Publications by authors named "Andrew W Bazemore"

110 Publications

One-Third of Family Physicians Remain in Independently Owned Practice, 2017-2019.

J Am Board Fam Med 2021 Sep-Oct;34(5):1033-1034

From the Mathematica, Oakland, CA (DRR); Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA (DRR); American Board of Family Medicine, Lexington, KY (AWB, ZJM, LEP); Center for Professionalism and Value in Health Care, Washington, DC (AWB); Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, KY (LEP).

The rise of health system and hospital ownership of primary care practices raises policy questions about the survival of independent physician-owned practices. Our data indicate that a substantial proportion of FPs in 2017-2019 remained in independently owned practice: 81% of solo practitioners and 35% of FPs in practices with 2-5 clinicians. These findings suggest that independent practice is surviving, and that it's incumbent on researchers, payers, and policymakers to better understand their unique contributions and challenges in the effort to improve primary care access, quality, and cost.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3122/jabfm.2021.05.210051DOI Listing
February 2021

Practice Patterns of Family Physicians With and Without Addiction Medicine Board Certification.

J Am Board Fam Med 2021 Jul-Aug;34(4):814-819

From the Agency for Healthcare Research and Quality, Rockville, MD (STT); American Board of Family Medicine, Lexington, KY (ZJM, AWB, ARE, LEP); Departments of Family Medicine, and Psychiatry and Behavioral Sciences, Rush University, Chicago, IL (RMF); Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, KY (LEP).

Background: The American Board of Medical Specialties recognized addiction medicine (ADM) as a subspecialty in 2016, which was timely given the recent rise in substance use disorder (SUD). The impact of this dual board opportunity on Family Medicine has not been described. Our study enumerates and characterizes physicians dually certified in Family Medicine and ADM.

Methods: We linked American Board of Medical Specialties data from March 2020 on physicians dually boarded in Family Medicine and ADM to responses on demographic and scope of practice questions in the American Board of Family Medicine (ABFM) National Graduate Survey and Family Medicine Certification Examination Registration Questionnaire.

Results: Of current ABFM Diplomates, 0.53% (492/93,269) are also boarded in ADM. Based on survey responses from a subset of dually certified physicians, those who are dually certified are more likely to practice in federally qualified health centers and to hold a faculty position. Dually certified physicians are more likely to provide HIV/AIDS and hepatitis C management and are as likely as non-dually certified physicians to provide newborn care, obstetric deliveries, inpatient adult medicine care, and intensive care.

Discussion: While only a small proportion of family physicians carry dual ADM board certification, those that do disproportionately serve vulnerable populations while retaining broad scope of care. Further work is needed to examine whether SUD treatment access could be addressed by implementing models that support dually certified physicians in consultative and educational efforts that would amplify their impact across the primary care workforce.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3122/jabfm.2021.04.200456DOI Listing
August 2020

Debt of Family Medicine Residents Continues to Grow.

J Am Board Fam Med 2021 May-Jun;34(3):663-664

From the Sparrow-Michigan State University Family Medicine Residency Program, Michigan State University College of Human Medicine, East Lansing (JPP); American Board of Family Medicine, Lexington, KY (ZJM, AWB, LEP); Department of Family and Community Medicine, University of Kentucky, Lexington (ZJM, AWB, LEP).

The proportion of family medicine residents with ≥$250,000 in self-reported educational debt rose from 26% in 2014% to 47% in 2019. Such a rapid rise in high indebtedness is concerning, given known associations with resident distress. Previous research has also shown that highly indebted residents are less likely to choose academics, geriatrics, and service-oriented career paths.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3122/jabfm.2021.03.200567DOI Listing
October 2020

Academic Achievement, Professionalism, and Burnout in Family Medicine Residents.

Fam Med 2021 Jun;53(6):423-432

American Board of Family Medicine, Lexington, KY.

Background And Objectives: Physician burnout has been shown to have roots in training environments. Whether burnout in residency is associated with the attainment of critical educational milestones has not been studied, and is the subject of this investigation.

Methods: We used data from a cohort of graduating family medicine residents registering for the 2019 American Board of Family Medicine initial certification examination with complete data from registration questionnaire, milestone data, in-training examination (ITE) scores, and residency characteristics. We used bivariate and multilevel multivariate analyses to measure the associations between four professionalism milestones ratings and ITE performance with burnout.

