title: A participatory model of the paradox of primary care.
abstract: OBJECTIVE
  The paradox of primary care is the observation that primary care is associated with apparently low levels of evidence-based care for individual diseases, but systems based on primary care have healthier populations, use fewer resources, and have less health inequality. The purpose of this article is to explore, from a complex systems perspective, mechanisms that might account for the effects of primary care beyond disease-specific care.
  
  
  METHODS
  In an 8-session, participatory group model-building process, patient, caregiver, and primary care clinician community stakeholders worked with academic investigators to develop and refine an agent-based computer simulation model to test hypotheses about mechanisms by which features of primary care could affect health and health equity.
  
  
  RESULTS
  In the resulting model, patients are at risk for acute illness, acute life-changing illness, chronic illness, and mental illness. Patients have changeable health behaviors and care-seeking tendencies that relate to their living in advantaged or disadvantaged neighborhoods. There are 2 types of care available to patients: primary and specialty. Primary care in the model is less effective than specialty care in treating single diseases, but it has the ability to treat multiple diseases at once. Primary care also can provide disease prevention visits, help patients improve their health behaviors, refer to specialty care, and develop relationships with patients that cause them to lower their threshold for seeking care. In a model run with primary care features turned off, primary care patients have poorer health. In a model run with all primary care features turned on, their conjoint effect leads to better population health for patients who seek primary care, with the primary care effect being particularly pronounced for patients who are disadvantaged and patients with multiple chronic conditions. Primary care leads to more total health care visits that are due to more disease prevention visits, but there are reduced illness visits among people in disadvantaged neighborhoods. Supplemental appendices provide a working version of the model and worksheets that allow readers to run their own experiments that vary model parameters.
  
  
  CONCLUSIONS
  This simulation model provides insights into possible mechanisms for the paradox of primary care and shows how participatory group model building can be used to evaluate hypotheses about the behavior of such complex systems as primary health care and population health.
authors.affiliation: Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
authors.forename: Laura
authors.initials: L
authors.lastname: Homa
authors.affiliation: Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
authors.forename: Johnie
authors.initials: J
authors.lastname: Rose
authors.affiliation: Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
authors.forename: Peter S
authors.initials: PS
authors.lastname: Hovmand
authors.affiliation: Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
authors.forename: Sarah T
authors.initials: ST
authors.lastname: Cherng
authors.affiliation: Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
authors.forename: Rick L
authors.initials: RL
authors.lastname: Riolo
authors.affiliation: Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
authors.forename: Alison
authors.initials: A
authors.lastname: Kraus
authors.affiliation: Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
authors.forename: Anindita
authors.initials: A
authors.lastname: Biswas
authors.affiliation: Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
authors.forename: Kelly
authors.initials: K
authors.lastname: Burgess
authors.affiliation: Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
authors.forename: Heide
authors.initials: H
authors.lastname: Aungst
authors.affiliation: Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger). kcs@case.edu.
authors.forename: Kurt C
authors.initials: KC
authors.lastname: Stange
authors.affiliation: Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
authors.forename: Kalanthe
authors.initials: K
authors.lastname: Brown
authors.affiliation: Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
authors.forename: Margaret
authors.initials: M
authors.lastname: Brooks-Terry
authors.affiliation: Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
authors.forename: Ellen
authors.initials: E
authors.lastname: Dec
authors.affiliation: Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
authors.forename: Brigid
authors.initials: B
authors.lastname: Jackson
authors.affiliation: Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
authors.forename: Jules
authors.initials: J
authors.lastname: Gilliam
authors.affiliation: Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
authors.forename: George E
authors.initials: GE
authors.lastname: Kikano
authors.affiliation: Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
authors.forename: Ann
authors.initials: A
authors.lastname: Reichsman
authors.affiliation: Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
authors.forename: Debbie
authors.initials: D
authors.lastname: Schaadt
authors.affiliation: Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
authors.forename: Jamie
authors.initials: J
authors.lastname: Hilfer
authors.affiliation: Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
authors.forename: Christine
authors.initials: C
authors.lastname: Ticknor
authors.affiliation: Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
authors.forename: Carl V
authors.initials: CV
authors.lastname: Tyler
authors.affiliation: Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
authors.forename: Anna
authors.initials: A
authors.lastname: Van der Meulen
authors.affiliation: Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
authors.forename: Heather
authors.initials: H
authors.lastname: Ways
authors.affiliation: Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
authors.forename: Richard F
authors.initials: RF
authors.lastname: Weinberger
authors.affiliation: Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
authors.forename: Christine
authors.initials: C
authors.lastname: Williams
mesh_terms: D003198:Computer Simulation; D003661:Decision Support Techniques; D005260:Female; D015438:Health Behavior; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D018803:Models, Economic; D015233:Models, Statistical; D010342:Patient Acceptance of Health Care; D011320:Primary Health Care / Q000458:organization & administration*; D012959:Socioeconomic Factors
keywords: decision modeling; economic models; statistical models