For years, research has shown us that more primary care physicians per capita leads to better population health outcomes. As a corollary, more subspecialists in a given geographic area leads to poorer health outcomes.
A perfunctory look at specialty choice by medical students shows that decreasing numbers of students are choosing primary care.
Likewise, research shows that team based, patient-centered care creates better health outcomes and potentially higher patient satisfaction. We also know that this approach can decrease ER visits and ultimately decrease costs.
Then, why haven't we enacted policies and laws to support these and many other findings? Reporting live from the North American Primary Care Research Group Conference (NAPCRG) this week, I have attended seminars and seen posters with outstanding research in chronic disease management, health delivery/services, medical education, you name it.
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Early yesterday afternoon, I was in the paper session for Health Care Delivery/Health Services Research and it was standing room only. One of the co-authors to a paper couldn't even get into the room because it was so full. Then, I attended a workshop on "Advocacy Skills for the Primary Care Researcher." 10 people in attendance (not counting the 5 workshop leaders and 3 organization staff members in the room).
This disconnect is the fundamental problem with why our research doesn't translate into policy. Researchers do research; the majority never set foot in a legislator's office, don't understand and shun politics, and focus on the statistics. On the other hand, legislators generally don't make evidence-based decisions; most legislators don't understand what a p-value is (forget picking up "Health Affairs" or "NEJM"). They base their decisions on what their constituents want, personal stories, interest groups and media reports.
In my Community and Consumer Organizing class at Harvard School of Public Health, we learned about Kingdon's Open Window Model for change. People generally sit in 1 of 3 streams:
- Problem Stream: identifying and validating problems through research
- Policy Stream: identifying and narrowing down solutions to short list of technically feasible policies
- Political Stream: enacting laws during favorable political climate for solutions
In this model, those who are able to get things done are those who sit at the borders of the streams and can align the streams to create an open window of opportunity.
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So, how can we get our researchers more interested in advocacy and politics? How can get legislators excited about the policy implications of research? Addressing these issues and creating more translational research will be fundamental as we pursue reform in primary care, in chronic disease management, in health systems... as we pursue a healthier and better America.