Results: Our sample included 2,509 residents; 36.8% met the criteria for burnout. Multilevel regression modeling showed a correlation between burnout and failure to meet only one of four professionalism milestones, specifically professional conduct and accountability (OR 1.41, 95% CI 1.07-1.87), while no statistically significant relationship was demonstrated between burnout and being in the lowest quartile of ITE scores. Other factors negatively associated with burnout included international medical education (OR 0.60, 95% CI 0.48-0.76) and higher salary compared to cost of housing (OR 0.62, 95% CI 0.46-0.82).

Conclusions: We found significant association between self-reported burnout and failing to meet expectations for professional conduct and accountability, but no relationship between burnout and medical knowledge as measured by lower ITE performance. Further investigation of how this impacts downstream conduct and accountability behaviors is needed, but educators can use this information to examine program-level interventions that can specifically address burnout and development of physician professionalism.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.22454/FamMed.2021.541354DOI Listing
June 2021

Purposeful Imprinting in Graduate Medical Education: Opportunities for Partnership.

Fam Med 2021 07 10;53(7):574-577. Epub 2021 May 10.

University of Michigan Department of Surgery.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.22454/FamMed.2021.264013DOI Listing
July 2021

How Comprehensive Medication Management Contributes to Foundational Elements of Primary Care.

J Am Board Fam Med 2021 Mar-Apr;34(2):420-423

From the University of Minnesota College of Pharmacy, Minneapolis (KAF, LAS, TDS); American Board of Family Medicine, Lexington, KY (AWB); University of North Carolina Eshelman School of Pharmacy, Chapel Hill (MTRM); American Academy of Family Physicians National Research Network, Leawood, KS (JKC); Center for Professionalism & Value in Health Care, Washington, DC (AWB).

Pharmacists are more often being recognized as a critical component of the primary care team. Previous literature has not clearly made the connection to how pharmacists and comprehensive medication management (CMM) contribute to recognized foundational elements of primary care. In this reflection, we examine how the delivery of CMM both supports and aligns with Starfield's 4 Cs of Primary Care. We illustrate how the delivery of CMM supports through increased provider access, through empanelment, by addressing unmet medication needs, and through collaborating with the primary care team and broader team. The provision of CMM addresses critical unmet medication-related needs in primary care and is aligned with the foundational elements of primary care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3122/jabfm.2021.02.190318DOI Listing
September 2021

The Essential Role of Family Physicians in Providing Cesarean Sections in Rural Communities.

J Am Board Fam Med 2021 Jan-Feb;34(1):10-11

From the Agency for Healthcare Research and Quality, Rockville, MD (STT); American Board of Family Medicine, Lexington, KY (ARE, ZJM, AWB, LEP); Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, KY (LEP).

Of family physicians who perform cesarean sections, more than half do so in rural communities and 38.6% provide cesarean sections in counties without any obstetrician/gynecologists. As policymakers in the United States struggle with a widening landscape of 'obstetrical deserts,' efforts to adequately train a family physician workforce prepared to provide cesarean sections could help maintain access to local obstetric services in rural communities and reduce perinatal morbidity and mortality.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3122/jabfm.2021.01.200132DOI Listing
August 2021

Advancing bibliometric assessment of research productivity: an analysis of US Departments of Family Medicine.

J Prim Health Care 2020 Jun;12(2):149-158

Royal New Zealand College of General Practitioners, Wellington, New Zealand.

INTRODUCTION Measurement of family medicine research productivity has lacked the replicable methodology needed to document progress. AIM In this study, we compared three methods: (1) faculty-to-publications; (2) publications-to-faculty; and (3) department-reported publications. METHODS In this cross-sectional analysis, publications in peer-reviewed, indexed journals for faculty in 13 US family medicine departments in 2015 were assessed. In the faculty-to-publications method, department websites to identify faculty and Web of Science to identify publications were used. For the publications-to-faculty method, PubMed's author affiliation field were used to identify publications, which were linked to faculty members. In the department-reported method, chairs provided lists of faculty and their publications. For each method, descriptive statistics to compare faculty and publication counts were calculated. RESULTS Overall, 750 faculty members with 1052 unique publications, using all three methods combined as the reference standard, were identified. The department-reported method revealed 878 publications (84%), compared to 616 (59%) for the faculty-to-publications method and 412 (39%) for the publication-to-faculty method. Across all departments, 32% of faculty had any publications, and the mean number of publications per faculty was 1.4 (mean of 4.4 per faculty among those who had published). Assistant Professors, Associate Professors, Professors and Chairs accounted for 92% of all publications. DISCUSSION Online searches capture a fraction of publications, but also capture publications missed through self-report. The ideal methodology includes all three. Tracking publications is important for quantifying the return on our discipline's research investment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1071/HC19098DOI Listing
June 2020

Clinicians' Overestimation of Their Geographic Service Area.

