C Workshops

I

AGENDA

Invitational Workshop

THE SCIENTIFIC BASE OF PRIMARY CARE

Institute of Medicine

National Academy of Sciences

Lecture Room

2101 Constitution Avenue, N.W.

Washington, D.C. 20418

January 24–25, 1995

TUESDAY, JANUARY 24, 1995

8:00–8:30 a.m.

Continental Breakfast

8:30–8:40 a.m.

Introductory Comments and Introduction of Dr. Karen Hein Neal A. Vanselow, M.D. (IOM); Chair, IOM Committee on the Future of Primary Care; Welcomes; Karen Hein, M.D. Executive Officer, IOM

8:40–10:50 a.m.

SESSION 1 THE NATURE OF PRIMARY CARE; Moderator: Neal A. Vanselow, M.D.

8:40–9:00 a.m.

Defining Primary Care: The IOM's Interim Report Neal A. Vanselow, M.D.

9:00–9:30 a.m.

Keynote: Relationship-Centered Health Care; Thomas S. Inui, Sc.M., M.D. (IOM); Professor and Chairman; Department of Ambulatory Care and Prevention; Harvard Medical School and Harvard Community Health Plan



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--> C Workshops I AGENDA Invitational Workshop THE SCIENTIFIC BASE OF PRIMARY CARE Institute of Medicine National Academy of Sciences Lecture Room 2101 Constitution Avenue, N.W. Washington, D.C. 20418 January 24–25, 1995 TUESDAY, JANUARY 24, 1995 8:00–8:30 a.m. Continental Breakfast 8:30–8:40 a.m. Introductory Comments and Introduction of Dr. Karen Hein Neal A. Vanselow, M.D. (IOM); Chair, IOM Committee on the Future of Primary Care; Welcomes; Karen Hein, M.D. Executive Officer, IOM 8:40–10:50 a.m. SESSION 1 THE NATURE OF PRIMARY CARE; Moderator: Neal A. Vanselow, M.D. 8:40–9:00 a.m. Defining Primary Care: The IOM's Interim Report Neal A. Vanselow, M.D. 9:00–9:30 a.m. Keynote: Relationship-Centered Health Care; Thomas S. Inui, Sc.M., M.D. (IOM); Professor and Chairman; Department of Ambulatory Care and Prevention; Harvard Medical School and Harvard Community Health Plan

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--> 9:30–10:00 a.m. What Do We Know About the Content of Primary Care?; Henk Lamberts, M.D., Ph.D. (IOM); Professor and Chair; Department of General Practice; University of Amsterdam 10:00–10:30 a.m. A Framework for Research in Primary Care; Barbara Starfield, M.D., M.P.H. (IOM); Professor and Head; Division of Health Policy; Johns Hopkins University; School of Hygiene and Public Health 10:30–10:50 a.m. Discussion 10:50–12:00 p.m. SESSION 2 PRIMARY CARE AND THE LIFE CYCLE: OPPORTUNITIES FOR INQUIRY ; Moderator: Sheila A. Ryan, Ph.D. (IOM); Dean, School of Nursing; Director, Medical Center Nursing; University of Rochester 10:50–11:00 a.m. Children; Robert J. Haggerty, M.D. (IOM); Professor of Pediatrics Emeritus; University of Rochester 11:00–11:10 a.m. Adolescents; Renee R. Jenkins, M.D.; Professor and Chairman; Department of Pediatrics and Child Health; Howard University College of Medicine 11:10–11:20 a.m. Adults—Women; Vicki Seltzer, M.D.; Professor and Chair; Department of Obstetrics and Gynecology; Long Island Jewish Medical Center 11:20–11:30 a.m. Adults—Men; Jeremiah A. Barondess, M.D. (IOM); President; New York Academy of Medicine

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--> 11:30–11:40 a.m. The Elderly (Over Age 70); Robert L. Kane, M.D.; Minnesota Chair in Long-Term Care and Aging; University of Minnesota 11:40–12:00 p.m. Workshop Participant Discussion 12:00–1:00 p.m. LUNCH (Refectory) 1:00–1:45 p.m. SESSION 3 PRIMARY CARE AND SPECIAL POPULATIONS: OPPORTUNITIES FOR INQUIRY; Moderator: R. Heather Palmer, M.B., B.Ch., M.S.; Director, Center for Quality of Care Research and Education; Harvard University School of Public Health 1:00–1:10 p.m. The Urban Poor; Roderick Seamster, M.D., M.P.H.; Associate Medical Director; Watts Health Foundation, Los Angeles 1:10–1:20 p.m. Rural Populations; Marjorie A. Bowman, M.D., M.P.A. (IOM); Professor and Chair; Department of Family and Community Medicine; Bowman Gray School of Medicine 1:20–1:45 p.m. Workshop Participant Discussion 1:45–3:15 p.m. SESSION 4 ESSENTIAL FIELDS OF INQUIRY: OPPORTUNITIES FOR RESEARCH; Moderator: Henk Lamberts, M.D., Ph.D. (IOM) 1:50–2:00 p.m. Biomedicine—Translating Research to Clinical Practice in Primary Care; Catherine D. DeAngelis, M.D.; Vice Dean for Academic Affairs; Johns Hopkins University; School of Medicine

