1. Meaningful use of electronic prescribing in 5 exemplar primary care practices.
Crosson JC, Etz RS, Wu S, Straus SG, Eisenman D, Bell DS
Ann Fam Med. 2011 Sep-Oct;9(5):392-7.
Summary
In order to identify factors that contribute to successful electronic prescribing implementation and use techniques, this study examined 5 ambulatory primary care practices that were identified as exemplars of e-prescribing. The study found that successful e-prescribing requires practice transformation, work process redesign, and special attention given to patient involvement in prescribing.

2. Successful health information technology implementation requires practice and health care system transformation.
Jaén CR.
Ann Fam Med. 2011 Sep-Oct;9(5):388-9.
Summary
In this invited Editorial, Dr. Jaén reviews two studies on the use of health information technology (HIT) in primary care practices. He argues that successful integration of HIT into primary care requires work to develop systems to address “higher-level primary care functions that involve integrating, personalizing, and prioritizing care across a broad spectrum of opportunities that range from patients’ acute concerns, management of (often multiple) chronic illnesses, prevention, mental health, family care, and often undifferentiated problems of daily living.”  He posits that, to realize the potential benefit of HIT,  the way human infrastructure is used to deliver care must be transformed.
 
3. Redesigning after-hours primary care.
Margolius D, Bodenheimer T.
Ann Intern Med. 2011 Jul 19;155(2):131-2.
Summary
In this invited editorial, Dr. Margolius and Dr. Bodenheimer review an article by Giesen and colleagues on after-hours care in the Netherlands. They discuss the potential for improved after-hours access to reduce avoidable and expensive emergency department visits in the US and argue for policy changes to enhance after-hours access.
 
4. Nice work if you can get it: comment on "Too little? Too much? Primary care physicians' views on US healthcare".
Chou, C
Arch Intern Med. 2011 Sep 26;171(17):1585-6.
Summary
In this invited editorial, Dr. Chou comments on a national survey of primary care physicians by Sirovich, et al (see article in Pub Hub), studying physician views on overuse and underuse of services.  With this study in mind, Dr. Chou presents two approaches to decrease “aggressive” practices: communication and avoidance of burnout.
 
 
6. Electronic medical record reminders and panel management to improve primary care of elderly patients.
Loo TS, Davis RB, Lipsitz LA, Irish J, Bates CK, Agarwal K, Markson L, Hamel MB.
Arch Intern Med. 2011 Sep 26;171(17):1552-8.
Summary
It is known that most elderly patients do not receive important and recommended preventive care for chronic conditions. In this study, researchers explored the effectiveness of electronic medical record (EMR) reminders, with or without panel management, on health care proxy designation, osteoporosis screening, and influenza and pneumococcal vaccinations in patients older than 65 years. They found that EMR reminders facilitated improvement in vaccination rates and, along with panel management, facilitated further improvement in vaccination rates and boosted the rates of health care proxy designation.
 
7. Collaborative care and the medical home: a good match.
O'Malley PG.     
Arch Intern Med. 2011 Sep 12;171(16):1428-9.
Summary
In this invited Editorial, Dr. O’Malley reviews two articles in Archives of Internal Medicine that show that collaborative care is effective at achieving improvement in process measures of care, but may not be enough to improve clinically relevant outcomes. He posits that collaborative care would be an important addition to medical homes, particularly if we can identify conditions that are most likely to benefit from collaborative care and clearly define collaborative care tasks and assign them to appropriate team members. 
 
8. Integrated telehealth and care management program for Medicare beneficiaries with chronic disease linked to savings.
Baker LC, Johnson SJ, Macaulay D, Birnbaum H.
Health Aff (Millwood). 2011 Sep;30(9):1689-97.
Summary
Researchers examined the impact of a care coordination approach called the Health Buddy Program, which integrates a telehealth tool with care management for chronically ill Medicare beneficiaries. They evaluated the program's impact on spending for patients of two clinics in the northwest US who were exposed to the intervention, and compared their experience with matched controls. They found significant savings (7.7-13.3%) among patients who used Health Buddy , which was associated with spending reductions of approximately ($312-$542) per person per quarter.
 
9. Community health workers "101" for primary care providers and other stakeholders in health care systems.
Brownstein JN, Hirsch GR, Rosenthal EL, Rush CH.
J Ambul Care Manage. 2011 Jul-Sep;34(3):210-20.
Summary
This article explains how community health workers (CHWs) can be engaged to address many patient- and system-related barriers currently experienced in ambulatory care practices. Among their varied roles, CHWs can educate and support patients in managing their risk factors and diseases, and link these patients to needed resources. As shown in this overview, including CHWs as members of multidisciplinary care teams has the potential to strengthen both current and emerging models of health care delivery.
 