Ann Fam Med 2019 08;17(Suppl 1):S63-S66

University of Texas Health Science Center at Houston, Houston, Texas.

In this study, we evaluated family physicians' ability to estimate the service area of their patient panel-a critical first step in contextual population-based primary care. We surveyed 14 clinicians and administrators from 6 practices. Participants circled their estimated service area on county maps that were compared with the actual service area containing 70% of the practice's patients. Accuracy was ascertained from overlap and the amount of estimated census tracts that were not part of the actual service area. Average overlap was 75%, but participants overestimated their service area by an average of 166 square miles. Service area overestimation impedes implementation of targeted community interventions by practices.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1370/afm.2383DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6827668PMC
August 2019

Disconnected: a survey of users and nonusers of telehealth and their use of primary care.

J Am Med Inform Assoc 2019 05;26(5):420-428

Robert Graham Center, Washington, DC, USA.

Objective: The study sought to assess awareness, perceptions, and value of telehealth in primary care from the perspective of patients.

Materials And Methods: We conducted a cross-sectional, Web-based survey of adults with access to telehealth services who visited healthcare providers for any of the 20 most-commonly seen diagnoses during telehealth visits. Three groups were studied: registered users (RUs) of telehealth had completed a LiveHealth Online (a health plan telehealth service provider) visit, registered nonusers (RNUs) registered for LiveHealth Online but had not conducted a visit, and nonregistered nonusers (NRNUs) completed neither step.

Results: Of 32 831 patients invited, 3219 (9.8%) responded and 766 met eligibility criteria and completed surveys: 390 (51%) RUs, 117 (15%) RNUs, and 259 (34%) NRNUs. RUs were least likely to have a primary care usual source of care (65.6% vs 78.6% for RNUs vs 80.0% for NRNUs; P < .001). Nearly half (46.8%) of RUs were unable to get an appointment with their doctor, and 34.8% indicated that their doctor's office was closed. Among the 3 groups, RUs were most likely to be employed (89.5% vs 88.9% vs 82.2%; P = .007), have post-high school education (94.4% vs 93.2% vs 86.5%; P = .003), and live in urban areas (81.0% vs 69.2% vs 76.0%; P = .021).

Conclusions: Telehealth users reported that they relied on live video for enhanced access and were less connected to primary care than nonusers were. Telehealth may expand service access but risks further fragmentation of care and undermining of the primary care function absent better coordination and information sharing with usual sources of patients' care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/jamia/ocy182DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7787350PMC
May 2019

Clinician Experiences with Screening for Social Needs in Primary Care.

J Am Board Fam Med 2018 May-Jun;31(3):351-363

From Virginia Commonwealth University, Richmond, VA (STT, PLK, JP, JR, AWB, AHK); The Robert Graham Center, Washington D.C. (WRL, AWB), University of Texas Health Science Center at Houston (WRL).

Background: Despite clear evidence demonstrating the influence of social determinants on health, whether and how clinicians should address these determinants remain unclear. We aimed to understand primary care clinicians' experiences of administering a social needs screening instrument.

Methods: Using a prospective, observational design, we identified patients living in communities with lower education and income seen by 17 clinicians from 12 practices in northern Virginia. Before office visits, patients completed social needs surveys, which probed about their quality of life, education, housing, finances, substance use, transportation, social connections, physical activity, and food access. Clinicians then reviewed the completed surveys with patients. Concurrently, clinicians participated in a series of learning collaboratives to consider how to address social needs as part of care and completed diary entries about how knowing the patient's social needs influenced care after seeing each patient.

Results: Out of a total of 123 patients, 106 (86%) reported a social need. Excluding physical activity, 71% reported a social need, although only 3% wanted help. Clinicians reported that knowing the patient had a social need changed care delivery in 23% of patients and helped improve interactions with and knowledge of the patient in 53%. Clinicians reported that assessing social needs is difficult and resource intensive and that there were insufficient resources to help patients with identified needs.

Conclusions: Clinicians reported that knowing patients' social needs changed what they did and improved communication for many patients. However, more evidence is needed regarding the benefit of social needs screening in primary care before widespread implementation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3122/jabfm.2018.03.170419DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6497466PMC
September 2019

Living in "Cold Spot" Communities Is Associated with Poor Health and Health Quality.

J Am Board Fam Med 2018 May-Jun;31(3):342-350

From the Robert Graham Center, Washington, DC (WL, AWB); Virginia Commonwealth University, Richmond, VA (AHK, STT, RS, CH); HealthLandscape, Cincinnati, OH (JR, DG, JG); McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX (WL).

