Research, Publications and Articles

Equity in health care is central to the mission of the Center and is interwoven into many areas of research. Our research includes how primary care health education can be transformed to advance health equity, and how primary care innovations and oral health can advance health equity.

Featured equity research

• Ravenna, P.A., Bream, K.D., Fancher, T., Juarez, P., Klusaritz, H.A., Matthews-Juarez, P., Persell, S.D., Phillips, R.S., Riedy, C., & Patterson, D.G. Who, What, and Where: Transforming Primary Care Education to Advance Health Equity. Journal of Health Care for the Poor and Underserved, 2020;31(4S):128-138. doi: 10.1353/hpu.2020.0144. PMID: 35061615.
• Primary Care in the COVID-19 Pandemic: Improving access to high quality primary care, accelerating transitions to alternative forms of care delivery, and addressing health disparities. In: Basu, S., Alpert, J.L., & Phillips, R.S., editors. New York, NY: Milbank Memorial Fund, 2021.
• Barrow, J., Silk, H., Phillips, R.S., & Riedy, C.A. (2020) Oral Health is Health: The Future is Now. Journal of Health Care for the Poor and Underserved, 2020 31(4S). 99-103. doi: 10.1353/hpu.2020.0140. PMID: 35061611.

 

View the full list of equity research

An important area of research concerns primary care financing and the impact of primary care transformation or innovation on health care financing. In this area, Center researchers have used microsimulation models to estimate the potential impact of COVID-19 on the operating expenses and revenues of primary care practices, to study primary care practices and financial risk, to examine the relationship between state commercial health care spending growth through price controls on health care quality, and to study the financial sustainability of team-based care and patient-centered medical home (PCMH) innovations. This research has also focused on how physician- and practice-level continuity are associated with Medicare expenditures and health care outcomes and the financial impact for primary care practices of integrating behavioral health services.

Featured financing research

• Kyle, M.A., Song, Z. (2023) The Consequences and Future of Prior-Authorization Reform. New England Journal of Medicine.
• Yang, Z., Ganguli, I., Davis, C., et al. (2022) Physician- versus practice-level primary care continuity and association with outcomes in Medicare beneficiaries. Health Services Research, 2022; 57( 4): 914- 929. doi:10.1111/1475-6773.13999
• Basu, S., Phillips, R.S., Phillips, R., Peterson, L.E., & Landon, B.E. (2020) Primary Care Practice Finances In The United States Amid The COVID-19 Pandemic. Health Affairs (Millwood), 2020 Sep;39(9):1605-1614. doi: 10.1377/hlthaff.2020.00794. Epub 2020 Jun 25. PMID: 32584605.
• Baum, A., Song, Z., Landon, B.E., Phillips, R.S., Bitton, A., Basu, S. (2019) Health Care Spending Slowed After Rhode Island Applied Affordability Standards To Commercial Insurers. Health Affairs (Millwood), 2019 Feb;38(2):237-245. doi: 10.1377/hlthaff.2018.05164. PMID: 30715981; PMCID: PMC6593124.

 

View the full list of leadership and team building research

Center research has focused on health outcomes in primary care and sub-specialties including radiology, oral health, and gastroenterology. Much of this work has focused on gaps in follow-up care, test scheduling and/or test completion (“open loops”). Prevalence rates of open loops, factors related to open loops, and innovations for closing loops have been a focus of the health outcome research.

Featured health outcomes research

• White, T., Aronson, M.D., Sternberg, S.B., et al. (2022) Analysis of Radiology Report Recommendation Characteristics and Rate of Recommended Action Performance. JAMA Network Open, 2022;5(7):e2222549. doi:10.1001/jamanetworkopen.2022.22549
• Basu, S., Berkowitz, S.A., Phillips, R.L., Bitton, A., & Landon, B.E., & Phillips, R.S. (2019) Association of Primary Care Physician Supply With Population Mortality in the United States, 2005-2015. JAMA Internal Medicine, 2019 Apr 1;179(4):506-514. doi: 10.1001/jamainternmed.2018.7624.

 

View the full list of health outcome research

The Center has conducted extensive research regarding primary care education at the undergraduate medical, resident/clerkship, and professional levels including the development of primary care curriculum for general medical education, models for engaging students in primary care, and the development and evaluation of programs to train students as innovators and members of interprofessional teams to address the current complex healthcare environment.

