Overview

Center for Primary Care Research

The Center for Primary Care Research (CPCR) was established in 1995 from the Division of Primary Care that had been established in 1990. The Center saw its role expanded considerably under the 1999 Congressional Reauthorization for AHRQ to provide expertise and leadership on primary care practice and research both within AHRQ and throughout the Department of Health and Human Services. The Center supports extramural and intramural research that informs a wide range of issues related to primary care practice and policy, including the quality, costs, and outcomes of primary care; patient-provider communication; generalist-specialist issues; workforce issues; and access to care, including disparities in care.

Staff / Vision / Primary Care Practice and Research / Populations, Programs, and Partnerships / Contact Information

Staff

Director: Helen Burstin, M.D., M.P.H.
Denise Anderson
Joy Basu, Ph.D.
Howard Bauchner, M.D.
Steve Bernstein
John Billings, J.D., A.B.
Frederick Chen, M.D., M.P.H.
Carole Dillard
Peter Gergen, M.D.
Lynn Kazemekas, Ed.D., R.N.
David Lanier, M.D.
Kelly Morgan
Eduardo Ortiz, M.D., M.P.H.
Sally Phillips, R.N., Ph.D.
Sari Siegel, M.A.
Robin Weinick, Ph.D.
Gloria Washington

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Vision

Primary Care: Where Research and Practice Meet

CPCR’s broadest vision is to support and conduct research that will improve the access, effectiveness, and quality of primary health care services in the U.S. Designated by Congress as "the principal source of funding for primary care practice research in the Department of Health and Human Services," CPCR also seeks to be known nationally as a major source of information on primary care practice and recognized internationally for the excellence of the research we support and conduct. This vision includes a commitment to building capacity within the primary care research community, and to forming productive, sustained partnerships with private and professional groups as well as other government organizations that share the goal of improved primary care services.

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Primary Care Practice and Primary Care Research

Two questions are commonly asked of CPCR staff: "What is unique about primary care?," and "What is primary care research?" CPCR staff have drawn from a wide range of well-respected materials to develop the following answers.

What is primary care, and what is unique about it?

Primary care is the provision of integrated, high-quality, accessible health care services by clinicians who are accountable for addressing a full range of personal health and health care needs, developing a sustained partnership with patients, practicing in the context of family and community, and working to minimize disparities across population sub-groups.

(Modified from Institute of Medicine and Barbara Starfield)

The core attributes of primary care include:

• Primary care serves as a point of first contact for the patient, playing a key role in access to care and in coordinating care for patients who use multiple providers or specialists.
• Primary care is holistic and comprehensive, focusing on the whole person and taking into account his or her social context.
• Uncertainty is a common attribute of clinical decisionmaking in primary care.
• Primary care practice is information intensive.
• Opportunities to promote health and prevent disease are intrinsic to primary care.
• A sustained personal relationship between patient and clinician is a key aspect of primary health care, emphasizing the importance of compassion, continuity, and communication between provider and patient.

(Modified from Institute of Medicine and Barbara Starfield)

What is primary care research?

"[P]rimary care research focuses on the first contact when illness or health concerns arise, the diagnosis, treatment or referral to specialty care, preventive care, and the relationship between the clinician and the patient in the context of the family and community...[including]...the nature and characteristics of primary care practice...the management of commonly occurring clinical problems...the management of undifferentiated clinical problems;...[and] the continuity and coordination of health services."

(From AHRQ's Reauthorization legislation, 12/99)

Primary care research:

• Is grounded in both clinical and social sciences.
• Emphasizes the complexities of conducting research in real-world settings and using secondary data.
• Focuses on disseminating key research findings back into real-world practice and policy, and encouraging their implementation.
• Addresses services that are often ignored in other medical or health services research, including mental health, dental, social, and enabling (e.g., outreach) services.
• May emphasize chronic care, acute care, or preventive care.
• Includes studies of lifestyles and risk factors, as well as ways to change health behaviors.

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Populations, Programs, and Partnerships

AHRQ's priority populations

AHRQ's priority populations are relevant to all areas of primary care research: children, women, historically under served racial and ethnic minority populations, low income, rural, urban and inner city, and patients with special health care needs, including chronically ill, disabled, and patients at the end of life. While conducting and sponsoring primary care research related to all of these populations, CPCR serves as the coordinating center for the Agency for low income populations, rural, urban, and inner city areas, and end-of life care. This coordinating role relates to primary care as well as other health care areas of interest to the Agency. The Agency's research agendas for low-income and rural populations are under development, and will be available at a future date.