Purpose: Little is known about incorporating community data into clinical care. This study sought to understand the clinical associations of cold spots (census tracts with worse income, education, and composite deprivation).

Methods: Across 12 practices, we assessed the relationship between cold spots and clinical outcomes (obesity, uncontrolled diabetes, pneumonia vaccination, cancer screening-colon, cervical, and prostate-and aspirin chemoprophylaxis) for 152,962 patients. We geocoded and linked addresses to census tracts and assessed, at the census tract level, the percentage earning less than 200% of the Federal Poverty Level, without high school diplomas, and the social deprivation index (SDI). We labeled those census tracts in the worst quartiles as cold spots and conducted bivariate and logistic regression.

Results: There was a 10-fold difference in the proportion of patients in cold spots between the highest (29.1%) and lowest practices (2.6%). Except for aspirin, all outcomes were influenced by cold spots. Fifteen percent of low-education cold-spot patients had uncontrolled diabetes compared with 13% of noncold-spot patients ( < .05). In regression, those in poverty, low education, and SDI cold spots were less likely to receive colon cancer screening (odds ratio [CI], 0.88 [0.83-0.93], 0.87 [0.82-0.92], and 0.89 [0.83-0.95], respectively) although cold-spot patients were more likely to receive cervical cancer screening.

Conclusion: Living in cold spots is associated with worse chronic conditions and quality for some screening tests. Practices can use neighborhood data to allocate resources and identify those at risk for poor outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3122/jabfm.2018.03.170421DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7085304PMC
September 2019

Wide Gap between Preparation and Scope of Practice of Early Career Family Physicians.

J Am Board Fam Med 2018 Mar-Apr;31(2):181-182

From the American Board of Family Medicine, Lexington, KY (LEP, BF, JCP); the Department of Family and Community Medicine, University of Kentucky, Lexington (LEP); and the Robert Graham Center, Washington, DC (AWB).

We found substantial gaps between preparation for, and practice of, early career family physicians in nearly all clinical practice areas. With reported intentions of graduates for a broad scope of practice, gaps between practice and preparation suggest family physicians early in their careers may not be finding opportunities to provide comprehensive care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3122/jabfm.2018.02.170359DOI Listing
September 2019

Intention Versus Reality: Family Medicine Residency Graduates' Intention to Practice Obstetrics.

J Am Board Fam Med 2017 Jul-Aug;30(4):405-406

From the Robert Graham Center, Washington, DC (TWB, SP, AWB); and American Board of Family Medicine, Lexington, KY (ARE, LEP).

Although 21% of new family medicine graduates in 2016 reported an intention to include obstetric delivery in their scope of practice, only 7% of family physicians currently do so. The reasons for this stark difference must be identified in order to address potential barriers leading to family medicine graduates ultimately not including obstetric delivery despite intent.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3122/jabfm.2017.04.170120DOI Listing
February 2018

Mobility of US Rural Primary Care Physicians During 2000-2014.

Ann Fam Med 2017 07;15(4):322-328

Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC.

Purpose: Despite considerable investment in increasing the number of primary care physicians in rural shortage areas, little is known about their movement rates and factors influencing their mobility. We aimed to characterize geographic mobility among rural primary care physicians, and to identify location and individual factors that influence such mobility.

Methods: Using data from the American Medical Association Physician Masterfile for each clinically active US physician, we created seven 2-year (biennial) mobility periods during 2000-2014. These periods were merged with county-level "rurality," physician supply, economic characteristics, key demographic measures, and individual physician characteristics. We computed (1) mobility rates of physicians by rurality; (2) linear regression models of county-level rural nonretention (departure); and (3) logit models of physicians leaving rural practice.

Results: Biennial turnover was about 17% among physicians aged 45 and younger, compared with 9% among physicians aged 46 to 65, with little difference between rural and metropolitan groups. County-level physician mobility was higher for counties that lacked a hospital (absolute increase = 5.7%), had a smaller population size, and had lower primary care physician supply, but area-level economic and demographic factors had little impact. Female physicians (odds ratios = 1.24 and 1.46 for those aged 45 or younger and those aged 46 to 65, respectively) and physicians born in a metropolitan area (odds ratios = 1.75 and 1.56 for those aged 45 or younger and those aged 46 to 65, respectively) were more likely to leave rural practice.