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--> 2:00–2:10 p.m. Health Promotion and Evidence-Based Medicine, Population-Based and Preventive Medicine; Robert S. Lawrence, M.D. (IOM); Senior Scientist; The Rockefeller Foundation 2:10–2:20 p.m. The Whole Person—The Patient's History; Mack Lipkin, Jr., M.D.; Associate Professor of Clinical Medicine and Director Division of Primary Care; New York University School of Medicine 2:20–2:30 p.m. The Whole Person—Shared Decision Making; Elizabeth A. Mort, M.D., M.P.H.; Massachusetts General Hospital 2:30–2:40 p.m. Primary Care in a Systems Context; David R. Nerenz, Ph.D.; Director, Center for Health System Studies; Henry Ford Health System 2:40–3:15 p.m. Workshop Participant Discussion 3:15–3:30 p.m. BREAK 3:30–5:00 p.m. General Discussion (Workshop Participants and Guests) WEDNESDAY, JANUARY 25, 1995 8:00–8:30 a.m. Continental Breakfast 8:30–10:15 am SESSION 5 CLINICAL REASONING IN PRIMARY CARE; Moderator: William L. Winters, Jr., M.D.; Clinical Professor of Medicine; Baylor College of Medicine 8:30–8:50 a.m. Harold C. Sox, Jr., M.D. (IOM); Chairman, Department of Medicine; Joseph M. Huber Professor of Medicine; Dartmouth-Hitchcock Medical Center

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--> 8:50–9:10 a.m. Walter W. Rosser, M.D.; Professor and Chair; Department of Family and Community Medicine; University of Toronto 9:10–9:30 a.m. Reactors; Marjorie A. Bowman, M.D., M.P.A. (IOM); Professor and Chair; Department of Family and Community Medicine; Bowman Gray School of Medicine   Rhetaugh G. Dumas, Ph.D., R.N. (IOM); The Lucille Cole Professor of Nursing and Vice Provost for Health Affairs; University of Michigan   L. Gregory Pawlson, M.D., M.P.H.; Chairman; Department of Health Care Sciences; George Washington University     9:30–10:15 a.m. Workshop Participant Discussion 10:15–10:30 a.m. BREAK 10:30–11:45 a.m. SESSION 6 A RESEARCH AGENDA FOR PRIMARY CARE; Moderator: Henry W. Foster, Jr., M.D. (IOM); Senior Scholar-in-Residence; Association of Academic Health Centers   Summary of Promising Directions for Research and Overlooked Questions; Gail J. Povar, M.D., M.P.H.; Clinical Professor of Health Care Sciences and Medicine; George Washington University   Developing a Research Agenda: Workshop Participants 11:45–12:45 p.m. LUNCH

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--> 12:45–3:15 p.m. SESSION 7 BUILDING CAPACITY IN PRIMARY CARE RESEARCH; Moderator: Larry A. Green, M.D. (IOM); Professor and Woodward-Chisholm Chairman of Family Medicine; University of Colorado Health Sciences Center 12:50–1:00 p.m. Building Capacity for Primary Care Research; Carolyn Clancy, M.D; Primary Care Division; Agency for Health Care Policy and Research 1:00–1:10 p.m. Mary O. Mundinger, R.N., Dr.P.H. (IOM); Dean, School of Nursing; Columbia University 1:10–1:20 p.m. Paul A. Nutting, M.D., M.S.P.H. (IOM); Director, Ambulatory Sentinel Practice Network; Denver, Colorado 1:20–1:30 p.m. Kurt C. Stange, M.D., Ph.D.; Assistant Professor; Family Medicine, Epidemiology & Biostatistics, and Sociology; Department of Family Medicine; Case Western Reserve University 1:30–3:15 p.m. General Discussion (Workshop Participants and Guests) 3:15–3:30 p.m. Synopsis; Larry A. Green, M.D. (IOM) 3:30 p.m. Adjourn

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--> II AGENDA Invitational Workshop on Roles Institute of Medicine STUDY OF THE FUTURE OF PRIMARY CARE Yorba Room Four Seasons Hotel Newport Beach, California June 12–14, 1995 MONDAY, JUNE 12, 1995 8:00 a.m.–9:00 a.m. CONTINENTAL BREAKFAST 9:00 a.m.–12:00 p.m. SESSION 1 INTRODUCTION AND PRESENTATIONS OF ISSUES ON ROLES; Moderator: Neal Vanselow, M.D. 9:00 a.m.–9:05 a.m. Welcome and Purposes of the Workshop; Neal Vanselow, M.D., Chair of IOM Study Committee 9:05 a.m.–9:15 a.m. Comments on the Clinicians' Perspectives on Roles; Joel Alpert, M.D.; Jean Johnson, RN-C, Ph.D.; Co-chairs of the IOM Subcommittee on Roles 9:15 a.m.–9:30 a.m. Introductions of Participants and Observers 9:30 a.m.–9:50 a.m. The IOM Study on the Future of Primary Care and the Committee's Definition of Primary Care; Neal A. Vanselow, M.D.

