is the Director of Center for Evidence and Practice Improvement (CEPI) at the United States Agency for Healthcare Research and Quality (AHRQ)
is a Family Physician and Senior Scientist and Program Lead of Primary Care and Population Health at the Institute for Clinical Evaluative Sciences () in Toronto, Canada
Primary care is foundational to optimizing individual and population health. Health systems based upon primary care provide better access to care while improving health equity and outcomes and reducing costs. Effective models of primary care can greatly enhance the value of increasingly constrained health care spending. Despite large investments on primary care transformation in the US and Canada, primary care has yet to achieve its full promise in either country. Sharing successes and failures from attempts at innovation on both sides of the border can help each country accelerate improvement.
Despite very different health systems, primary care practices in both countries encounter remarkably similar challenges in delivering care. At the point of care, patients’ needs are similar and their experiences too often suboptimal. ...continue reading →
is Senior Scientist at the Institute for Clinical Evaluative Sciences, Family Physician and Scientist at St. Michael’s Hospital, and Professor of Family and Community Medicine at the University of Toronto. He is currently serving as President of the North American Primary Care Research Group ()
I see patients in a setting where there is an inter-professional team, electronic medical records, patient reminders for cancer screening, physician payment through capitation incentives, and after-hours coverage. These changes have all occurred in the past few years and they have been very costly to the provincial health system.
Most primary care settings in the developed world have undergone similar changes, or want to have them. Like my setting, very few places are able to say whether these changes have made patient care better, improved health, or reduced costs. Sure, we all know of success stories: a plan that has reduced emergency department visits; a group that has improved immunization coverage. But are these successes sustained over time and when they are successful do they spread elsewhere? The evidence from somewhere else, produced about a decade ago, suggest that these types of changes produce better health and better equity at lower costs. But what about right now, where I practice? Sadly, not much is known.