Featured education research

• Duong, D.B., Nguyen, T.A., Goodell, K., et al. (2022). Undergraduate Medical Education Reform in Viet Nam for a Primary Health Care Workforce. Ann Glob Health.
• Rotenstein, L., Perez, K., Wohler, D., Sanders, S., Im, D., Kazberouk, A., & Phillips, R.S. (2019). Preparing health professions students to lead change. Leadership in Health Services, 32, 182-194.
• Cahn, P.S., Bzowyckyj, A., Collins, L., Dow, A., Goodell, K., Johnson, A.F., Klocko, D., Knab, M., Parker, K., Reeves, S., & Zierler, B.K. (2016) A design thinking approach to evaluating interprofessional education. J Interprof Care, 2016 May 30(3):378-80. doi: 10.3109/13561820.2015.1122582. Epub 2016 Mar 30. PMID: 27030030.

 

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The Center has led numerous studies of leadership and team-building including qualitative analysis of high functioning teams, the relationship between team functioning and colorectal cancer screening, building strong teams in the Covid-19 era of virtual care, and the impact of team-based care practice transformation in primary care settings on care for chronically ill patients, and on primary care provider work satisfaction.

Featured Primary care leadership and team building research

• Sullivan, E.E., Ibrahim, Z., Ellner, A.L., & Giesen, L.J. (2016) Management Lessons for High-Functioning Primary Care Teams. Journal of Healthcare Managment, 2016 Nov/Dec;61(6):449-465. PMID: 28319964.
• Meyers, D.J., Chien, A.T., Nguyen, K.H., Li, Z., Singer, S.J., & Rosenthal, M.B. (2019) Association of Team-Based Primary Care With Health Care Utilization and Costs Among Chronically Ill Patients. JAMA Internal Medicine, 2019 Jan 1;179(1):54-61. doi: 10.1001/jamainternmed.2018.5118. PMID: 30476951; PMCID: PMC6583420.
• Song, H., Ryan, M., Tendulkar, S., Fisher, J., Martin, J., Peters, A.S., Frolkis, J.P., Rosenthal, M.B., Chien, A.T., & Singer, S.J. (2017) Team dynamics, clinical work satisfaction, and patient care coordination between primary care providers: A mixed methods study. Health Care Management Review, 2017 Jan/Mar;42(1):28-41. doi: 10.1097/HMR.0000000000000091. PMID: 26545206.

 

View the full list of leadership and team-building research

Primary Care transformation, specifically from fee-for-service to value-based care payment structures, has been a focus of The Center’s research program. This area includes the qualitative study of data collected from leaders in population health, the impact of innovations such as care integration and the patient-centered medical home on health outcomes and patient experience, and the use of learning collaboratives to foster primary care transformation. Research on community health workers has investigated the impact of CHWs on patient health outcomes and on health care costs. The Center has served as a thought leader in this area by publishing commentary regarding future directions for primary care, and how primary care transformation can best improve health outcomes, patient experience, clinician wellbeing, and equity while reducing overall healthcare costs.

Featured primary care transformation research

• Singer, S.J., Sinaiko, A.D., Tietschert, M.V., Kerrissey, M., Phillips, R.S., Martin, V., Joseph, G., Bahadurzada, H., Agniel, D. (2020). Care integration within and outside health system boundaries. Health Services Research, 2020 Dec;55 Suppl 3(Suppl 3):1033-1048. doi: 10.1111/1475-6773.13578. PMID: 33284521; PMCID: PMC7720712.
• Ellner, A.L. &  Phillips, R.S. (2017) The Coming Primary Care Revolution. Journal of General Internal Medicine, 2017 Apr;32(4):380-386. doi: 10.1007/s11606-016-3944-3. Epub 2017 Feb 27. PMID: 28243869; PMCID: PMC5377886.

 

View a full list of primary care transformation research

Primary care must innovate to improve health equity and meet the needs of all patients.

• Phillips, R.S. Creating Value Through "Accompaniment" in Primary Care: a Call for Advocacy [published online ahead of print, 2023 Jul 5]. J Gen Intern Med. 2023;10.1007/s11606-023-08298-x. doi:10.1007/s11606-023-08298-x

• Alpert, J. & Sullivan, E. E. (2017). How digital health care can help prevent chronic diseases like diabetes. Harvard Business Review.

• Bailey, G. and Bährer-Kohler, S. (2017). The Promotion and Delivery of Mental Health Services in Primary Care Settings. Global Mental Health (pp. 183-192). Springer, Cham.

