Primary care : America's health in a new era

Primary care America's health in a new era

Detalles Bibliográficos
Autor principal: Institute of Medicine (U.S.).
Autor Corporativo: Institute of Medicine (U.S.). Division of Health Care Services. Committee on the Future of Primary Care (-)
Otros Autores: Donaldson, Molla S. (-)
Formato: Libro electrónico
Idioma:Inglés
Publicado: Washington, D.C. : National Academy Press 1996.
Edición:1st ed
Materias:
Primary health care > United States.
Ver en Biblioteca Universitat Ramon Llull:https://discovery.url.edu/permalink/34CSUC_URL/1im36ta/alma991009820305506719
Tabla de Contenidos:
  • Primary Care
  • Copyright
  • Preface
  • Acknowledgments
  • Contents
  • Summary
  • DEFINITION OF PRIMARY CARE
  • VALUE OF PRIMARY CARE
  • THE NATURE OF PRIMARY CARE
  • THE DELIVERY OF PRIMARY CARE
  • THE PRIMARY CARE WORKFORCE
  • EDUCATION AND TRAINING FOR PRIMARY CARE
  • RESEARCH AND EVALUATION IN PRIMARY CARE
  • A STRATEGY FOR IMPLEMENTATION
  • 1 Introduction
  • THE INSTITUTE OF MEDICINE STUDY
  • Funding
  • The Study Committee and Its Charge
  • Study Activities
  • Commissioned Papers
  • Interim Report
  • Site Visits
  • Public Hearing
  • Workshops
  • UNDERLYING ASSUMPTIONS
  • HISTORIC ROOTS AND THE CONTEMPORARY CONTEXT FOR PRIMARY CARE
  • Historic Roots
  • Before World War II
  • The 1960s
  • The 1970s
  • Current Forces
  • Health Care Reform
  • Other Forces
  • ORGANIZATION OF THE REPORT
  • REFERENCES
  • 2 Defining Primary Care
  • EARLY DEFINITIONS
  • THE FIRST IOM DEFINITION
  • DISTINGUISHING PUBLIC AND PERSONAL HEALTH SERVICES
  • THE 1984 REPORT ON COMMUNITY-ORIENTED PRIMARY CARE
  • CHANGES IN HEALTH CARE DELIVERY TODAY
  • THE NEW DEFINITION AND AN EXPLANATION OF TERMS
  • Recommendation 2.1 To Adopt the Committee's Definition
  • Patient
  • Family
  • Community
  • Clinician
  • Partnership
  • Health Care Needs and Health Care Services
  • Integrated
  • Comprehensive
  • Coordinated
  • Interaction with Communities
  • Continuous
  • Comment: Who Is a Primary Care Clinician?
  • Accessible
  • Accountable
  • Quality of Care
  • Quality Measurement
  • Patient Satisfaction
  • Efficiency
  • Ethical Behavior
  • Accountability of Patients
  • ACHIEVING THE GOALS OF PRIMARY CARE AS DEFINED
  • REFERENCES
  • 3 The Value of Primary Care
  • THE VALUE OF PRIMARY CARE FOR INDIVIDUALS
  • Addressing Most Problems That Patients Bring
  • Guiding Patients in Using the Health Care System
  • Providing an Ongoing Relationship Between Patient and Clinician
  • Continuity.
