is a paid consultant for the Leapfrog Group and serves as chair of its expert panel on evidence-based hospital referral.

Objective. To develop and characterize utilization‐based service areas for the United States which reflect the travel of Medicare beneficiaries to primary care clinicians. Data Source/Study Setting. The 1996–1997 Part B and 1996 Outpatient File primary care claims for fee‐for‐service Medicare beneficiaries aged 65 and older. The 1995 Medicaid claims from six states (1995) and commercial claims from Blue Cross Blue Shield of Michigan (1996). Study Design. A patient origin study was conducted to assign 1999 U.S. zip codes to Primary Care Service Areas on the basis of the plurality of beneficiaries' preference for primary care clinicians. Adjustments were made to establish geographic contiguity and minimum population and service localization. Generality of areas to younger populations was tested with Medicaid and commercial claims. Data Collection/Extraction Methods. Part B primary care claims were selected on the basis of provider specialty, place of service, and CPT code. Selection of Outpatient File claims used provider number, type of facility/service, and revenue center codes. Principal Findings. The study delineated 6,102 Primary Care Service Areas with a median population of 17,276 (range 1,005–1,253,240). Overall, 63 percent of the Medicare beneficiaries sought the plurality of their primary care from within area clinicians. Service localization compared to Medicaid (six states) and commercial primary care utilization (Michigan) was comparable but not identical. Conclusions. Primary Care Service Areas are a new tool for the measurement of primary care resources, utilization, and associated outcomes. Policymakers at all jurisdictional levels as well as researchers will have a standardized system of geographical units through which to assess access to, supply, use, organization, and financing of primary care services.

No abstract

This study found no relationship between greater geographic availability of family planning facilities and a risk of unintended pregnancies. Greater geographic availability of family planning services was associated with a higher risk of teenage pregnancy, although these results may be confounded by facilities locating in areas with greater family planning needs.

This study is a contribution to the small existing pool of state level research on Advanced Practice Registered Nurse (APRN) workforce supply. Data from four biennial surveys of Vermont APRNs from 2003, 2005, 2007, and 2009 (n = 1,538) were analyzed to produce descriptive statistics of one small state's APRN demographic, educational, employment, job satisfaction, intention to leave, and practice-setting characteristics. Survey results were then used to identify patterns or trends that existed in the data. There was a marked shift in the employment settings and a decrease time worked as an APRN, despite an aging APRN workforce. There was an increase in the aggregate education level of APRNs; however, the percentage educated at the doctoral level remained flat at 2%. Overall, APRNs were a satisfied segment of the health workforce; however, those intending to leave for dissatisfaction voiced more concern about job stress and less concern about salary and benefits over time. Implications for workforce planning and public policy are discussed.