An article authored by Dartmouth Institute researcher Chiang-Hua Chang examining the effects of the primary care workforce on health outcomes over time has been selected as the 2018 John M. Eisenberg Article-of-the-Year in Health Services Research. Established in 2003, the annual award recognizes “excellent and original” research among all articles published in the Journal in the year prior to the award.
Chang and her co-authors, Dartmouth Institute Professors, James O’Malley and David Goodman, used American Medical Association (AMA) Masterfiles and fee-for-service Medicare claims for 2001 and 2011 to calculate two primary care workforce measures: the number of primary care physicians per 10,000 population (per capita) and the number of Medicare primary care full-time equivalents (FTEs) per 10,000 Medicare beneficiaries. (In contrast to this study, most of the previous studies on the effects of the primary care workforce did not examine the effects of workforce change over time.)
While the researchers found that overall Medicare beneficiaries’ health outcomes improved as the number of primary care physicians and their clinical effort increased, one unexpected finding was the relatively stronger growth in the clinical primary care FTEs per beneficiary than in primary care physicians per capita. Chang and her co-authors conclude that their findings not only support reform proposals advocated since the 1970s that herald primary care as the key to improving the healthcare delivery system, but also support the idea that “clinical effort provided by primary care physicians is more important than the headcount of local primary care physicians for better patient outcomes.”
“This study is a wonderful example of the work and the mindset The Dartmouth Institute is known for,” Director Elliott Fisher said. “We question conventionally accepted norms, not to prove them wrong, but to get the data we need to understand the big picture, to better allocate time and resources, and, ultimately, to achieve a higher-performing and more equitable system.”
Chang will receive her award at the annual Health Services Research Editorial Board meeting and dinner on June 24 in Seattle, Washington.
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