Roger Lienke, MD, a pediatrician-turned-family physician, who died at the age of 91 last year, founded one of the first 4 family medicine residency training programs in the United States at the University of Oklahoma. (The other 3 programs were established by Lynn Carmichael in Miami, Florida, Gene Farley in Rochester, New York, and Gayle Stephens in Wichita, Kansas.)
A conversation with Roger in 2011 about the origins of our discipline and its subsequent evolution led to a 2-year quest to create a logic model explaining how and why more and better primary care produces better health outcomes at lower cost.
The work was driven by our concern that primary care was still not well understood by many of those now engaged in its transformation. It was our shared bias that primary care is qualitatively different from other medical disciplines, being defined by a set of processes or attributes rather than by a set of clinical problems, organ systems, or demographic characteristics of patients.
We began by creating a list of desired outcomes based upon a review of the literature. Based upon that list, we identified a set of intermediate outcomes again from our systematic literature review. Finally, we developed a list of attributes derived from the Institute of Medicine’s 1996 definition of primary care and attempted to identify, based upon the available literature and our own clinical experience, a set of possible mechanisms through which the attributes might act to produce better intermediate outcomes. The result is a long, extensively referenced manuscript that we agreed to post on the NAPCRG website as a living document. A medical student, Brenden Drew, created an accompanying Prezi, also posted, which contains definitions, constructs, and published measures for most of the components of the model. Our hope was that this material could be useful to teachers, researchers, and policy makers. We also hoped that others might want to get involved in its ongoing development. It has not been published elsewhere.
I have used the logic model for teaching 3rd-year medical students about primary care and when advising researchers about what to assess when measuring the impact of ongoing primary care innovations. It was also used as a framework for advising the Office of the National Coordinator for Health Information Technology about meaningful use of electronic health records in primary care.
Those who want to add material or references or to discuss or dispute any of its contents in a constructive way, please contact james-mold{at}ouhsc.edu.
The manuscript can be found at: https://www.napcrg.org/AboutUs/Committees/CommitteeonAdvancingtheScienceofFamilyMedicine(CASFM).
- © 2014 Annals of Family Medicine, Inc.