  • Accountability
  • Preventing Illness and Detecting Diseases Early
  • Bridging Personal Health Care, Family, and Community
  • Primary Care and the School
  • Primary Care and the Elderly
  • Primary Care and Public Health
  • Comment
  • PRIMARY CARE AND COSTS, ACCESS, AND QUALITY
  • Costs of Care
  • Access to Care
  • Quality of Care
  • General Observations
  • Outcomes
  • Attributes of Primary Care
  • Management of Referrals
  • Preventive Care
  • THE LIMITS OF PRIMARY CARE IN IMPROVING POPULATION HEALTH
  • SUMMARY
  • REFERENCES
  • 4 The Nature of Primary Care
  • CONTENT OF PRIMARY CARE
  • The Large Majority of Health Care Needs
  • Episodes of Primary Care
  • CHARACTERISTICS OF PRIMARY CARE
  • Biomedical and Social Sciences
  • Biomedical Sciences
  • Social Sciences and the Humanities in Primary Care
  • Evidence-Based Medicine
  • Clinical Decisionmaking
  • General Observations
  • Influence of Different Clinical Roles
  • Personal Aspects of Primary Care
  • Mental Health and Physical Health
  • Health Promotion And Disease Prevention
  • The Power of Information
  • SUMMARY
  • APPENDIX: DATA ON THE MAJORITY OF PERSONAL HEALTH CARE NEEDS
  • Description of Data
  • The Netherlands Transition Project
  • The U.S. Data
  • Results
  • The Netherlands Transition Project
  • The U.S. Data
  • Comment
  • REFERENCES
  • 5 The Delivery of Primary Care
  • CURRENT PATHWAYS FOR PRIMARY CARE
  • Spread of Managed Care
  • Development of Integrated Health Care Delivery Systems
  • Consolidation of Health Plans and Systems
  • Growth in For-Profit Health Plans and Delivery Systems
  • Diversity Among and Within Markets
  • Coordination of Primary Care with Other Services
  • Current and Evolving Professional Roles
  • Primary Care in Rural Settings
  • Care of the Urban Poor
  • Role of Academic Health Centers
  • MOVING TOWARD DELIVERY OF PRIMARY CARE AS DEFINED.
  • Recommendation 5.1 Availability of Primary Care for All Americans
  • Financing of Primary Care Services
  • Recommendation 5.2 Health Care Coverage for All Americans
  • Recommendation 5.3 Payment Methods Favorable to Primary Care
  • Recommendation 5.4 Payment for Primary Care Services
  • Organizing Primary Care Services
  • Understanding Professional Roles in Primary Care
  • Background
  • The Primary Care Team
  • Recommendation 5.5 Practice by Interdisciplinary Teams
  • Role of Specialists in Primary Care
  • Roles of Other First-Contact Health Professionals
  • Ensuring Primary Care for Underserved Populations
  • Background
  • Managed Care and Underserved Populations
  • Recommendation 5.6 The Underserved and Those with Special Needs
  • Other Approaches for Underserved Populations
  • Coordinating Primary Care with Other Services
  • Public Health and Primary Care
  • Recommendation 5.7 Primary Care and Public Health
  • Mental Health and Primary Care
  • Recommendation 5.8 Primary Care and Mental Health Services
  • Long-Term Care and Primary Care
  • Recommendation 5.9 Primary Care and Long-Term Care
  • Performance Monitoring for Primary Care
  • Recommendation 5.10 Quality of Primary Care
  • Infrastructure Development for Primary Care
  • Role of Academic Health Centers in Delivery Of Care
  • Recommendation 5.11 Primary Care in Academic Health Centers
  • SUMMARY
  • REFERENCES
  • 6 The Primary Care Workforce
  • WORKFORCE TRENDS AND SUPPLY PROJECTIONS: PHYSICIANS
  • Overall Levels of Supply
  • Primary Care Physicians
  • Who Is Included
  • Trends in Supply
  • Education, Training, and Licensure
  • Geographic Distribution of Primary Care Physicians
  • WORKFORCE TRENDS AND SUPPLY PROJECTIONS: NURSE PRACTITIONERS
  • Primary Care Nurse Practitioners
  • Trends in Supply
  • Current Work Environments and Responsibilities.
