• improved information systems and quality assurance programs for primary care;
  • ways to make primary care available to all Americans, regardless of economic status, geographic location, language, or cultural background;
  • financing mechanisms that encourage quality primary care rather than episodic interventions late in the disease process;
  • a primary care workforce sufficient in numbers to meet the needs for primary care, equipped with appropriate skills and competencies, and prepared to work in teams that include primary care physicians, nurse practitioners, physician assistants, community health workers, and other health professionals;
  • an enhanced knowledge base for primary care, drawn from clinical and health services research; and
  • program evaluation, dissemination of innovations, and continued education of both clinician and patient as means continually to improve the primary care system in an era of rapid change.

As can be seen from these objectives, primary care is not just a label for a set of clinicians. Rather, the committee views primary care as a system of services guided by a common vision. Realizing this vision poses a complex agenda—one that requires a coordinated strategy for implementation, many actors, and both short- and long-term steps. Primary care must include the appropriate organizational and financing arrangements, the necessary infrastructure, the knowledge base, a way of thinking and acting for the clinicians, and the understanding and support of patients and consumers. The committee hopes that this report will serve as a road map for a journey that will continue for many years.

The Institute Of Medicine Study


The IOM initiated this study with major funding provided by the U.S. Public Health Service (the Health Resources and Services Administration [HRSA] and the Agency for Health Care Policy and Research [AHCPR]), the Department of Veterans Affairs, The Robert Wood Johnson Foundation, The Pew Charitable Trusts, and The Josiah Macy, Jr. Foundation. All these foundations and government agencies as well as the IOM have had a long-standing interest in issues relating to primary care such as workforce, financing, organization and delivery, education and training, and research. As the study proceeded, the committee identified additional activities that would contribute to its deliberations, and additional support for these activities was received from a number of professional organizations and foundations (see list of sponsors in acknowledgments).

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