The essential value of primary care is not the sum of organ part management but the comprehensive care we give to people.
1: People are much more complex than their organs.
It is possible to maximize adherence to an organ system guideline and create an overall decline in health & well being. The feedback from patients is along the lines of "yes, doctor, but my quality of life is terrible."
2: Excellence in organ system management does not translate to excellence in primary care.
A decade of teaching the Chronic Care Model all over the US demonstrate the lack of 'spread' from excellent condition management to excellence overall. The recent study of the massive p4p program in the UK's NHS demonstrates the same.
3: Excellence in primary care is linked to overall population health improvement and reduced costs, organ system management is not.
What's the ultimate goal - every diabetic person gets great guideline adherent-care or we serve all our patients well?
Ultimately we want both, but the premise that we can do both by starting with a paradigm based in organ system management flies in the face of years of experience observing this approach fail across the US (with very rare exception) and the evidence in numerous studies.
Because it is a fundamentally flawed paradigm that impedes our ability to deliver on the true quality of care we offer as primary care, we must reject PQRI and other flawed p4p approaches.
L Gordon Moore