Family Medicine’s Role in Generating Evidence to Inform Primary Care Payment Reform and New Care Delivery Models

Helen Newton; Margaret Helton; Erin Fraher

doi:10.3122/jabfm.2024.240009R1

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Table 1.

Sample of Impactful Journals Routinely Publishing Primary Care Payment and Delivery System Reform Scholarship

Journal Title	Impact factor (2022)	All publications included in dimensions database (2018–2022)	All Primary Care Payment and delivery system reform publications (2018–2022)
Cross-disciplinary journals
New England Journal of Medicine	176.1	7,643	404
JAMA	157.4	8,830	780
JAMA Health Forum	11.5	897	255
Health Affairs	9.0	1,655	831
Milbank Quarterly	6.6	265	142
Medical Care	3.0	990	510
Journal of Health Politics, Policy, and Law	3.0	274	133
Health Services Research	2.7	1,147	521
Family medicine-specific journals
Annals of Family Medicine	4.4	1,025	304
Journal of the American Board of Family Medicine	3.0	863	336
Internal medicine-specific journals
Annals of Internal Medicine	39.2	4,196	408
Journal of General Internal Medicine	5.7	3,653	1,086
Pediatrics-specific journals
JAMA Pediatrics	26.1	2,098	122
Pediatrics	8.0	8,538	380
Total (14 journals)		42,074	6,212

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Table 2.

Trends in Authorship of Primary Care Payment and Delivery System Reform Scholarship Among Departments of Family Medicine, Internal Medicine, and Pediatrics-Affiliated Scholars, 2018-2022

		All primary care payment and delivery system reform articles						Impactful Primary Care Payment and delivery system reform articles*
		Any Department of Family Medicine Authors		Any Department of Internal Medicine Authors		Any Department of Pediatrics Authors			Any Department of Family Medicine Authors		Any Department of Internal Medicine Authors		Any Department of Pediatrics Authors
Year	N Articles	N	%	N	%	N	%	N Articles	N	%	N	%	N	%
2018	1225	105	8.6%	209	17.1%	104	8.5%	126	9	7.1%	22	17.5%	15	11.9%
2019	1242	96	7.7%	260	20.9%	109	8.8%	106	7	6.6%	32	30.2%	5	4.7%
2020	1318	106	8.0%	231	17.5%	109	8.3%	124	9	7.3%	24	19.4%	9	7.3%
2021	1282	108	8.4%	252	19.7%	105	8.2%	102	10	9.8%	19	18.6%	4	3.9%
2022	1145	104	9.1%	245	21.4%	77	6.7%	108	15	13.9%	27	25.0%	14	13.0%
Total	6212	519	8.4%	1197	19.3%	504	8.1%	566	50	8.8%	124	21.9%	47	8.3%

Note: Sample includes articles from impactful clinical and policy journals that routinely publish health policy and delivery system scholarship, including JAMA, JAMA Health Forum, New England Journal of Medicine, Health Services Research, Health Affairs, JHPPL, Medical Care, Milbank Quarterly, Annals of Family Medicine, JABFM, Annals of Internal Medicine, JGIM, JAMA Pediatrics, and Pediatrics. We identified affiliation with individual clinical departments using the Authors’ Raw Affiliation included for each article (Family Medicine = any affiliation that included “Family Medicine”, “Family and Community Medicine”, “Community and Family Medicine”, or “Family and Preventive Medicine”; Internal Medicine = any affiliation that included “Department of Medicine”, “Internal Medicine”, or “General Internal Medicine”; Pediatrics = any affiliation that included “Pediatrics”).
*Impactful refers to publications that were in the top decile of Altmetric scores (calculated by journal-year).