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--> 9:50 a.m.–10:15 a.m. Keynote Presentation Roles in Primary Care: Issues and Challenges; Fitzhugh Mullan, M.D.; Director, Bureau of the Health Professions; Public Health Service 10:15 a.m.–10:30 a.m. Discussion by Participants 10:30 a.m.–10:45 a.m. BREAK 10:45 a.m.–11:10 a.m. Reconfiguration of the Health Workforce in a Changing Health Care Environment; Richard Scheffler, Ph.D.; Professor of Health Economics and Policy; School of Public Health; University of California at Berkeley 11:10 a.m.–12:00 p.m. Discussion by Participants to Identify Issues to Be Addressed During Workshop 12:00 p.m.–1:00 p.m. LUNCH 1:00 p.m.–5:00 p.m. SESSION 2 ROLES AND RELATIONSHIPS OF PROVIDING COMPREHENSIVE PRIMARY CARE; Moderator: Jean Johnson, RN-C, Ph.D. 1:00 p.m.–3:00 p.m. Roles and Relationships in Providing Comprehensive Primary Care; Family Practitioners, General Pediatrics, General Internal Medicine, Osteopathy, Nurse Practitioners, Physician Assistants, Other Nurses, and Primary Care OB-GYNs   How Health Professionals and Other Health Workers Are Being Used in Real Primary Care Environments; Including Examples of Cooperative Models and Teams   Presentation of Several Case Studies and Vignettes

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--> 3:00 p.m.–3:15 p.m. BREAK 3:15 p.m.–5:00 p.m. Issues Around the Primary Care Team and the Provision of Comprehensive Primary Care: Directions for the Future   Discussion 5:00 p.m. ADJOURN 6:00 p.m. DINNER TUESDAY, JUNE 13, 1995 8:00 a.m.–9:00 a.m. CONTINENTAL BREAKFAST 9:00 a.m.–12:00 p.m. SESSION 3 THE ROLES OF MEDICAL SPECIALISTS IN PRIMARY CARE; Moderator: Peter Ellsworth 9:00 a.m.–10:45 a.m. The Roles of Medical Specialists in Primary Care; — Mixed Practice; — Principal Physician; — Consultation and Referral   Vignettes and Discussion 10:45 a.m.–11:00 a.m. BREAK 11:00 a.m.–12:00 p.m. Direct Access by Patients to Specialists for ''First Contact"; Care of Problems; — Differences between First Contact and Primary Care   Discussion 12:00 p.m.–1:00 p.m. LUNCH

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--> 1:00 p.m.–3:00 p.m. SESSION 4 ROLES AND RELATIONSHIPS OF OTHER "FIRST CONTACT" PROFESSIONALS IN PRIMARY CARE; Moderator: Richard Scheffler, Ph.D.   Examples of Dentistry and Optometry 3:00 p.m.–3:15 p.m. BREAK 3:15 p.m.–4:00 p.m. SESSION 5 ROLE OF THE PATIENT AS ACTIVE PARTICIPANT IN PRIMARY CARE ; Moderator: carolyn Brown, M.D.   Vignettes; Discussion 4:00 p.m.–5:30 p.m. SESSION 6 IMPLICATIONS OF DISCUSSIONS OF ROLES; Moderator: Joel Alpert, M.D.; — Demand for Health Professionals; — Education and Training; — Organization, Financing, and Infrastructure; — Patterns of Cooperation, Referral, and Coordination; — Legal and Credentialing Issues; (Discussion to be continued on Wednesday morning) 5:30 p.m. ADJOURN 6:00 p.m. DINNER

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--> WEDNESDAY, JUNE 14, 1995 7:30 a.m.–8:30 a.m. CONTINENTAL BREAKFAST 8:30 a.m.–10:00 a.m. SESSION 6 CONTINUED IMPLICATIONS OF DISCUSSIONS OF ROLES 10:00 a.m.–10:15 a.m. BREAK 10:15 a.m.–11:15 a.m. SESSION 7 OBSERVATIONS ON THE WORKSHOP; Moderator: Neal Vanselow, M.D.   Michael Whitcomb, M.D.; Vice President, Division of Education Policy American Association of Medical Colleges   Catherine Gilliss, D.N.Sc.; Professor and Chair Department of Family Health Care Nursing University of California, San Francisco   Karl Yordy; Study Director Institute of Medicine Study of the Future of Primary Care 11:15 a.m.–11:30 a.m. Final Comments and Observations by Participants 11:30 a.m. ADJOURN