  • WORKFORCE TRENDS AND SUPPLY PROJECTIONS: PHYSICIAN ASSISTANTS
  • Primary Care Physician Assistants
  • Current Work Environments and Settings
  • OTHER FIRST-CONTACT PROVIDERS
  • COMMENT ON WORKFORCE ESTIMATION
  • CONCLUSIONS AND RECOMMENDATIONS ABOUT THE SUPPLY OF PRIMARY CARE CLINICIANS
  • Training Programs for Primary Care Clinicians
  • Basic Goals
  • Recommendation 6.1 Programs Regarding the Primary Care Workforce
  • General Issues of Access and Quality of Care
  • Minority Participation in Primary Care Training and Practice
  • Monitoring Supply And Requirements
  • Recommendation 6.2 Monitoring the Primary Care Workforce
  • Geographic Maldistribution of the Primary Care Workforce
  • Recommendation 6.3 Addressing Issues of Geographic Maldistribution
  • Impediments to the Use of Nurse Practitioners and Physician Assistants
  • Recommendation 6.4 State Practice Acts for Nurse Practitioners and Physician Assistants
  • SUMMARY
  • REFERENCES
  • 7 Education and Training for Primary Care
  • APPROPRIATE TRAINING IN PRIMARY CARE
  • THE EDUCATION OF PHYSICIANS
  • Undergraduate Medical Education
  • Experience in Primary Care Settings
  • Recommendation 7.1 Training in Primary Care Sites
  • Curricular and Other Structural Reforms
  • Graduate Medical Education
  • Residency Programs in Family Practice, Internal Medicine and Pediatrics
  • Primary Care Tracks
  • OTHER CONTENT ISSUES IN TRAINING FOR PRIMARY CARE
  • Future Steps for Academic Health Centers
  • Common Core Competencies
  • Defining Core Competencies in Medicine
  • Defining Core Competencies in Nursing
  • Defining Core Competencies Across Primary Care Clinical Fields
  • Recommendation 7.2 Common Core Competencies
  • Implementing Common Core Competencies
  • Recommendation 7.3 Emphasis on Common Core Competencies by Accrediting and Certifying Bodies
  • Special Areas of Curricular Emphasis.
  • Recommendation 7.4 Special Areas of Emphasis in Primary Care Training
  • FINANCIAL SUPPORT FOR GRADUATE TRAINING IN PRIMARY CARE
  • Current Sources of Graduate Medical Education Funding
  • Medicare Funding
  • Title VII Funds for Primary Care Training
  • Funding of Nurse Practitioner Education
  • Graduate Medical Education as a Public Good
  • Recommendation 7.5 All-Payer Support for Primary Care Training
  • Support for Advanced Training in Primary Care Sites
  • Recommendation 7.6 Support for Graduate Medical Education in Primary Care Sites
  • INTERDISCIPLINARY EDUCATION OF PRIMARY CARE CLINICIANS
  • Recommendation 7.7 Interdisciplinary Training
  • Recommendation 7.8 Experimentation and Evaluation
  • INTEGRATED DELIVERY SYSTEMS AND PRIMARY CARE TRAINING
  • CONTINUING MEDICAL EDUCATION
  • PHYSICIAN RETRAINING
  • Reasons for Retraining
  • Kinds of Retraining
  • Certification After Retraining
  • Recommendation 7.9 Retraining
  • SUMMARY
  • REFERENCES
  • 8 Research and Evaluation in Primary Care
  • SUPPORT FOR THE INFRASTRUCTURE FOR PRIMARY CARE RESEARCH
  • Federal Leadership and Support for Primary Care Research
  • Recommendation 8.1 Federal Support for Primary Care Research
  • Placement and Role of a Lead Agency
  • Collaborative Responsibilities of a Lead Agency
  • Data Sources and Needs
  • Need for a Primary Care Database
  • Existing Data Sources Relevant to Primary Care Research
  • Recommendation 8.2 National Database and Primary Care Data Set
  • Episodes of Care
  • Structure of a Primary-Care-Oriented Survey
  • Primary Care Research in Practice-Based Research Networks
  • Recommendation 8.3 Research in Practice-Based Primary Care Research Networks
  • Using Practice-Based Research Networks
  • Funding for Research Through Practice-Based Networks
  • Standards for Data Collection
  • Recommendation 8.4 Data Standards.
  • PRIORITY AREAS FOR PRIMARY CARE RESEARCH.

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