 

View a full list of primary care innovation research

Supporting health care worker resilience and finding solutions to burnout is a part of our mission. Center research includes the impact of the Covid-19 epidemic and potential pathways to promoting health care worker well-being.  

Featured resiliency and burnout publications

• Sullivan, E.E., Breton, M., McKinstry, D. & Phillips, R.S. (2022). COVID-19's Perceived Impact on Primary Care in New England: A Qualitative Study. The Journal of the American Board of Family Medicine, March 2022, 35 (2) 265-273; DOI: https://doi.org/10.3122/jabfm.2022.02.210317
• Phillips R.S. & Himmelstein D.U. (2016). Should we abandon routine visits? Annals of Internal Medicine, 164 (7), 498-499.

 

View a full list of resiliency and burnout research

Around the world, primary care is essential to community health and well-being. Our research has focused on global primary care development and capacity building to support health systems in low- and middle-income countries.

Featured global health research

• Holt,B., Fernandez, M., Nguyen, D., Pollack, T., Duong, D. et al. Embedding viral hepatitis into primary healthcare: results of a strategic landscape analysis in Vietnam and the Philippines. Lancet Reg Health West Pac. 2023;44:100990. Published 2023 Dec 20. doi:10.1016/j.lanwpc.2023.100990Duong, D.B., Nguyen, T.A., Goodell, K., et al. (2022). Undergraduate Medical Education Reform in Viet Nam for a Primary Health Care Workforce. Ann Glob Health.
• Duong, D.B., King, A.J., Grépin, K.A., et al. (2022) Strengthening national capacities for pandemic preparedness: a cross-country analysis of COVID-19 cases and deaths. Health Policy Plan.
• Duong, D.B., Minh, H.V., Ngo, L.H,. Ellner, A.L. Readiness, Availability and Utilization of Rural Vietnamese Health Facilities for Community Based Primary Care of Non-communicable Diseases: A CrossSectional Survey of 3 Provinces in Northern Vietnam. Int J Health Policy Manag. 2019;8(3):150-157. Published 2019 Mar 1. doi:10.15171/ijhpm.2018.104
• Basu, S., Jack, H. E., Arabadjis, S. D., & Phillips, R. S. (2016). Benchmarks for reducing emergency department visits and hospitalizations through community health workers integrated into primary care: a cost-benefit analysis. Medical Care.
• Vasan, A., Hudelson, C. E., Greenberg, S. L., & Ellner, A. E. (2015). An integrated approach to surgery and primary care systems strengthening in low-and middle-income countries: building a platform to deliver across the spectrum of disease. Surgery, 157(6), 965-970.

Case studies conducted by the Center offer an in-depth exploration of health care organizations and primary care practices as they negotiate financial and systemic constraints to address patient and community needs. Themes of customer-owner-physician relationships, patient agency, addressing community needs, access, behavioral health integration, health care worker resilience, primary care leadership, equity, and cost/value are also highlighted. These case studies have been widely used as teaching tools highlighting and illustrating challenges in primary care as well as innovation and primary care transformation.

Featured case studies

• Naithani, P.K. & Weilnau, T. (2019) Daniel Driscoll Neponset Health Center: Interdisciplinary Approach to Chronic Pain Management. Boston, MA USA: Harvard Medical School Center for Primary Care.
•  Ibrahim, Z. & Sullivan, E. E. (2015). Martin’s Point Health Care-Bangor: Pioneers in a Landscape of Constant Change. Boston, MA, USA: Harvard Medical School Center for Primary Care.
• Alpert, J. & Sullivan, E. E. (2016). Qliance Management Inc: Pioneers in Opportunity and Scale. Boston, MA, USA: Harvard Medical School Center for Primary Care.

View a list of all Center for Primary Care case studies

Gun violence surpassed car accidents as the leading cause of death for American children. The clinical and economic impact of these firearm injuries on survivors and family members remains poorly understood. Our research hopes to bring more clarity around gun violence and inform policy.

 

Featured gun violence research

• Song, Z., Zubizarreta, J.R., Giuriato, M., Koh, K.A., Sacks, C.A. Firearm Injuries In Children And Adolescents: Health And Economic Consequences Among Survivors And Family Members. Health Aff (Millwood). 2023;42(11):1541-1550. doi:10.1377/hlthaff.2023.00587