Conclusions: These flndings provide national-level evidence of rural physician mobility rates and factors associated with both county-level retention and individual-level departures. Outcomes were notably poorer in the most remote locations and those already having poorer physician supply and professional support. Rural health workforce planners and policymakers must be cognizant of these key factors to more effectively target retention policies and to take into account the additional support needed by these more vulnerable communities.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1370/afm.2096DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5505450PMC
July 2017

Family Physicians Practicing High-Volume Obstetric Care Have Recently Dropped by One-Half.

Am Fam Physician 2017 06;95(12):762

Robert Graham Center, Washington, DC, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
June 2017

Aggregation to promote health in an era of data and value based payment.

Healthc (Amst) 2017 Sep 29;5(3):92-94. Epub 2017 Jun 29.

American Board of Family Medicine, United States.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.hjdsi.2017.05.004DOI Listing
September 2017

Measuring the attractiveness of rural communities in accounting for differences of rural primary care workforce supply.

Rural Remote Health 2017 Apr-Jun;17(2):3925. Epub 2017 Apr 28.

1133 Connecticut Ave NW #1100, Washington, DC 20036, United States.

Introduction: Many rural communities continue to experience an undersupply of primary care doctor services. While key professional factors relating to difficulties of recruitment and retention of rural primary care doctors are widely identified, less attention has been given to the role of community and place aspects on supply. Place-related attributes contribute to a community's overall amenity or attractiveness, which arguably influence both rural recruitment and retention relocation decisions of doctors. This bi-national study of Australia and the USA, two developed nations with similar geographic and rural access profiles, investigates the extent to which variations in community amenity indicators are associated with spatial variations in the supply of rural primary care doctors.

Methods: Measures from two dimensions of community amenity: geographic location, specifically isolation/proximity; and economics and sociodemographics were included in this study, along with a proxy measure (jurisdiction) of a third dimension, environmental amenity. Data were chiefly collated from the American Community Survey and the Australian Census of Population and Housing, with additional calculated proximity measures. Rural primary care supply was measured using provider-to-population ratios in 1949 US rural counties and in 370 Australian rural local government areas. Additionally, the more sophisticated two-step floating catchment area method was used to measure Australian rural primary care supply in 1116 rural towns, with population sizes ranging from 500 to 50 000. Associations between supply and community amenity indicators were examined using Pearson's correlation coefficients and ordinary least squares multiple linear regression models.

Results: It was found that increased population size, having a hospital in the county, increased house prices and affluence, and a more educated and older population were all significantly associated with increased workforce supply across rural areas of both countries. While remote areas were strongly linked with poorer supply in Australia, geographical remoteness was not significant after accounting for other indicators of amenity such as the positive association between workforce supply and coastal location. Workforce supply in the USA was negatively associated with fringe rural area locations adjacent to larger metropolitan areas and characterised by long work commutes. The US model captured 49% of the variation of workforce supply between rural counties, while the Australian models captured 35-39% of rural supply variation.

Conclusions: These data support the idea that the rural medical workforce is maldistributed with a skew towards locating in more affluent and educated areas, and against locating in smaller, poorer and more isolated rural towns, which struggle to attract an adequate supply of primary care services. This evidence is important in understanding the role of place characteristics and rural population dynamics in the recruitment and retention of rural doctors. Future primary care workforce policies need to place a greater focus on rural communities that, for a variety of reasons, may be less attractive to doctors looking to begin or remain working there.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.22605/RRH3925DOI Listing
February 2018

Prevalence of Burnout in Board Certified Family Physicians.

J Am Board Fam Med 2017 Mar-Apr;30(2):125-126

From the American Board of Family Medicine, Lexington, KY (JCP, TRO, LEP); the American Academy of Family Physicians, Leawood, KS (HCK); the McLaren Flint Family Medicine Residency, Michigan State University, Flint (MR); the Robert Graham Center, Washington, DC (AWB); and Department of Family Medicine, East Carolina University, Greeneville, NC (EGB).

Physician burnout has become a critical issue in a rapidly changing health care environment and is reported to be increasing. However, little is known about the prevalence of this problem among board-certified family physicians. Using an abbreviated burnout survey, we found a lower prevalence of this problem than has been previously reported.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3122/jabfm.2017.02.160295DOI Listing
December 2017

Regional Variation in Primary Care Involvement at the End of Life.

Ann Fam Med 2017 01 6;15(1):63-67. Epub 2017 Jan 6.

Robert Graham Center, Washington, DC.

Purpose: Variation in end-of-life care in the United States is frequently driven by the health care system. We assessed the association of primary care physician involvement at the end of life with end-of-life care patterns.

