New Knowledge for and About Primary Care: A View Through the Looking Glass of the Annals of Family Medicine

William L. Miller; William R. Phillips; Louise S. Acheson; Benjamin F. Crabtree; Stephen J. Zyzanski; Paul A. Nutting; Robin S. Gotler; Laura A. McLellan; Kurt C. Stange

doi:10.1370/afm.330

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The Future of Quality Improvement Collaborations
David W. Moskowitz MD FACP

Published on: 21 July 2005
The real value of reflection
Jessie C. Gruman

Published on: 06 June 2005

Published on: (21 July 2005)
Page navigation anchor for The Future of Quality Improvement Collaborations
The Future of Quality Improvement Collaborations
David W. Moskowitz MD FACP, St. Louis, MO, USA
The May/June issue of Annals of Family Medicine was highlighted by AMA News under the headline "Primary care practice-based research comes of age." Primary-care based research networks (PBRNs) engaged in a quality improvement collaboration (QIC) are a very exciting development from the scientific as well as the public health points of view. A public-private sector collaboration will be necessary to fully realize their val...
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The May/June issue of Annals of Family Medicine was highlighted by AMA News under the headline "Primary care practice-based research comes of age." Primary-care based research networks (PBRNs) engaged in a quality improvement collaboration (QIC) are a very exciting development from the scientific as well as the public health points of view. A public-private sector collaboration will be necessary to fully realize their value.
Medical genomics, the science of which genomic polymorphisms are associated with which common diseases, will revolutionize primary care medicine, enabling primary care practitioners to delay the onset of many diseases. PBRN's engaged in QIC's need to translate this information to the clinic.
For example, we've shown (1) in 1,000 patients followed for an average of 12 months, that it's possible to achieve regression of diabetic and hypertensive nephropathy in whites, blacks, and, in unpublished data, Hispanics. But health plans, including CMS, won't act on this information, saying instead, "Come back when your 'n' is 100,000." For this we need the assistance of PBRN's. Chronic renal failure lends itself to study very nicely, because each patient can serve as their own control; there's no need for placebo-controls.
We've developed a revenue enhancement model for participating physicians in PBRN's. We look forward to working with PBRN's to rapidly translate clinical hunches from medical genomics into better patient outcomes.
Dave Moskowitz MD FACP tel. 314.983.9938 dwmoskowitz@genomed.com
1. Moskowitz DW. From pharmacogenomics to improved patient outcomes: angiotensin I-converting enzyme as an example. Diabetes Technol Ther. 2002;4(4):519-32. PMID: 12396747 [PubMed - indexed for MEDLINE]
Competing interests: CEO of GenoMed, Inc., a for-profit company
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Competing Interests: None declared.
Published on: (6 June 2005)
Page navigation anchor for The real value of reflection
The real value of reflection
Jessie C. Gruman, Washington, DC
The article “New Knowledge for and About Primary Care: A View Through the Looking Glass of the Annals of Family Medicine” by Miller et al. was an important update for the primary care constituency, although not precisely the one the authors noted.
Their stated aim was to characterize primary care research and identify opportunities for new directions. To have done so, however, they would have needed at a minimum...
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The article “New Knowledge for and About Primary Care: A View Through the Looking Glass of the Annals of Family Medicine” by Miller et al. was an important update for the primary care constituency, although not precisely the one the authors noted.
Their stated aim was to characterize primary care research and identify opportunities for new directions. To have done so, however, they would have needed at a minimum to analyze all submissions to the journal, not just the articles that survived review and other selection criteria for publication.
But falling short of the claim to analyze the state of primary care research in no way undermines the value of this work.
What the article does artfully is to map its publication record onto a pre-existing model of the knowledge base that family practitioners need in order to be effective (Stange KC, Miller WL, McWhinney I. Developing the knowledge base of family practice. Fam Med. 2001;33;286-297.) In doing so, the authors show that the journal -- with its sponsorship of six family medicine organizations – is accountable to the field, to its readers, to its sponsors, and to those who are working to build the strength and authority of family practitioners.
Competing interests: None declared
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Competing Interests: None declared.