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Research ArticleOriginal Research

A Participatory Model of the Paradox of Primary Care

Laura Homa, Johnie Rose, Peter S. Hovmand, Sarah T. Cherng, Rick L. Riolo, Alison Kraus, Anindita Biswas, Kelly Burgess, Heide Aungst, Kurt C. Stange, Kalanthe Brown, Margaret Brooks-Terry, Ellen Dec, Brigid Jackson, Jules Gilliam, George E. Kikano, Ann Reichsman, Debbie Schaadt, Jamie Hilfer, Christine Ticknor, Carl V. Tyler, Anna Van der Meulen, Heather Ways, Richard F. Weinberger and Christine Williams
The Annals of Family Medicine September 2015, 13 (5) 456-465; DOI: https://doi.org/10.1370/afm.1841
Laura Homa
Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
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Johnie Rose
Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
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Peter S. Hovmand
Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
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Sarah T. Cherng
Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
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Rick L. Riolo
Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
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Alison Kraus
Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
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Anindita Biswas
Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
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Kelly Burgess
Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
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Heide Aungst
Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
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Kurt C. Stange
Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
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  • For correspondence: kcs@case.edu
Kalanthe Brown
Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
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Margaret Brooks-Terry
Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
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Ellen Dec
Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
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Brigid Jackson
Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
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Jules Gilliam
Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
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George E. Kikano
Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
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Ann Reichsman
Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
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Debbie Schaadt
Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
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Jamie Hilfer
Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
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Christine Ticknor
Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
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Carl V. Tyler
Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
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Anna Van der Meulen
Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
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Heather Ways
Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
MD
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Richard F. Weinberger
Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
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Christine Williams
Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
RN, FNP
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Supplemental Appendix 3

Download of Paradox of Primary Care Netlogo model.nlogo file.

Files in this Data Supplement:

  • Download model - Download zipped Paradox of Primary Care model.logo file. Unzip, then run using free NetLogo software. See Supplemental Appendix 4 for instructions.

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