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J Fam Pract. 1998 Jul;47(1):62-7.

The future of primary care. The enhanced primary care model.

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HealthPartners, Health Partners Research Foundation, Minneapolis, Minnesota 44550-1309, USA.


In today's competitive health care market, only innovators who demonstrate improvements in both quality and price will survive. Primary care physicians can survive, and even thrive, in this environment if they take a hard look at their goals, reflect on necessary changes, and experiment boldly to forge a new primary care model that can achieve the necessary goal of improved clinical care effectively and efficiently. We propose a new model of primary care, the Enhanced Primary Care Model, that combines clinical tools with quality improvement methods to improve health outcomes. Tools include clinical guidelines, patient registries, team care, monitoring, tracking, prioritization, outreach, and the formation of multidisciplinary teams that use continuous quality improvement (CQI) methods. The Enhanced Primary Care Model has many advantages for both patients and clinicians as compared with competing models, such as the Subspecialty Model and the Disease Management Carve-out Model. There is a short window of opportunity for primary care physicians to demonstrate improved health care processes and outcomes using the Enhanced Primary Care Model. Some improvements in primary care have been achieved by increasing efficiency and rearranging what we have to make it work better. However, more radical change is now urgently needed. In the absence of radical improvement in quality of care, the future of primary care may be much more bleak than most physicians have assumed.

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