Publications
The Center exists in part to create original evidence and information that support and advance conversations around professionalism, value, and other health care issues.
READ about scientific publications, briefs, and reports emerging from the Center and its collaborators below.
Radical Reorientation of the US Health Care System Around Relationships
- Christine A. Sinsky, MD; Tait D. Shanafelt, MD; and Alexandra M. Ristow, MD
Submitted on: October, 2022
Over the past several decades, health care has increasingly been conceptualized as a series of independent encounters (ie, transactions) that can be distributed nearly randomly among health care workers: any physician can round on the patient, any clinician can be on the other side of the telemedicine screen, any resident can cover “continuity clinic.” Although this is a factor in almost all specialties, this transactional mindset that treats physicians as interchangeable parts is particularly problematic in specialties where continuity and longitudinal care play a critical role (eg, primary care disciplines, neurology, oncology, and psychiatry).
Repairing the Social Contract by Adopting AAMC’s Fourth Mission of Embracing Community Collaboration
- Robert L. Phillips Jr., MD, MSPH
- Savage Hoggard
- Courtney L. MBE
- Michener, J. Lloyd MD
Submitted on: October, 2022
A 2021 article, “Now is our time to act: Why academic medicine must embrace community collaboration as its fourth mission,” by Association of American Medical Colleges (AAMC) authors, including AAMC president and CEO Dr. David J. Skorton, offers 2 aims that are highly related: community collaboration and health equity. The AAMC’s call to prioritize community collaboration and health equity as pillars of the academic medicine mission echo earlier work on community-oriented primary care (COPC) and an even more robust model that builds on COPC, community-engaged health care (CEHC). COPC is a tested, systematic approach to health care by which a health clinic or system collaborates with a community to reshape priorities and services based on assessed health needs and determinants of health. COPC affirms health inequities’ socioeconomic and political roots, emphasizing health care as a relationship, not a transaction or commodity. Communities where COPC is implemented often see reductions in health inequities, especially those related to socioeconomic, structural, and environmental factors. COPC was the foundation on which community health centers were built, and early models had demonstrable effects on community health and engagement. Several academic health centers build on COPC to achieve community-engaged health care (CEHC). In CEHC, primary care remains critical, but more of the academic health center’s functions are pulled into community engagement and trust building. Thus, the AAMC has described and embraced a care and training model for which there are good, longitudinal examples among medical schools and teaching hospitals. Spreading CEHC and aligning the Community Health Needs Assessment requirements of academic health centers with the fourth mission could go a long way to improving equity, building trust, and repairing the social contract for health care.
Physician-versus practice-level primary care continuity and association with outcomes in Medicare beneficiaries
- Zhou Yang PhD, MPH, Ishani Ganguli MD, Caitlin Davis MD, Mingliang Dai PhD, MS, Jill Shuemaker RN, CPHIMS, Lars Peterson MD, PhD, Andrew Bazemore MD, MPH, Robert Phillips MD, MSPH, Yoon Kyung Chung PhD
Submitted on: July, 2022
We studied 2,359,400 beneficiaries who sought care from 13,926 physicians. Every 0.1 increase in physician continuity score was associated with a $151 reduction in expenditure per beneficiary per year (p < 0.01), and every 0.1 increase in practice continuity score was associated with $282 decrease (p < 0.01) per beneficiary per year. Both physician- and practice-level continuity were associated with lower Medicare expenditures among small, medium, and large practices. Both physician- and practice-level continuity were associated with lower probabilities of hospitalization, ED visit, admissions for ACSC, and readmission.
Primary care continuity of care could serve as a potent value-based care quality metric. Physician-level continuity is a unique value center that cannot be supplanted by practice-level continuity.