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Primary Care: America's Health in a New Era (1996)

Chapter: C Workshops

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Suggested Citation:"C Workshops." Institute of Medicine. 1996. Primary Care: America's Health in a New Era. Washington, DC: The National Academies Press. doi: 10.17226/5152.
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C Workshops

I

AGENDA

Invitational Workshop

THE SCIENTIFIC BASE OF PRIMARY CARE

Institute of Medicine

National Academy of Sciences

Lecture Room

2101 Constitution Avenue, N.W.

Washington, D.C. 20418

January 24–25, 1995

TUESDAY, JANUARY 24, 1995

8:00–8:30 a.m.

Continental Breakfast

8:30–8:40 a.m.

Introductory Comments and Introduction of Dr. Karen Hein Neal A. Vanselow, M.D. (IOM); Chair, IOM Committee on the Future of Primary Care; Welcomes; Karen Hein, M.D. Executive Officer, IOM

8:40–10:50 a.m.

SESSION 1 THE NATURE OF PRIMARY CARE; Moderator: Neal A. Vanselow, M.D.

8:40–9:00 a.m.

Defining Primary Care: The IOM's Interim Report Neal A. Vanselow, M.D.

9:00–9:30 a.m.

Keynote: Relationship-Centered Health Care; Thomas S. Inui, Sc.M., M.D. (IOM); Professor and Chairman; Department of Ambulatory Care and Prevention; Harvard Medical School and Harvard Community Health Plan

Suggested Citation:"C Workshops." Institute of Medicine. 1996. Primary Care: America's Health in a New Era. Washington, DC: The National Academies Press. doi: 10.17226/5152.
×

9:30–10:00 a.m.

What Do We Know About the Content of Primary Care?; Henk Lamberts, M.D., Ph.D. (IOM); Professor and Chair; Department of General Practice; University of Amsterdam

10:00–10:30 a.m.

A Framework for Research in Primary Care; Barbara Starfield, M.D., M.P.H. (IOM); Professor and Head; Division of Health Policy; Johns Hopkins University; School of Hygiene and Public Health

10:30–10:50 a.m.

Discussion

10:50–12:00 p.m.

SESSION 2 PRIMARY CARE AND THE LIFE CYCLE: OPPORTUNITIES FOR INQUIRY ; Moderator: Sheila A. Ryan, Ph.D. (IOM); Dean, School of Nursing; Director, Medical Center Nursing; University of Rochester

10:50–11:00 a.m.

Children; Robert J. Haggerty, M.D. (IOM); Professor of Pediatrics Emeritus; University of Rochester

11:00–11:10 a.m.

Adolescents; Renee R. Jenkins, M.D.; Professor and Chairman; Department of Pediatrics and Child Health; Howard University College of Medicine

11:10–11:20 a.m.

Adults—Women; Vicki Seltzer, M.D.; Professor and Chair; Department of Obstetrics and Gynecology; Long Island Jewish Medical Center

11:20–11:30 a.m.

Adults—Men; Jeremiah A. Barondess, M.D. (IOM); President; New York Academy of Medicine

Suggested Citation:"C Workshops." Institute of Medicine. 1996. Primary Care: America's Health in a New Era. Washington, DC: The National Academies Press. doi: 10.17226/5152.
×

11:30–11:40 a.m.

The Elderly (Over Age 70); Robert L. Kane, M.D.; Minnesota Chair in Long-Term Care and Aging; University of Minnesota

11:40–12:00 p.m.

Workshop Participant Discussion

12:00–1:00 p.m.

LUNCH (Refectory)

1:00–1:45 p.m.

SESSION 3 PRIMARY CARE AND SPECIAL POPULATIONS: OPPORTUNITIES FOR INQUIRY; Moderator: R. Heather Palmer, M.B., B.Ch., M.S.; Director, Center for Quality of Care Research and Education; Harvard University School of Public Health

1:00–1:10 p.m.

The Urban Poor; Roderick Seamster, M.D., M.P.H.; Associate Medical Director; Watts Health Foundation, Los Angeles

1:10–1:20 p.m.

Rural Populations; Marjorie A. Bowman, M.D., M.P.A. (IOM); Professor and Chair; Department of Family and Community Medicine; Bowman Gray School of Medicine

1:20–1:45 p.m.

Workshop Participant Discussion

1:45–3:15 p.m.

SESSION 4 ESSENTIAL FIELDS OF INQUIRY: OPPORTUNITIES FOR RESEARCH; Moderator: Henk Lamberts, M.D., Ph.D. (IOM)

1:50–2:00 p.m.

