## NEJM publishes Robert Graham Center study

BY SHERI PORTER

When you sit down to read the June 28 New England Journal of Medicine, don't miss "The Ecology of Medical Care Revisited," a study from the Robert Graham Center in Washington.

Larry Green, M.D., director of the AAFP center and principal investigator for the study, said that despite the passage of 40 years -- and major changes in the U.S health care system -- the health services delivery model described in his study closely resembles the original model published in NEJM in 1961. Even an aging U.S. population and the inclusion of children in the new model did not significantly change the outcomes.

"The ecology model is a framework that allows us to think about health care and how people make the decision to actually go see a doctor," said Green.

Larry Green, M.D., left, and Kerr White, M.D., stand in front of worksheets in the Robert Graham Center. Green calls White "a father of health service research who has championed the cause of family physicians since the 1950s."
The Ecology Scheme* *Source: Robert Graham Center in Washington

The study shows, once again, the importance of health care administered outside of the hospital setting, said Green. The results suggest that policy-makers should seek a better balance in allocating funds earmarked for medical education, medical research and clinical practice, "in order to meet all the needs of all the people," he said.

"We would hope that this updated model will be used with renewed confidence that the estimates are contemporary and relevant to current health care issues," said Greene. "However, the stability of the model over the 40-year period of time doesn't mean that people necessarily have done the right thing. There were imbalances in 1961, and the model shows that there are still imbalances in 2001."

Kerr White, M.D., lead author of the 1961 study, serves on the Robert Graham Center advisory board.

The figures cited in the recent study reflect positively on FPs and other primary care physicians: For every 1,000 people, it is estimated that 113 visit a primary care physician's office in any one-month period (see graph at above).

"If there should be any primary care physicians who are feeling beleaguered today and, particularly, wondering if the work they do matters, this framework should alleviate their doubts about the importance of their role -- and not based on the world's experience up to 1961, but based on the behavior of the American people at the end of the last century," said Green.