Methods: We analyzed 2010 Medicare Part B claims data for US hospital referral regions (HRRs). The independent variable was the ratio of primary care physicians to specialist visits in the last 6 months of life. Dependent variables included the rate of hospital deaths, hospital and intensive care use in the last 6 months of life, percentage of patients seen by more than 10 physicians, and Medicare spending in the last 2 years of life. Robust linear regression analysis was used to measure the association of primary care physician involvement at the end of life with the outcome variables, adjusting for regional characteristics.

Results: We assessed 306 HRRs, capturing 1,107,702 Medicare Part B beneficiaries with chronic disease who died. The interquartile range of the HRR ratio of primary care to specialist end-of-life visits was 0.77 to 1.21. HRRs with high vs low primary care physician involvement at the end of life had significantly different patient, population, and health system characteristics. Adjusting for these differences, HRRs with the greatest primary care physician involvement had lower Medicare spending in the last 2 years of life ($65,160 vs $69,030; = .003) and fewer intensive care unit days in the last 6 months of life (2.90 vs 4.29; <.001), but also less hospice enrollment (44.5% of decedents vs 50.4%; = .004).

Conclusions: Regions with greater primary care physician involvement in end-of-life care have overall less intensive end-of-life care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1370/afm.2002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5217845PMC
January 2017

The Effects of Training Institution Practice Costs, Quality, and Other Characteristics on Future Practice.

Ann Fam Med 2017 03;15(2):140-148

The American Board of Family Medicine, Inc, Lexington, KY.

Purpose: Medicare beneficiary spending patterns reflect those of the 306 Hospital Referral Regions where physicians train, but whether this holds true for smaller areas or for quality is uncertain. This study assesses whether cost and quality imprinting can be detected within the 3,436 Hospital Service Areas (HSAs), 82.4 percent of which have only 1 teaching hospital, and whether sponsoring institution characteristics are associated.

Methods: We conducted a secondary, multi-level, multivariable analysis of 2011 Medicare claims and American Medical Association Masterfile data for a random, nationally representative sample of family physicians and general internists who completed residency between 1992 and 2010 and had more than 40 Medicare patients (3,075 physicians providing care to 503,109 beneficiaries). Practice and training locations were matched with Dartmouth Atlas HSAs and categorized into low-, average-, and high-cost spending groups. Practice and training HSAs were assessed for differences in 4 diabetes quality measures. Institutional characteristics included training volume and percentage of graduates in rural practice and primary care.

Results: The unadjusted, annual, per-beneficiary spending difference between physicians trained in high- and low-cost HSAs was $1,644 (95% CI, $1,253-$2,034), and the difference remained significant after controlling for patient and physician characteristics. No significant relationship was found for diabetes quality measures. General internists were significantly more likely than family physicians to train in high-cost HSAs. Institutions with more graduates in rural practice and primary care produced lower-spending physicians.

Conclusions: The "imprint" of training spending patterns on physicians is strong and enduring, without discernible quality effects, and, along with identified institutional features, supports measures and policy options for improved graduate medical education outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1370/afm.2044DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5348231PMC
March 2017

Increasing Family Medicine Faculty Diversity Still Lags Population Trends.

J Am Board Fam Med 2017 01;30(1):100-103

From the Association of American Medical Colleges, Washington, DC (IMX); University of Texas Southwestern Medical Center, Dallas, TX (MAN); National Center for Primary Care, Department of Family Medicine, Morehouse School of Medicine, Atlanta, GA (AHG); Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC (WRL, AWB).

Background: Faculty diversity has important implications for medical student diversity. The purpose of this analysis is to describe trends in racial, ethnic, and gender diversity in family medicine (FM) departments and compare these trends to the diversity of matriculating medical students, the diversity of all medical school faculty, and the population in general.

Methods: We used the Association of American Medical Colleges Faculty Roster to describe trends in proportions of female and minorities under-represented in medicine (URM) in FM department full-time faculty in U.S. MD-granting medical schools.

Results: Among FM faculty, the proportions of female and URM faculty have grown more than 2-fold between 1980 and 2015. Increasing faculty rank was associated with lower diversity across the study period. FM departments had higher female and URM proportions than the average of all other specialties, but URM representation still lagged population trends.

Conclusion: Although FM faculty diversity is growing over time, continued attention to URM representation should remain a priority.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3122/jabfm.2017.01.160211DOI Listing
January 2017

How to write a health policy brief.

Fam Syst Health 2017 Mar 1;35(1):21-24. Epub 2016 Dec 1.

Department of Family Medicine, Eugene S. Farley, Jr. Health Policy Center, University of Colorado School of Medicine.

