Laboratory

Fifty years ago, Dr. Kerr White demonstrated that most care happens in primary care and that many of the people it cares for are not seen elsewhere. Efforts to reproduce Dr. White’s study in 2001 and 2016 found that this pattern had not changed. We desperately need primary care laboratories, otherwise our care is guided and judged by evidence from other settings. The best primary care laboratories have been practice based research networks, but these are severely underfunded and do not often take advantage of the data sitting in electronic health records—data entered meticulously, laboriously, and faithfully by primary care clinicians who derive almost no direct benefit from this work.  

Currently, PRIME data pulled from EHRs are being used to help develop quality measures that better capture the value of primary care and to make the case for why they should have priority over the hundreds of other measures currently in use. Those same data can help understand which quality improvement efforts are worthwhile and enhance patient care and population health. More meaningful measures are likely to result in outcomes that matter and help prevent physician burnout.

We are also exploring how these data can teach us basic things like how illness presents and resolves, which medications are most effective or dangerous in patients with multiple conditions, when influenza or coronavirus accelerates, peaks, and goes away, and whether current primary care payments support good care. While most primary care clinicians are not able to participate in PRIME, most are likely to benefit from what it teaches us.