.2018.7624
                PMC ID: 6450307
                PubMed ID: 30776056
                SO-VID: 79f918ae-9ec1-48d9-9cde-bd52bd77a706
                Copyright © © 2019
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