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

描述（由申请人提供）：初级保健和服务不足地区的卫生保健人力短缺严重限制了农村和社会经济地位较低社区获得卫生保健的机会，大大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，研究生医学教育（GME）是美国医生劳动力生产的关键一步。GME的项目因素，如地点、课程和使命影响毕业生的职业选择。GME还代表了联邦政府在医学教育方面的最大投资，教学医院每年从医疗保险中获得超过90亿美元的GME活动支持。然而，综合研究检验GME系统作为一个整体的产出，包括项目的贡献和高初级保健和服务不足的实践生产者的总体特征，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。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生产机构的特征。本研究将使用现有的数据集（美国医学会医师主档案、国家提供者识别数据库和医疗保险索赔数据）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地区的最终实践之间的关系。我们还将研究医师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。具有成本效益的做法将是在未来维持一个高功能，可访问的卫生保健系统的关键，更好地了解影响医生消费实践模式的因素将有助于建立这样一个具有成本效益的系统。最后，我们将检查教学健康中心模型，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。2010年，《患者保护和可负担医疗法案》通过了教学卫生中心立法，这代表了联邦政府支持GME项目的新模式。了解当前的培训和该模型的结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基于证据的政策，以解决卫生保健获取和差距问题。

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.