Primary Care Workforce Study: Examining the Output of U.S. Graduate Medical Educa

说明(申请人提供)：初级保健和服务不足地区的卫生保健劳动力短缺严重限制了农村和较低社会经济社区的卫生保健机会，极大地加剧了这些社区面临的卫生保健差距。医生是医疗保健劳动力的重要组成部分，而医学研究生教育(GME)是培养美国医生劳动力的关键一步。GME项目的地点、课程和使命等因素会影响毕业生的职业选择。GME还代表着联邦政府对医学教育的最大投资，教学医院每年获得超过90亿美元的医疗保险支持，用于GME活动。然而，对GME系统作为一个整体的产出进行的全面研究，包括方案的贡献以及初级保健水平高和服务不足的执业生产者的总体特征，是有限的。研究不足限制了围绕GME制定有效的循证政策的能力。这项拟议研究的目标是检查美国GME赞助机构的产出，并确定成功的初级保健和服务不足的实践产生机构的特征。这项研究将使用现有的数据集(美国医学会医师主文件、国家提供者识别数据库和联邦医疗保险索赔数据)来确定医生的研究生医学教育培训机构，并检查培训机构特征与初级保健和服务不足领域最终实践之间的关系。我们还将研究医生医疗保险支出实践模式与其培训机构支出模式之间的关系。成本效益实践将是未来维持一个高功能、可获得的医疗保健系统的关键，更好地了解影响医生支出实践模式的因素将有助于建立这样一个成本效益系统。最后，我们将研究教学健康中心模式，确定目前正在培训医生的健康中心，并确定这些医生的最终执业地点。教学健康中心立法在2010年的患者保护和平价医疗法案中获得通过，代表了联邦支持GME项目的新模式。了解当前的培训和这一模式的成果与当前和未来的政策相关。在所有情况下，提高对研究生医学教育的理解水平将导致以证据为基础的政策，以解决卫生保健机会和差异问题。

DESCRIPTION (provided by applicant): Health care workforce shortages in primary care and underserved areas severely limit health care access to rural and lower socioeconomic communities, significantly contributing to the health care disparities faced by these communities. Physicians are one important component of the health care workforce and graduate medical education (GME) is a critical step in the production of the U.S. physician workforce. GME program factors, such as location, curriculum and mission affect graduate career choices. GME also represents the greatest federal investment in medical education, with teaching hospitals receiving over $9 billion annually in Medicare support for GME activities. However, comprehensive research examining the output of the GME system as a whole, including contributions of programs and the overarching characteristics of high primary care and underserved practice producers, is limited. Insufficient research limits the ability to produce effective evidence based policies around GME. The goal of the proposed research is to examine the output of U.S. GME sponsoring institutions and identify the characteristics of successful primary care and underserved practice producing institutions. This study will use existing datasets (the American Medical Association Physician Masterfile, National Provider Identification database, and Medicare claims data) to identify physicians' graduate medical education training institutions and examine the relationship between training institution characteristics and eventual practice in primary care and underserved areas. We will also examine the relationship between physician Medicare spending practice patterns and the spending patterns of their training institutions. Cost effective practice will be critical to maintaining a high functioning, accessible health care system in the future and a better understanding of the factors influencing physician spending practice patterns will help to establish such a cost effective system. Finally, we will examine the Teaching Health Centers model, identifying health centers that are currently training physicians and determining the eventual practice location of these physicians. Teaching Health Centers legislation was passed in the Patient Protection and Affordable Care Act of 2010 and represents a new model of federal support for GME programs. Understanding current training and the outcomes of this model is relevant to current and future policy. In all cases, increasing the level of understanding of graduate medical education will lead to evidence based policies to address health care access and disparities issues.