Biomedicine—Translating Research to Clinical Practice in Primary Care; Catherine D. DeAngelis, M.D.; Vice Dean for Academic Affairs; Johns Hopkins University; School of Medicine

Suggested Citation:"C Workshops." Institute of Medicine. 1996. Primary Care: America's Health in a New Era. Washington, DC: The National Academies Press. doi: 10.17226/5152.
×

2:00–2:10 p.m.

Health Promotion and Evidence-Based Medicine, Population-Based and Preventive Medicine; Robert S. Lawrence, M.D. (IOM); Senior Scientist; The Rockefeller Foundation

2:10–2:20 p.m.

The Whole Person—The Patient's History; Mack Lipkin, Jr., M.D.; Associate Professor of Clinical Medicine and Director Division of Primary Care; New York University School of Medicine

2:20–2:30 p.m.

The Whole Person—Shared Decision Making; Elizabeth A. Mort, M.D., M.P.H.; Massachusetts General Hospital

2:30–2:40 p.m.

Primary Care in a Systems Context; David R. Nerenz, Ph.D.; Director, Center for Health System Studies; Henry Ford Health System

2:40–3:15 p.m.

Workshop Participant Discussion

3:15–3:30 p.m.

BREAK

3:30–5:00 p.m.

General Discussion (Workshop Participants and Guests)

WEDNESDAY, JANUARY 25, 1995

8:00–8:30 a.m.

Continental Breakfast

8:30–10:15 am

SESSION 5 CLINICAL REASONING IN PRIMARY CARE; Moderator: William L. Winters, Jr., M.D.; Clinical Professor of Medicine; Baylor College of Medicine

8:30–8:50 a.m.

Harold C. Sox, Jr., M.D. (IOM); Chairman, Department of Medicine; Joseph M. Huber Professor of Medicine; Dartmouth-Hitchcock Medical Center

Suggested Citation:"C Workshops." Institute of Medicine. 1996. Primary Care: America's Health in a New Era. Washington, DC: The National Academies Press. doi: 10.17226/5152.
×

8:50–9:10 a.m.

Walter W. Rosser, M.D.; Professor and Chair; Department of Family and Community Medicine; University of Toronto

9:10–9:30 a.m.

Reactors; Marjorie A. Bowman, M.D., M.P.A. (IOM); Professor and Chair; Department of Family and Community Medicine; Bowman Gray School of Medicine

 

Rhetaugh G. Dumas, Ph.D., R.N. (IOM); The Lucille Cole Professor of Nursing and Vice Provost for Health Affairs; University of Michigan

 

L. Gregory Pawlson, M.D., M.P.H.; Chairman; Department of Health Care Sciences; George Washington University

 

 

9:30–10:15 a.m.

Workshop Participant Discussion

10:15–10:30 a.m.

BREAK

10:30–11:45 a.m.

SESSION 6 A RESEARCH AGENDA FOR PRIMARY CARE; Moderator: Henry W. Foster, Jr., M.D. (IOM); Senior Scholar-in-Residence; Association of Academic Health Centers

 

Summary of Promising Directions for Research and Overlooked Questions; Gail J. Povar, M.D., M.P.H.; Clinical Professor of Health Care Sciences and Medicine; George Washington University

 

Developing a Research Agenda: Workshop Participants

11:45–12:45 p.m.

LUNCH

Suggested Citation:"C Workshops." Institute of Medicine. 1996. Primary Care: America's Health in a New Era. Washington, DC: The National Academies Press. doi: 10.17226/5152.
×

12:45–3:15 p.m.

SESSION 7 BUILDING CAPACITY IN PRIMARY CARE RESEARCH; Moderator: Larry A. Green, M.D. (IOM); Professor and Woodward-Chisholm Chairman of Family Medicine; University of Colorado Health Sciences Center

12:50–1:00 p.m.

Building Capacity for Primary Care Research; Carolyn Clancy, M.D; Primary Care Division; Agency for Health Care Policy and Research

1:00–1:10 p.m.

Mary O. Mundinger, R.N., Dr.P.H. (IOM); Dean, School of Nursing; Columbia University

1:10–1:20 p.m.

Paul A. Nutting, M.D., M.S.P.H. (IOM); Director, Ambulatory Sentinel Practice Network; Denver, Colorado

1:20–1:30 p.m.

Kurt C. Stange, M.D., Ph.D.; Assistant Professor; Family Medicine, Epidemiology & Biostatistics, and Sociology; Department of Family Medicine; Case Western Reserve University

1:30–3:15 p.m.

General Discussion (Workshop Participants and Guests)

3:15–3:30 p.m.