Appendix Table 1. MeSH Search Terms Used to Identify Articles That Were Related to Primary Care Redesign and Payment Reform

	Terms
1. Primary Care	“primary care” OR “nursing, primary care” OR “physician, primary care” OR “physicians, primary care” OR “primary care nursing”
AND
2. Care Delivery and Payment Models	“Policy” OR “Health Policy” OR “Delivery of Health Care” OR “Quality of Health Care” OR “Medicare” OR “Medicaid” OR “Payment Model” OR “Payment Methods” OR “Reimbursement” OR “Reimbursement Methods” OR “Fee-For-Service Plans” OR “Fee-for service Reimbursement” OR “Government Programs” OR “Health Expenditures” OR “Health Care Costs” OR “Cost Savings” OR “Cost” OR “Cost Analysis” OR “Investment” OR “ACOs” OR “Accountable Care Organizations” OR “Care organization, accountable” OR “Accountable Health Plans” OR “pay for performance” OR “P4P” OR “Financial Risk Sharing” OR “Risk Sharing, Financial” OR “Capitation Fee” OR “Healthcare Financing” OR “Health Care Reform” OR “Health Care Sector/organization and administration”

Appendix Table 2. Trends in Authorship of Primary Care Payment and Delivery System Reform Scholarship Among Departments of Family Medicine by Author Position and Role, 2018–2022

	All primary care payment and delivery system reform articles
		Department of Family Medicine Any Author		Department of Family Medicine First Author		Department of Family Medicine Senior Author
Year	N Total Articles	N	%	N	%	N	%
2018	1,225	105	8.6%	42	3.4%	4	0.3%
2019	1,242	96	7.7%	45	3.6%	4	0.3%
2020	1,318	106	8.0%	53	4.0%	10	0.8%
2021	1,282	108	8.4%	48	3.7%	4	0.3%
2022	1,145	104	9.1%	50	4.4%	6	0.5%
Total	6,212	519	8.4%	238	3.8%	28	0.5%

	Impactful primary care payment and delivery system reform articles*
	N High Impact Articles	Department of Family Medicine Any Author		Department of Family Medicine First Author		Department of Family Medicine Senior Author
Year	N	N	%	N	%	N	%
2018	126	9	7.1%	4	3.2%	0	0.0%
2019	106	7	6.6%	4	3.8%	0	0.0%
2020	124	9	7.3%	2	1.6%	0	0.0%
2021	102	10	9.8%	4	3.9%	0	0.0%
2022	108	15	13.9%	6	5.6%	2	1.9%
Total	566	50	8.8%	20	3.5%	2	0.4%

Sample includes articles from impactful clinical and policy journals that routinely publish health policy and delivery system scholarship, including JAMA, JAMA Health Forum, New England Journal of Medicine, Health Services Research, Health Affairs, JHPPL, Medical Care, Milbank Quarterly, Annals of Family Medicine, JABFM, Annals of Internal Medicine, JGIM, JAMA Pediatrics, and Pediatrics. We identified affiliation with individual clinical departments using the Authors’ Raw Affiliation included for each article (Family Medicine = any affiliation that included “Family Medicine”, “Family and Community Medicine”, “Community and Family Medicine”, or “Family and Preventive Medicine”; Internal Medicine = any affiliation that included “Department of Medicine”, “Internal Medicine”, or “General Internal Medicine”; Pediatrics = any affiliation that included “Pediatrics”).
*Impactful refers to publications that were in the top decile of Altmetric scores (calculated by journal-year).

Appendix Table 3. Trends in Authorship of Primary Care Payment and Delivery System Reform Scholarship Among Departments of Medicine by Author Position and Role, 2018–2022

	All primary care payment and delivery system reform articles
		Department of Medicine Any Author		Department of Medicine First Author		Department of Medicine Senior Author
Year	N Total Articles	N	%	N	%	N	%
2018	1,225	209	17.1%	92	7.5%	6	0.5%
2019	1,242	260	20.9%	109	8.8%	4	0.3%
2020	1,318	231	17.5%	80	6.1%	4	0.3%
2021	1,282	252	19.7%	94	7.3%	8	0.6%
2022	1,145	245	21.4%	93	8.1%	3	0.3%
Total	6,212	1,197	19.3%	468	7.5%	25	0.4%