Although many health care professionals are interested in health policy, relatively few have training in how to utilize their clinical experience and scientific knowledge to impact policy. Developing a policy brief is one approach that health professionals may use to draw attention to important evidence that relates to policy. This article offers guidance on how to write a policy brief by outlining 4 steps: (a) define the problem, (b) state the policy, (c) make your case, and (d) discuss the impact. The steps and tips offer a starting point for health care professionals interested in health policy and translating research or clinical experience to impact policy. (PsycINFO Database Record
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1037/fsh0000238DOI Listing
March 2017

Federal Research Funding for Family Medicine: Highly Concentrated, with Decreasing New Investigator Awards.

J Am Board Fam Med 2016 Sep-Oct;29(5):531-2

From Central New York Master of Public Health Alumnus, SUNY Upstate Medical University, Syracuse, NY (BJC); the Robert Graham Center for Policy Studies, Washington, DC (AWB); and the Departments of Family Medicine, Public Health & Preventive Medicine, and Psychiatry & Behavioral Sciences, SUNY Upstate Medical University, Syracuse (CPM).

A small proportion of National Institutes of Health and other federal research funding is received by university departments of family medicine, the largest primary care specialty. That limited funding is also concentrated, with roughly a quarter of all National Institutes of Health, Centers for Disease Control and Prevention, and Agency for Healthcare Research and Quality funding awarded to 3 departments, almost half of that funding coming from 3 agencies, and a recent trend away from funding for new investigators.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3122/jabfm.2016.05.160076DOI Listing
November 2017

Lost in Translation: NIH Funding for Family Medicine Research Remains Limited.

J Am Board Fam Med 2016 Sep-Oct;29(5):528-30

From Central New York Master of Public Health Alumnus, SUNY Upstate Medical University, Syracuse, NY (BJC); the Robert Graham Center for Policy Studies, Washington, DC (AWB); and the Departments of Family Medicine, Public Health & Preventive Medicine, and Psychiatry & Behavioral Sciences, SUNY Upstate Medical University, Syracuse (CPM).

Departments of Family Medicine (DFMs) in the United States consistently received around 0.2% of total research funding dollars and 0.3% of all awards awarded by the National Institutes of Health (NIH) across the years 2002 to 2014. We used the NIH Reporter tool to quantify the amount of funding and the number of grants received by DFMs from the NIH from 2002 to 2014, using criteria similar to those applied by previous researchers. NIH funding to DFMs as remained fairly consistent across the time period, at roughly 0.2% of total NIH funding and 0.3% of total grants awarded. Changing these proportions will likely require considerable effort to build research capacity within DFMs and their frontline practice research networks, and to shift policymaker and funder perceptions of the value of the FM research enterprise.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3122/jabfm.2016.05.160063DOI Listing
November 2017

Office Visits for Women Aged 45-64 Years According to Physician Specialties.

J Womens Health (Larchmt) 2016 12 1;25(12):1231-1236. Epub 2016 Sep 1.

1 Robert Graham Center, Center for Policy Studies , American Academy of Family Physicians, Washington, District of Columbia.

Background: The increase in access to healthcare through the Affordable Care Act highlights the need to track where women seek their office-based care. The objectives of this study were to examine the types of physicians sought by women beyond their customary reproductive years and before being elderly.

Methods: This retrospective cohort study involved an analysis of national data from the Medical Expenditure Panel Survey (MEPS) between 2002 and 2012. Women between 45 and 64 years old (n = 44,830) were interviewed, and reviews of corresponding office visits (n = 330,114) were undertaken.

Results: In 2002, women aged 45-64 years (62%) went to a family or internal medicine physician only and this reached 72% in 2012. The percentage of women who went to an obstetrician-gynecologist (ob-gyn) only decreased from 20% in 2002 to 12% in 2012. Most went to a family physician or general internist for a general checkup or for diagnosis or treatment. By contrast, visits to ob-gyn physicians were predominantly for general checkups. Those who went to an ob-gyn office were more likely to have a higher family income, live in the Northeast, and describe their overall health as being excellent.

Conclusions: Women aged 45-64 years were substantially more likely to obtain care exclusively at offices of family physicians or general internists than of ob-gyn physicians. Overlap in care provided at more than one physician's office requires continued surveillance in minimizing redundant cost and optimizing resource utilization.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/jwh.2015.5599DOI Listing
December 2016

The Impact of Administrative Academic Units (AAU) Grants on the Family Medicine Research Enterprise in the United States.

Fam Med 2016 Jun;48(6):452-8

Department of Family Medicine, SUNY Upstate Medical University.

