摘要：Objectives. We sought to understand how national policy key informants perceive the value and changing role of primary care in the context of emerging political opportunities. Methods. We conducted 13 semistructured interviews in May 2011 with leaders of federal agencies, think tanks, nonprofits, and quality standard–defining organizations with influence over health care reform policies and implementation. We recorded the interviews and used an editing and immersion–crystallization analysis approach to identify themes. Results. We identified 4 themes: (1) affirmation of primary care as the foundation of a more effective health care system, (2) the patient-centered medical home as a transitional step to foster practice innovation and payment reform, (3) the urgent need for an increased focus on community and population health in primary care, and (4) the ongoing need for advocacy and research efforts to keep primary care on public and policy agendas. Conclusions. Current efforts to reform primary care are only intermediate steps toward a system with a greater focus on community and population health. Transformed and policy-enabled primary care is an essential link between personalized care and population health. Primary care, feared to be dying over the past decade in a fragmented US health care system, 1–4 has reemerged to the public and policymakers as a foundation of integrated, high-value health care. 5–13 It is no coincidence that this reemergence is paralleled by a growing awareness of the social, 14 environmental, 15 and community 16 determinants of health and the essential role of our beleaguered public health infrastructure in shaping them. 17 However, despite their parallel ascent, the interdependence of primary care and public health 18–22 has not entirely been recognized. In the wake of landmark health care reform, it is important to understand the current policy landscape to imagine more fully the health care system of the future and the steps we must take as a nation to get there. Therefore, we interviewed national policy key informants to ascertain their understanding of the value of primary care and its changing role, and to obtain their guidance on the emerging political opportunities for primary care to become a stronger foundation for the US health care system.
