Basic Health Access

Just in from Annals of Family Medicine (Miller, Rubenstein, Howard, Crabtree) Shifting Implementation Science Theory to Empower Primary Care Practices Hope for primary care, generalists, rural health, and care where needed requires a very different perspective after decades of failed designs. Not surprisingly this will need to come from inside of these practices and places. Not surprisingly policies and practices dictated from outside have been not only a poor fit - but have been abusive to the populations most in need of care and the practices that serve them. There is hope from the primary care research community. The perspective must be inside of practice looking out - instead of outsiders forcing changes. Qualitative research explores and discovers and reflects as Ben, Will, and others taught me along with the various rural family physicians interviewed and researched in the 1990s in Nebraska. The current focus on quantitative research has demonstrated little to ...

It is clear from the recent Supplement to Annals of Family Medicine that some of the best and brightest primary care researchers have been focused on a specific area. They may not have much choice as primary care research is poorly supported. They have millions of reasons to do "quality improvement" research - 117 million ARHQ dollars. But is this a good choice? AHRQ continues to follow the Bandwagon of quality micromanagement - disappointing for an evidence-based entity because of the evidence basis mounting up against quality improvement efforts set in motion with To Err is Human and accelerated by the Dartmouth Assumptions, ACA, MACRA, CMS, and various associations. Even when primary care association members are hurt, the Bandwagon rolls on and over them. Particularly distressing are the various for-profit entities cashing in on quality improvement claims - often claiming to do it all or improve costs, quality, and more. What is most clear is the tran...