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INTRODUCTION NAPCRG celebrated its first 50 years at its 2022 annual meeting. A varied group of members reflected on the organization and its place in family medicine and primary care [...], NAPCRG celebrated 50 years of leadership and service at its 2022 meeting. A varied team of primary care investigators, clinicians, learners, patients, and community members reflected on the organization's past, present, and future. Started in 1972 by a small group of general practice researchers in the United States, Canada, and the United Kingdom, NAPCRG has evolved into an international, interprofessional, interdisciplinary, and intergenerational group devoted to improving health and health care through primary care research. NAPCRG provides a nurturing home to researchers and teams working in partnership with individuals, families, and communities. The organization builds upon enduring values to create partnerships, advance research methods, and nurture a community of contributors. NAPCRG has made foundational contributions, including identifying the need for primary care research to inform primary care practice, practice-based research networks, qualitative and mixed-methods research, community-based participatory research, patient safety, practice transformation, and partnerships with patients and communities. Landmark documents have helped define classification systems for primary care, responsible research with communities, the central role of primary care in health care systems, opportunities to revitalize generalist practice, and shared strategies to build the future of family medicine. The future of health and health care depends upon strengthening primary care and primary care research with stronger support, infrastructure, training, and workforce. New technologies offer opportunities to advance research, enhance care, and improve outcomes. Stronger partnerships can empower primary care research with patients and communities and increase commitments to diversity and quality care for all. NAPCRG offers a home for all partners in this work. Key words: primary care; family practice; general practice; research; organizations; NAPCRG; interdisciplinary research; community-based participatory research

THE IMPERATIVE AND THE PROBLEM The terms population health, community health, and public health are often used interchangeably, yet imprecisely, leading to conceptual and practical misunderstandings. Each term relates in [...], People working on behalf of population health, community health, or public health often experience confusion or ambiguity in the meaning of these and other common terms--the similarities and differences and how they bear on the tasks and division of labor for care delivery and public health. Shared language must be clear enough to help, not hinder people working together as they ultimately come to mutual understanding of roles, responsibilities, and actions in their joint work. Based on an iterative lexicon development process, the authors developed and propose a definitional framework as an aid to navigating among related population and community health terms. These terms are defined, similarities and differences clarified, and then organized into 3 categories that reflect goals, realities, and ways to get the job done. Goals include (a) health as well-being for persons, (b) population health as that goal expressed in measurable terms for groups, and (c) community health as population health for particular communities of interest, geography, or other defining characteristic--groups with shared identity and particular systemic influences on health. Realities are social determinants as influences, health disparities as effects, and health equity as both a goal and a design principle. Ways to get the job done include health care delivery systems for enrollees and public health in population-based civic activities--with a broad zone of collaboration where streams of effort converge in partnership with served communities. This map of terms can enable people to move forward together in a broad zone of collaboration for health with less confusion, ambiguity, and conflict. Key words: population health; lexicon; definitions; primary care public health integration

Presenters Stephanie Gold, MD, Larry Green, MD, Perry Dickinson, MD, Stephanie Kirchner, MSPH, RD, Emma Gilchrist, MPH, Bahroze [...], Context: Behavioral health integration (BHI) in primary care improves outcomes and decreases costs; yet its uptake has been limited by inadequate payment. Payers have expressed a need to understand how additional resources for BHI will be used. Implementation of BHI varies depending on patient population needs, practice resources, and local workforce availability. Objective: To develop a framework for BHI in primary care that would inform the design of alternative payment models supporting BHI, align payer expectations, decrease administrative burden on practices, and achieve a level of standardization of BHI care delivery requirements that enhance patient care while still allowing for flexibility. Study design: (1) Milestones used for the Colorado State Innovation Model were examined to select items specific to BHI that could be overlaid on more general milestones for advancing primary care. These items were divided into foundation and additional modular components of BHI: advanced coordination and care management, integrated behavioral health professionals, psychiatry, and the advanced care of substance use disorders. (2) Other frameworks for BHI were reviewed to identify any gaps. (3) Key informant interviews were held to obtain feedback from relevant stakeholders to further refine the framework. Dataset: Other frameworks and tools reviewed: Colorado State Innovation Model milestones, NCQA BH distinction, Continuum-based framework for integrated care, Integrated Practice Assessment Tool, Practice Integration Profile. Population studied: 15 key informant interviews were conducted with payers, policymakers, behavioral health and primary care providers, practice transformation experts, and patient advocates. Instrument: A semi- structured, piloted interview guide was used for key informant interviews. Results: A refined framework outlining care delivery expectations for varied implementation approaches of BHI, designed to be used by payers and policymakers in developing alternative payment methodologies to support BHI. Conclusions: This framework can be applied to alternative payment models at the state, regional, and federal levels to improve alignment of expectations across payers, providers, and patients.