Synopsis; Larry A. Green, M.D. (IOM)

3:30 p.m.

Adjourn

Suggested Citation:"C Workshops." Institute of Medicine. 1996. Primary Care: America's Health in a New Era. Washington, DC: The National Academies Press. doi: 10.17226/5152.
×

II

AGENDA

Invitational Workshop on Roles

Institute of Medicine

STUDY OF THE FUTURE OF PRIMARY CARE

Yorba Room

Four Seasons Hotel

Newport Beach, California

June 12–14, 1995

MONDAY, JUNE 12, 1995

8:00 a.m.–9:00 a.m.

CONTINENTAL BREAKFAST

9:00 a.m.–12:00 p.m.

SESSION 1 INTRODUCTION AND PRESENTATIONS OF ISSUES ON ROLES; Moderator: Neal Vanselow, M.D.

9:00 a.m.–9:05 a.m.

Welcome and Purposes of the Workshop; Neal Vanselow, M.D., Chair of IOM Study Committee

9:05 a.m.–9:15 a.m.

Comments on the Clinicians' Perspectives on Roles; Joel Alpert, M.D.; Jean Johnson, RN-C, Ph.D.; Co-chairs of the IOM Subcommittee on Roles

9:15 a.m.–9:30 a.m.

Introductions of Participants and Observers

9:30 a.m.–9:50 a.m.

The IOM Study on the Future of Primary Care and the Committee's Definition of Primary Care; Neal A. Vanselow, M.D.

Suggested Citation:"C Workshops." Institute of Medicine. 1996. Primary Care: America's Health in a New Era. Washington, DC: The National Academies Press. doi: 10.17226/5152.
×

9:50 a.m.–10:15 a.m.

Keynote Presentation Roles in Primary Care: Issues and Challenges; Fitzhugh Mullan, M.D.; Director, Bureau of the Health Professions; Public Health Service

10:15 a.m.–10:30 a.m.

Discussion by Participants

10:30 a.m.–10:45 a.m.

BREAK

10:45 a.m.–11:10 a.m.

Reconfiguration of the Health Workforce in a Changing Health Care Environment; Richard Scheffler, Ph.D.; Professor of Health Economics and Policy; School of Public Health; University of California at Berkeley

11:10 a.m.–12:00 p.m.

Discussion by Participants to Identify Issues to Be Addressed During Workshop

12:00 p.m.–1:00 p.m.

LUNCH

1:00 p.m.–5:00 p.m.

SESSION 2 ROLES AND RELATIONSHIPS OF PROVIDING COMPREHENSIVE PRIMARY CARE; Moderator: Jean Johnson, RN-C, Ph.D.

1:00 p.m.–3:00 p.m.

Roles and Relationships in Providing Comprehensive Primary Care; Family Practitioners, General Pediatrics, General Internal Medicine, Osteopathy, Nurse Practitioners, Physician Assistants, Other Nurses, and Primary Care OB-GYNs

 

How Health Professionals and Other Health Workers Are Being Used in Real Primary Care Environments; Including Examples of Cooperative Models and Teams

 

Presentation of Several Case Studies and Vignettes

Suggested Citation:"C Workshops." Institute of Medicine. 1996. Primary Care: America's Health in a New Era. Washington, DC: The National Academies Press. doi: 10.17226/5152.
×

3:00 p.m.–3:15 p.m.

BREAK

3:15 p.m.–5:00 p.m.

Issues Around the Primary Care Team and the Provision of Comprehensive Primary Care: Directions for the Future

 

Discussion

5:00 p.m.

ADJOURN

6:00 p.m.

DINNER

TUESDAY, JUNE 13, 1995

8:00 a.m.–9:00 a.m.

CONTINENTAL BREAKFAST

9:00 a.m.–12:00 p.m.

SESSION 3 THE ROLES OF MEDICAL SPECIALISTS IN PRIMARY CARE; Moderator: Peter Ellsworth

9:00 a.m.–10:45 a.m.

The Roles of Medical Specialists in Primary Care; — Mixed Practice; — Principal Physician; — Consultation and Referral

 

Vignettes and Discussion

10:45 a.m.–11:00 a.m.

BREAK

11:00 a.m.–12:00 p.m.

Direct Access by Patients to Specialists for ''First Contact"; Care of Problems; — Differences between First Contact and Primary Care

 

Discussion

12:00 p.m.–1:00 p.m.

LUNCH

Suggested Citation:"C Workshops." Institute of Medicine. 1996. Primary Care: America's Health in a New Era. Washington, DC: The National Academies Press. doi: 10.17226/5152.
×

1:00 p.m.–3:00 p.m.

