Original Research

The Development and Goals of the AAFP Center for Policy Studies in Family Practice and Primary Care

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In this article we describe the creation and role of the Center for Policy Studies in Family Practice and Primary Care established by the American Academy of Family Physicians in Washington, DC, this year. We recount the events leading to the decision to implement the Center, list its guiding assumptions, and explain its initial structure and function. We also identify the 3 themes that will guide the early work of the Center: sustaining the functional domain of family practice and primary care; investing in key infrastructures; and securing universal health coverage.


 

References

This year the American Academy of Family Physicians (AAFP) opened a new policy center in Washington, DC. The idea for this center can be traced back to AAFP Executive Vice President Robert Graham, MD, who envisioned a research unit focused on family practice and primary care policy in the relatively small community of health policy advocates in Washington.

In 1996, several officers and staff of the AAFP agreed that a policy center in Washington could fit into a framework focused on building the infrastructures necessary to support family practice and primary care. Concurrently, the membership and leadership of the Academy rediscovered the critical role of research in strengthening family practice, and the concepts of research and a policy center converged.

When the idea was taken to the AAFP Board of Directors for formal action, the board approved the policy center without controversy and directed the staff to proceed. Key leaders supported a comprehensive plan to enhance research capacity and included a policy center with other strategies for achieving this goal. There was agreement that effective advocacy requires facts and that the envisioned policy center would have to be sufficiently independent to be credible. And there was agreement that the center should be located in Washington, DC, to affirm family practice and primary care and react to vagaries of health care policy at a federal level.

A favorable financial position permitted immediate movement toward implementation. By the end of 1998, the first director was designated and the exact location of the Center was determined. Ideas about the work and focus of the Center were elicited from practicing family physicians and other leaders within and beyond the primary care community. The Center for Policy Studies in Family Practice and Primary Care opened for business on June 8, 1999. The Center operates according to a set of assumptions which are outlined in the Table 1

Initial structure and function

The Center is structured to operate as an independent unit working under the personnel and financial policies of the AAFP. The initial staff of 5 (supplemented with consultative relationships) have knowledge and skills in the areas of primary care, family practice, epidemiology, statistics, research design, and data/information management. These individuals share leadership and responsibility for various projects and activities and coordinate their efforts with the help of an office administrator. Because the policy of the Center is to use existing data sets and the study results of researchers worldwide whenever possible, the Center’s staff will only do primary data collection when necessary.

The staff of the Center is accountable to the Director, who reports to the Vice President of Socioeconomic Affairs. There are no lines of accountability to the various AAFP commissions and committees. The AAFP Board decided that the Center would have editorial independence to pursue and publish work according to traditional academic and peer-review standards. A formally constituted advisory board advises the Center. This volunteer group does not have administrative authority but provides commentary on the Center’s direction and work on a regular basis. The Center relies on the AAFP’s Washington office and other AAFP divisions for assistance in detecting relevant policy opportunities, guidance about the Washington environment, and decisions about communication strategies.

Issues from the field

The United States is spending much more for health care than other countries, with relatively mediocre results. The commitment of this huge amount of wealth is accompanied by widespread dissatisfaction among patients, physicians, nurses, psychologists, hospital administrators, employers, and governments. Indeed, there are those who suggest that the marriage of medicine and the market has left medicine purposeless and adrift.3 Something is terribly wrong.

Starting a new health policy center in Washington, DC, in this context will be challenging. As a way of grounding the Center in its stated purpose of bringing a family practice and primary care perspective to health policy issues, the initial staff of the Center sought advice from those people most committed to family practice and primary care from a provider perspective. From the autumn of 1998 to the winter of 1999, approximately 400 individuals responded to queries about what the important health policy issues are for family practice and primary care. Among these respondents were officers of all of the national family medicine organizations, officers of national internal medicine and pediatric organizations, the chairmen of academic departments of family medicine, family practice residency directors, participants in a national meeting concerning practice-based research networks, leaders of safety-net organizations, members of the Institute of Medicine, faculty at medical schools (including those working primarily with medical students), international health workers, state legislators and activists, Robert Wood Johnson Generalist Scholars, and several early leaders of family medicine in the United States. Practicing family physicians and the staff of the AAFP were also polled. The various committees of the Academic Family Medicine Organization, directors of other health policy centers, staff working in agencies of the US Department of Health and Human Services, and a few deans of nursing and medical schools also provided their perspectives.

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