In 2022 NAPCRG is celebrating its 50th anniversary of researchers coming together to share their questions and solutions! Since 1972, when Maurice Wood first envisioned NAPCRG, we have become a [...]

We live in a world that is more connected than it has ever been in human history, and although that connectivity brings with it opportunities for innovation and societal advancement, [...]

The article reports that Maurice Wood first envisioned North American Primary Care Research Group become a premier international primary care research organization with research representation continuing to grow from North America, Europe, the Pacific Rim, and Asia. It mentions that research brings about community and population health from a primary care perspective to explore new research ideas from qualitative research to practice-based research to community-based research.

The article reports developments in the efforts by the global health care sector to align health care to a person-focused, individually tailored, and goal-oriented model of care as of July 2018. Also cited are the need to compromise the biomedical, patient and professional views on the elements of best care to make effective decisions, as well as the four components of best quality generalist practice including the goals of care, data use, and quality of care assessment.

The article discusses a shared data model for primary care that develops health information technology (IT) standards and describes the essential core functions of a transformed U. S. health care system. Topics include the challenges on the content standard, the key operational components, and the strategy map to support primary care.

Genomic research has generated much new knowledge into mechanisms of human disease, with the potential to catalyze novel drug discovery and development, prenatal and neonatal screening, clinical pharmacogenomics, more sensitive risk prediction, and enhanced diagnostics. Genomic medicine, however, has been limited by critical evidence gaps, especially those related to clinical utility and applicability to diverse populations. Genomic medicine may have the greatest impact on health care if it is integrated into primary care, where most health care is received and where evidence supports the value of personalized medicine grounded in continuous healing relationships. Redesigned primary care is the most relevant setting for clinically useful genomic medicine research. Taking insights gained from the activities of the Institute of Medicine (IOM) Roundtable on Translating Genomic-Based Research for Health, we apply lessons learned from the patient-centered medical home national experience to implement genomic medicine in a patient-centered, learning health care system. [ABSTRACT FROM AUTHOR]

The article presents information on a study conducted to examine the increasing adoption of electronic health records (EHRs) among family physicians. The study found that the EHR adoption rate by family physicians had reached 68 percent nationally in the U.S. during 2011. The study concluded that EHR adoption can lead to better, affordable health care.

The article reports on the study that investigates the characteristics associated with differential participation in the American Board of Family Medicine's Maintenance of Certification (MOC) by family physicians. The study found significant association between practicing in underserved areas and lapsed board certification. It shows that MOC has the potential to convey substantial practice-relevant medical information to physicians and offers potential channel to improve health care knowledge.

An essay is presented on the life of the town's family doctor, John Anderson. It explores the testimonies and reflections given by the public at the memorial service for Doctor Anderson, in which the public narrated their experiences of how the doctor considered their needs and fears. The author notes that the stories serve as evidence of the value provided by personal doctoring to patients and communities.

This article characterizes the large research domain of family medicine. It is a domain that can be productively explored from different perspectives, including: (1) the ecology of medical care and its focus on the environments of health care and interactions among them; (2) the realm of causation and important opportunities to discover how people lose and regain their health; (3) knowing medicine in different ways, focusing on what things mean in the inner and outer realities of individuals and groups of individuals; (4) the nature of the work of family physicians, such as first-contact care for any type of problem, sticking with patients regardless of their diagnoses, incorporating context into decision making, development of relevant technologies, articulating useful theory, and measuring what happens in family medicine; (5) the standard research categories of basic, clinical, health services, health policy, and educational research; and (6) thinking of family medicine research as both a linear process of translation and a wheel of knowledge with iterative loops of discovery that come from within family medicine. The domain of family medicine research is important and ripe for fuller discovery, and it invites the thinking and imagination of the best investigators. It seems unlikely that medical research can ever be complete without a robust family medicine research enterprise. As the domain of family medicine research is explored, not a few, but billions of people will benefit. [ABSTRACT FROM AUTHOR]

