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DMS Researchers Complete Comprehensive Primary Care Database

Hanover, NH - The Primary Care Service Area (PCSA) database, the first comprehensive national database describing primary care resources, went online June 17 at the Health Resources and Services Administration (HRSA) within the U.S. Department of Health and Human Services (HHS). Developed by Dartmouth Medical School and Virginia Commonwealth University with funding support-from HRSA's Bureau of Health Professions and Bureau of Primary Health Care, the database-is expected to be used by federal and state analysts to help improve primary care delivery, and by academics researching primary care.

"Similar to a genome database-this is the primary care genome of the US," says project director David Goodman, MD, associate professor of pediatrics and of community and family medicine at Dartmouth Medical School. Dr. Goodman continues, "The data are national in scope, but local in detail. Its release brings new information to efforts to improve the availability of primary care."

The Dartmouth team has worked intensively over the past three years with Dr. Stephen Mick and his research group at Virginia Commonwealth University to describe primary care resources and populations within small standardized areas that reflect patients' utilization patterns. PCSA boundaries and the description of these areas are contained within a database linked to an internet-based geographic information system to allow registered users easy access.

The effective delivery of primary care remains one of the most important challenges facing the US health care system. Despite a national consensus that primary care is essential to high quality cost-effective health care, disparities remain in availability and utilization. The PCSA project, designed at the DMS Center for the Evaluative Clinical Sciences, builds on the hospital service area approach that has been successfully employed by Dr. John Wennberg and DMS to produce the Dartmouth Atlas of Health Care series.

"Its release opens a new era in primary care planning," predicts Goodman. Accessible at http://datawarehouse.hrsa.gov, this innovative geographic information system, which requires users to register with HRSA, will allow health policy makers and analysts to track primary care resources and patient services. Web pages describing the project methods and data types are public, including a file that identifies the PCSA for every ZIP Code in the US.

Efforts to improve primary care service delivery have been impeded by limitations in available information. Several weaknesses stand out. Information about primary care resources and utilization are often difficult and expensive to access. Data are frequently outdated by the time they are available and updating the information is not always feasible. Most importantly, data are usually summarized to geographic levels (e.g., counties, states) that poorly reflect utilization patterns.

For example, per capita measures of clinician supply at the county level are often inadequate because patients travel to primary care services across geopolitical boundaries such as counties. Similarly, states are too large to be useful for understanding primary care which is the most localized type of medical service. Current measurement systems also lack standardization. While some states individually have developed internal measurements for primary care utilization and distribution, they are not part of a national measurement system that allows for comparability across states and regions.

An important goal of the PCSA project is to develop systems for the dissemination of primary care-related data in forms suitable for widely diverse users with differing needs and computing resources. Novice users may gain access with a simple internet browser to an internet-based Geographic Information System (GIS) that is easy-to-use, detail-oriented and multi-user accessible. More sophisticated users may download files for use with desktop GIS systems.

Using the geographic database, planners may look at both ends of the primary care supply spectrum to pinpoint areas with high and low per capita numbers of providers and determine the benefits or drawbacks of varying levels of physician supply. More physicians may or may not mean more care, but whether or not that always brings greater benefits to patients is uncertain, Goodman notes.

For more information, contact David Goodman, MD, at david.c.goodman@dartmouth.edu.

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