Results Summary

PCORI funded the Pilot Projects to explore how to conduct and use patient-centered outcomes research in ways that can better serve patients and the healthcare community. Learn more.

Background

Research has found that individuals and whole populations who see primary care physicians often have better health, even though primary care doctors have less experience treating specific diseases than specialty care doctors. Primary care also costs less than specialty care. Researchers want to understand why primary care leads to better health at a lower cost.

Project Purpose

The researchers in the study worked with patients and providers to better understand why primary care is so valuable and to develop a computer program to test different ways of organizing primary care to achieve the best outcomes for individuals and communities. The researchers thought that these new ways of organizing primary care could help guide future research, healthcare policy, and decisions about how to deliver care in primary care practices.

Methods

Health experts and patients worked together to create a computer program that compares ways of providing primary care.

The researchers held group discussions with 76 people from different healthcare settings. These settings included community health centers and the Safety Net Providers Strategic Alliance, a research network that includes federally qualified health centers, free clinics, and health clinics for the homeless. The group discussions included people from different races, people with more than one health condition, and people with different income levels. The researchers also held discussions with a variety of doctors. The researchers asked all participants about their experiences providing or receiving care.

The researchers then invited nine patients, five family doctors, and one nurse practitioner from the discussion groups to take part in developing the computer program.

Over eight discussion sessions, the participants created and refined the computer program, which focused on actual care experiences of patients and providers. Important medical research about primary and specialty care also influenced the program.

Findings

This project brought together patients and providers to discuss their experiences with primary care and to create a computer program based on those experiences. The final computer program could look at different ways of providing primary care to achieve the best outcomes for patients at risk for sudden illness, life-changing illness, long-term illness, and mental illness, and communities.

In the program, which reflected patient and provider experiences, primary care had the following characteristics:

  • Primary care is not as good as specialty care in treating a single disease, but it can treat multiple diseases at once.
  • Primary care can help patients prevent future illness, improve their health behaviors, and refer them to the specialty care they may need.
  • Having relationships with primary care providers can make patients seek the care they need sooner.

Researchers used the final program to conduct a series of tests to understand the impact of primary care, they found the following:

  • Primary care that includes all of the characteristics listed above results in better patient health than when primary care does not have all those characteristics.
  • Primary care was most helpful for patients who have lower incomes, less access to care, and those who have worse health.
  • People in neighborhoods with limited resources had more doctor visits overall when primary care included all of the above characteristics. However, these visits were more often for disease prevention and less often to treat illness.

Limitations

The study involved a small number of participants who were handpicked by the researchers. A different group of participants may have pointed out other ways primary care can make a difference in health outcomes. A different group might also have built the program differently.

Conclusions

The study showed that it is possible to engage people with different backgrounds in a group process to create a computer program that allows users to compare different ways of providing patient care and to see how these ways affect health outcomes. This type of comparison is not easy to do using other methods.

Sharing the Results

The research team has published the results of this study and provided a version of the computer program that people can use on their own.

Journal Citations

Results of This Project

Project Information

Kurt C. Stange, MD, PhD
Case Western Reserve University
$649,987
Group Model Building to Engage Patient & Clinician Wisdom to Design Primary Care

Key Dates

June 2012
December 2014
2012
2014

Study Registration Information

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Last updated: March 4, 2022