Background And Objectives: The Health Resources and Services Administration (HRSA) awards funding to primary care departments-or "Academic Administrative Units" (AAUs) at US medical schools-to strengthen or grow these departments and ultimately increase the output of primary care physicians into the US workforce. One aspect of these AAU grants that is often overlooked is the fact that they support research infrastructure for these departments.

Methods: This study used multiple methods, including content analysis of current AAU grant abstracts (n=23), publications resulting from AAU funding (n=79), and survey responses from AAU project directors (n=19) to explore and describe the impact of current AAU grants on family medicine research in the United States.

Results: Federal support for family medicine departments remains very low compared to other disciplines. Several AAU grants have provided direct support for research activities as stipulated in the grant abstracts (6/23). However, most grants appear to have facilitated scholarly activity of some sort, including evaluation and quality improvement activities. Two practice-based research networks are supported with AAU funds, and at least 79 publications over the past 10 years, representing a wide variety of methodological approaches and topics, have been produced and indexed in PubMed with explicit acknowledgment of AAU funding.

Conclusions: In the absence of substantial NIH support for family medicine departments, the AAU funding mechanism remains a crucial, but often overlooked, factor in facilitating scholarly activity in departments of family medicine.
View Article and Find Full Text PDF

Download full-text PDF

Source
June 2016

Community Vital Signs: Taking the Pulse of the Community While Caring for Patients.

J Am Board Fam Med 2016 May-Jun;29(3):419-22

From the Pennsylvania Department of Health, Harrisburg (LSH); the American Board of Family Medicine, Lexington, KY (RLP); OCHIN, Inc., Portland, OR (JED); Department of Family Medicine, Oregon Health & Science University, Portland (JED); and The Robert Graham Center, Washington, DC (AWB).

In 2014 both the Institute of Medicine and the National Quality Forum recommended the inclusion of social determinants of health data in electronic health records (EHRs). Both entities primarily focus on collecting socioeconomic and health behavior data directly from individual patients. The burden of reliably, accurately, and consistently collecting such information is substantial, and it may take several years before a primary care team has actionable data available in its EHR. A more reliable and less burdensome approach to integrating clinical and social determinant data exists and is technologically feasible now. Community vital signs-aggregated community-level information about the neighborhoods in which our patients live, learn, work, and play-convey contextual social deprivation and associated chronic disease risks based on where patients live. Given widespread access to "big data" and geospatial technologies, community vital signs can be created by linking aggregated population health data with patient addresses in EHRs. These linked data, once imported into EHRs, are a readily available resource to help primary care practices understand the context in which their patients reside and achieve important health goals at the patient, population, and policy levels.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3122/jabfm.2016.03.150172DOI Listing
November 2017

Status of underrepresented minority and female faculty at medical schools located within Historically Black Colleges and in Puerto Rico.

Med Educ Online 2016 9;21:29535. Epub 2016 Mar 9.

Department of Family Medicine, SUNY Upstate Medical University, Syracuse, NY, USA.

Background And Objectives: To assess the impact of medical school location in Historically Black Colleges and Universities (HBCU) and Puerto Rico (PR) on the proportion of underrepresented minorities in medicine (URMM) and women hired in faculty and leadership positions at academic medical institutions.

Method: AAMC 2013 faculty roster data for allopathic medical schools were used to compare the racial/ethnic and gender composition of faculty and chair positions at medical schools located within HBCU and PR to that of other medical schools in the United States. Data were compared using independent sample t-tests.

Results: Women were more highly represented in HBCU faculty (mean HBCU 43.5% vs. non-HBCU 36.5%, p=0.024) and chair (mean HBCU 30.1% vs. non-HBCU 15.6%, p=0.005) positions and in PR chair positions (mean PR 38.23% vs. non-PR 15.38%, p=0.016) compared with other allopathic institutions. HBCU were associated with increased African American representation in faculty (mean HBCU 59.5% vs. non-HBCU 2.6%, p=0.011) and chair (mean HBCU 73.1% vs. non-HBCU 2.2%, p≤0.001) positions. PR designation was associated with increased faculty (mean PR 75.40% vs. non-PR 3.72%, p≤0.001) and chair (mean PR 75.00% vs. non-PR 3.54%, p≤0.001) positions filled by Latinos/Hispanics.

Conclusions: Women and African Americans are better represented in faculty and leadership positions at HBCU, and women and Latino/Hispanics at PR medical schools, than they are at allopathic peer institutions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4788771PMC
http://dx.doi.org/10.3402/meo.v21.29535DOI Listing
October 2016
-->