	Impactful primary care payment and delivery system reform articles*
	N High Impact Articles	Department of Medicine Any Author		Department of Medicine First Author		Department of Medicine Senior Author
Year	N	N	%	N	%	N	%
2018	126	22	17.5%	8	6.3%	0	0.0%
2019	106	32	30.2%	13	12.3%	0	0.0%
2020	124	24	19.4%	12	9.7%	0	0.0%
2021	102	19	18.6%	10	9.8%	1	1.0%
2022	108	27	25.0%	1f5	13.9%	1	0.9%
Total	566	124	21.9%	58	10.2%	2	0.4%

Sample includes articles from impactful clinical and policy journals that routinely publish health policy and delivery system scholarship, including JAMA, JAMA Health Forum, New England Journal of Medicine, Health Services Research, Health Affairs, JHPPL, Medical Care, and Milbank Quarterly Annals of Family Medicine, JABFM, Annals of Internal Medicine, JGIM, JAMA Pediatrics, and Pediatrics. We identified affiliation with individual clinical departments using the Authors’ Raw Affiliation included for each article (Family Medicine = any affiliation that included “Family Medicine”, “Family and Community Medicine”, “Community and Family Medicine”, or “Family and Preventive Medicine”; Internal Medicine = any affiliation that included “Department of Medicine”, “Internal Medicine”, or “General Internal Medicine”; Pediatrics = any affiliation that included “Pediatrics”).
*Impactful refers to publications that were in the top decile of Altmetric scores (calculated by journal-year).

Appendix Table 4. Trends in Authorship of Primary Care Payment and Delivery System Reform Scholarship Among Departments of Pediatrics by Author Position and Role, 2018–2022

	All primary care payment and delivery system reform articles
		Department of Pediatrics Any Author		Department of Pediatrics First Author		Department of Pediatrics Senior Author
Year	N Total Articles	N	%	N	%	N	%
2018	1,225	104	8.5%	50	4.1%	8	0.7%
2019	1,242	109	8.8%	47	3.8%	5	0.4%
2020	1,318	109	8.3%	59	4.5%	7	0.5%
2021	1,282	105	8.2%	53	4.1%	5	0.4%
2022	1,145	77	6.7%	34	3.0%	1	0.1%
Total	6,212	504	8.1%	243	3.9%	26	0.4%

	Impactful primary care payment and delivery system reform articles*
	N High Impact Articles	Department of Pediatrics Any Author		Department of Pediatrics First Author		Department of Pediatrics Senior Author
Year	N	N	%	N	%	N	%
2018	126	15	11.9%	5	4.0%	0	0%
2019	106	5	4.7%	1	0.9%	0	0%
2020	124	9	7.3%	4	3.2%	0	0%
2021	102	4	3.9%	2	2.0%	0	0%
2022	108	14	13.0%	6	5.6%	0	0%
Total	566	47	8.3%	18	3.2%	0	0%

Sample includes articles from impactful clinical and policy journals that routinely publish health policy and delivery system scholarship, including JAMA, JAMA Health Forum, New England Journal of Medicine, Health Services Research, Health Affairs, JHPPL, Medical Care, and Milbank Quarterly Annals of Family Medicine, JABFM, Annals of Internal Medicine, JGIM, JAMA Pediatrics, and Pediatrics. We identified affiliation with individual clinical departments using the Authors’ Raw Affiliation included for each article (Family Medicine = any affiliation that included “Family Medicine”, “Family and Community Medicine”, “Community and Family Medicine”, or “Family and Preventive Medicine”; Internal Medicine = any affiliation that included “Department of Medicine”, “Internal Medicine”, or “General Internal Medicine”; Pediatrics = any affiliation that included “Pediatrics”).
*Impactful refers to publications that were in the top decile of Altmetric scores (calculated by journal-year).