Background: Recognizing fundamental flaws in the fragmented US health care systems and the potential of an integrative, generalist approach, the leadership of 7 national family medicine organizations initiated the Future of Family Medicine (FFM) project in 2002. The goal of the project was to develop a strategy to transform and renew the discipline of family medicine to meet the needs of patients in a changing health care environment.Methods: A national research study was conducted by independent research firms. Interviews and focus groups identified key issues for diverse constituencies, including patients, payers, residents, students, family physicians, and other clinicians. Subsequently, interviews were conducted with nationally representative samples of 9 key constituencies. Based in part on these data, 5 task forces addressed key issues to meet the project goal. A Project Leadership Committee synthesized the task force reports into the report presented here.Results: The project identified core values, a New Model of practice, and a process for development, research, education, partnership, and change with great potential to transform the ability of family medicine to improve the health and health care of the nation. The proposed New Model of practice has the following characteristics: a patient-centered team approach; elimination of barriers to access; advanced information systems, including an electronic health record; redesigned, more functional offices; a focus on quality and outcomes; and enhanced practice finance. A unified communications strategy will be developed to promote the New Model of family medicine to multiple audiences. The study concluded that the discipline needs to oversee the training of family physicians who are committed to excellence, steeped in the core values of the discipline, competent to provide family medicine's basket of services within the New Model, and capable of adapting to varying patient needs and changing care technologies. Family medicine education must continue to include training in maternity care, the care of hospitalized patients, community and population health, and culturally effective and proficient care. A comprehensive lifelong learning program for each family physician will support continuous personal, professional, and clinical practice assessment and improvement. Ultimately, systemwide changes will be needed to ensure high-quality health care for all Americans. Such changes include taking steps to ensure that every American has a personal medical home, promoting the use and reporting of quality measures to improve performance and service, advocating that every American have health care coverage for basic services and protection against extraordinary health care costs, advancing research that supports the clinical decision making of family physicians and other primary care clinicians, and developing reimbursement models to sustain family medicine and primary care practices.Conclusions: The leadership of US family medicine organizations is committed to a transformative process. In partnership with others, this process has the potential to integrate health care to improve the health of all Americans. [ABSTRACT FROM AUTHOR]

Background: We wanted to quantify how the location in which medical care is delivered in the United States varies with the sociodemographic characteristics and health care arrangements of the individual person.Methods: Data from the 1996 Medical Expenditures Panel Survey (MEPS) were used to estimate the number of persons per 1,000 per month in 1996 who had at least 1 contact with physicians' offices, hospital outpatient departments, or emergency departments, hospitals, or home care. These data were stratified by age, sex, race, ethnicity, household income, education of head of household, residence in or out of metropolitan statistical areas, having health insurance, and having a usual source of care.Results: Physicians' offices were overwhelmingly the most common site of health care for all subgroups studied. Lacking a usual source of care was the only variable independently associated with a decreased likelihood of care in all 5 settings, and lack of insurance was associated with lower rates of care in all settings but emergency departments. Generally, more complicated patterns emerged for most sociodemographic characteristics. The combination of having a usual source of care and health insurance was especially related to higher rates of care in all settings except the emergency department.Conclusion: Frequency and location of health care delivery varies substantially with sociodemographic characteristics, insurance, and having a usual source of care. Understanding this variation can inform public consideration of policy related to access to care. [ABSTRACT FROM AUTHOR]

The article discusses the joint principles on integrating behavioral health care into the Patient-centered Medical Home (PCMH), an innovative approach of providing primary care. It states that a physician's practice would be the location of the PCMH. The principles on areas including quality and safety, access to behavioral health care resources, and payment is explored. Some of the critical issues that need to be addressed to realize these principles are also outlined.

The article presents author's view on family medicine and primary care in considerations of the importance of the family in health and disease and the field of medical family therapy. According to the author mental illness can distort normal family relationship and can affect behavioral health with the help of primary care.

The article discusses the inauguration of family medicine physician Gayle Stephens and his intellectual leadership. It mentions the contributions of Stephens in providing the important relationship between the role of personal physician and clinical practice. Information regarding The G. Gayle Stephens Keystone Conference Series which focuses on the legacy of Stephens.

The article discusses the Joint Principles for Integrating Behavioral Health Care into the Patient-Centered Medical Home (PCMH) that has been drafted by six family medicine organizations in the U.S. It states that the draft has been forwarded for comments and endorsement to the American Academy of Pediatrics (AAP), the American Osteopathic Association (AOA), and the American College of Physicians (ACP). The core principle of the PCMH is also mentioned.

Information about several papers discussed at a meeting sponsored by physicians on the P4 (Preparing the Personal Physician for Practice) project is presented. Topics include the "baseline" data collection of the residents and residencies, the first "collaboration visits" of the Oregon Health and Science University and programs achieved by the group.