SESSION 4 ROLES AND RELATIONSHIPS OF OTHER "FIRST CONTACT" PROFESSIONALS IN PRIMARY CARE; Moderator: Richard Scheffler, Ph.D.

 

Examples of Dentistry and Optometry

3:00 p.m.–3:15 p.m.

BREAK

3:15 p.m.–4:00 p.m.

SESSION 5 ROLE OF THE PATIENT AS ACTIVE PARTICIPANT IN PRIMARY CARE ; Moderator: carolyn Brown, M.D.

 

Vignettes; Discussion

4:00 p.m.–5:30 p.m.

SESSION 6 IMPLICATIONS OF DISCUSSIONS OF ROLES; Moderator: Joel Alpert, M.D.; — Demand for Health Professionals; — Education and Training; — Organization, Financing, and Infrastructure; — Patterns of Cooperation, Referral, and Coordination; — Legal and Credentialing Issues; (Discussion to be continued on Wednesday morning)

5:30 p.m.

ADJOURN

6:00 p.m.

DINNER

Suggested Citation:"C Workshops." Institute of Medicine. 1996. Primary Care: America's Health in a New Era. Washington, DC: The National Academies Press. doi: 10.17226/5152.
×

WEDNESDAY, JUNE 14, 1995

7:30 a.m.–8:30 a.m.

CONTINENTAL BREAKFAST

8:30 a.m.–10:00 a.m.

SESSION 6 CONTINUED IMPLICATIONS OF DISCUSSIONS OF ROLES

10:00 a.m.–10:15 a.m.

BREAK

10:15 a.m.–11:15 a.m.

SESSION 7 OBSERVATIONS ON THE WORKSHOP; Moderator: Neal Vanselow, M.D.

 

Michael Whitcomb, M.D.; Vice President, Division of Education Policy American Association of Medical Colleges

 

Catherine Gilliss, D.N.Sc.; Professor and Chair Department of Family Health Care Nursing University of California, San Francisco

 

Karl Yordy; Study Director Institute of Medicine Study of the Future of Primary Care

11:15 a.m.–11:30 a.m.

Final Comments and Observations by Participants

11:30 a.m.

ADJOURN

Suggested Citation:"C Workshops." Institute of Medicine. 1996. Primary Care: America's Health in a New Era. Washington, DC: The National Academies Press. doi: 10.17226/5152.
×
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Suggested Citation:"C Workshops." Institute of Medicine. 1996. Primary Care: America's Health in a New Era. Washington, DC: The National Academies Press. doi: 10.17226/5152.
×
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Suggested Citation:"C Workshops." Institute of Medicine. 1996. Primary Care: America's Health in a New Era. Washington, DC: The National Academies Press. doi: 10.17226/5152.
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Suggested Citation:"C Workshops." Institute of Medicine. 1996. Primary Care: America's Health in a New Era. Washington, DC: The National Academies Press. doi: 10.17226/5152.
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Suggested Citation:"C Workshops." Institute of Medicine. 1996. Primary Care: America's Health in a New Era. Washington, DC: The National Academies Press. doi: 10.17226/5152.
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Suggested Citation:"C Workshops." Institute of Medicine. 1996. Primary Care: America's Health in a New Era. Washington, DC: The National Academies Press. doi: 10.17226/5152.
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Suggested Citation:"C Workshops." Institute of Medicine. 1996. Primary Care: America's Health in a New Era. Washington, DC: The National Academies Press. doi: 10.17226/5152.
×
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Ask for a definition of primary care, and you are likely to hear as many answers as there are health care professionals in your survey. Primary Care fills this gap with a detailed definition already adopted by professional organizations and praised at recent conferences. This volume makes recommendations for improving primary care, building its organization, financing, infrastructure, and knowledge base--as well as developing a way of thinking and acting for primary care clinicians. Are there enough primary care doctors? Are they merely gatekeepers? Is the traditional relationship between patient and doctor outmoded? The committee draws conclusions about these and other controversies in a comprehensive and up-to-date discussion that covers

  • The scope of primary care.
  • Its philosophical underpinnings.
  • Its value to the patient and the community.
  • Its impact on cost, access, and quality.

This volume discusses the needs of special populations, the role of the capitation method of payment, and more. Recommendations are offered for achieving a more multidisciplinary education for primary care clinicians. Research priorities are identified. Primary Care provides a forward-thinking view of primary care as it should be practiced in the new integrated health care delivery systems--important to health care clinicians and those who train and employ them, policymakers at all levels, health care managers, payers, and interested individuals.

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