Programs Housed in CPCR

Clinical Informatics

Recent initiatives under this program include a Request for Application (RFA) entitled "Clinical Informatics to Promote Patient Safety" (CLIPS) and the Small Business Innovative Research (SBIR) program on patient safety and information technology (IT). The CLIPS RFA will fund the development and testing of technology tools that can be used to reduce the risk of medical errors and improve quality of care. Research will focus on:

• The role of informatics in improving clinical decision-making, reducing errors, and advancing patient safety.
• Barriers to acceptance and adoption of health information technology for improved patient safety.
• Using effective strategies to improve patient safety while maintaining patient confidentiality.

CPCR also serves as the liaison to the American Medical Informatics Association (AMIA) Work Group on Primary Care Informatics.

Primary Care Practice-Based Research Networks (PBRNs)

The practice-based research network provides a very useful approach to the study of important primary care issues. A PBRN is a group of practices devoted principally to the care of patients but also affiliated with each other for the purpose of investigating the phenomena of clinical practice occurring in communities. PBRNs are characterized by an organizational framework that transcends any one practice or study. They provide a "laboratory" for studying unselected populations of patients and care providers in community-based settings.

As part of the Agency's efforts to build research capacity in primary care, AHRQ awarded planning grants to 19 primary care practice-based research networks in September, 2000. Each grant supported the development of a PBRN-specific plan to:

1. Enhance the network's capacity to collect and aggregate primary care data electronically.
2. Study the health care of minority and underserved patient populations.
3. Translate new research findings into practice.
4. Explore sustainable funding options.

Over 5,000 clinicians are enrolled in the 19 networks and include physicians, advanced practice nurses and physician assistants from the fields of family practice, pediatrics, and general internal medicine. The networks provide access to almost 7 million patients being followed in a variety of primary care practice settings across the U.S.

In September 2001, 18 of these networks were awarded continuation grants (cooperative agreements) to conduct network-defining surveys, using standardized instruments. The surveys will provide baseline data on the clinicians enrolled in each network, the services provided, and the characteristics of patients receiving those services. Potential uses of the data include practice benchmarking and guiding the selection and design of specific PBRN research projects. Four of the networks were awarded additional funds to pilot test and evaluate electronic methods of collecting and aggregating practice-derived research data. Two networks were awarded additional funds to assess clinician and patient knowledge and attitudes about protecting the privacy and confidentiality of research data.

AHRQ's overall goal is to improve the capacity of PBRNs to expand the primary care knowledge base and to establish mechanisms that will assure that new knowledge is incorporated into actual practice and its impact is assessed. Additional information on PBRNs is available at: http://www.ahrq.gov/research/pbrn/pbrnfact.htm

Health Care Workforce Initiatives

The most recent initiative under this program is an RFA entitled "The Effect of Health Care Working Conditions on Quality of Care". This RFA is intended to identify, characterize, and directly measure the effect of the health care work environment on the safety and quality of care provided by health care workers. Grants funded under this initiative will:

• Explore the relationship between working conditions that affect health care workers and the safety and quality of care they provide.
• Test innovative approaches to working conditions that have been effective in improving the quality of a product or service in industries other than health care.

Partnerships

The Center has established collaborative relationships with a number of national professional organizations representing primary care clinicians, as well as with other Federal, private-sector, and non-profit organizations with primary-care related issues of mutual interests. These include:

• American Academy of Family Physicians.
• American Nurses Association.
• American Academy of Pediatrics.
• Society for General Internal Medicine.
• Health Resources and Services Administration, Department of Health and Human Services.
  • Bureau of Health Professions.
  • Office of Rural Health.
• Centers for Disease Control and Prevention, Department of Health and Human Services.
• Health Care Financing Administration, Department of Health and Human Services.
• National Institutes for Health, including National Institute for Mental Health, National Institute for Nursing Research, National Cancer Institute, and National Institute on Alcohol Abuse and Alcoholism.

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Contact Information

You can reach the Center for Primary Care Research at:

Center for Primary Care Research
540 Gaither Road, Suite 6000

Rockville, MD 20850
Phone: (301) 427-1500
Fax: (301) 427-1595
E-mail: info@ahrq.gov

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Current as of September 2001

Internet Citation:

Overview, Center for Primary Care Research. September 2001. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/about/cpcr/cpcrover.htm

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