10. Turning on the care coordination switch in rural primary care: voices from the practices—clinician champions, clinician partners, administrators, and nurse care managers.
Fagnan LJ, Dorr DA, Davis M, McGinnis P, Mahler J, King MM, Michaels L.
J Ambul Care Manage. 2011 Jul-Sep;34(3):304-18.
Summary
This study sought to understand the acceptability and feasibility of office-based nurse care management in medium to large rural primary care practices. A qualitative assessment of Care Management Plus (a focused medical home model for complex patients) implementation was conducted using semi-structured interviews with four staff cohorts. Seven key implementation attributes were: a proven care coordination program; adequate staffing; practice buy-in; adequate time; measurement; practice facilitation; and functional information technology. Although staff was positive about the care coordination concept, model acceptability was varied, and additional study is required to determine sustainability.
 
11. Clinical community health workers: linchpin of the medical home.
Volkmann K, Castañares T.
J Ambul Care Manage. 2011 Jul-Sep;34(3):221-33.
Summary
The emerging clinical community health worker model integrates community health workers as members of primary care teams inside a medical home. This evaluation documents the case management services provided by two clinical community health worker programs at La Clínica del Cariño in Hood River, Oregon, and how they affected the care team's ability to deliver efficient and effective primary care. Clinical community health workers have the potential to make a significant impact on clinical efficiency and effectiveness as ambulatory primary care clinics strive to transform into high-quality, patient-centered medical homes and become linchpins in accountable care organizations.
 

1. Preparing the personal physician for practice (P⁴): site-specific innovations, hypotheses, and measures at baseline.
Carney PA, Eiff MP, Green LA, Lindbloom E, Jones SE, Osborn J, Saultz JW.
Fam Med. 2011 Jul-Aug;43(7):464-71.
Summary
This study's purpose was to describe the innovations, hypotheses being tested, and measures used in residency training redesign in 14 family medicine residencies associated with the P⁴ project. Though no direct funding was provided by P⁴ to individual sites, all have focused on important contemporary challenges for training excellent family physicians, all are engaged in important evaluations, and nearly half have successfully obtained project funding to support their specific P⁴ activities during the baseline period.
 
2. Overcoming early barriers to PCMH practice improvement in family medicine residencies.
Fernald DH, Deaner N, O'Neill C, Jortberg BT, degruy FV 3rd, Dickinson WP.
Fam Med. 2011 Jul-Aug;43(7):503-9.
Summary
This study aimed to identify barriers that could help align priorities and augment the capacity to change and redesign practices, thereby improving resident training and attaining higher-quality care for patients. Researchers were able to successfully identify nine common early barriers that interfered with practices getting started with cultural and structural transformation.
 
3. Implementing radical curriculum change in a family medicine residency: the majors and masteries program.
Mazzone M, Krasovich S, Fay D, Ginn P, Lopresti L, Nelson K, Ambuel B.
Fam Med. 2011 Jul-Aug;43(7):514-21.
Summary
There is urgent need for experimentation and innovation in residency training to better prepare family physicians. Waukesha Family Medicine Residency used a strategic planning process to identify four guiding concepts for a new model of residency education and developed a new curriculum that begins with 19 months of training core family medicine skills. The curriculum and the process used to implement it may benefit other residencies considering radical curriculum change.
 
4. The revolving door of resident continuity practice: identifying gaps in transitions of care.
Caines LC, Brockmeyer DM, Tess AV, Kim H, Kriegel G, Bates CK.
J Gen Intern Med. 2011 Sep;26(9):995-8. Epub 2011 May 11.
Summary
Researchers in this study observed that transfer of graduating residents’ patient panels to incoming interns resulted in approximately 50% of patients not returning for follow-up care within a year. In order to explore the implications of this lapse of care with respect to chronic disease management, follow-up of abnormal test results, and adherence with routine health care maintenance, researchers conducted a retrospective chart review. The study demonstrated the high-risk nature of patient handoffs in the ambulatory setting when residents graduate and discussed changes that might improve the panel transfer process.
 
5. A differentiation diagnosis--specialization and the medical student.
Xu R.
N Engl J Med. 2011 Aug 4;365(5):391-3.
Summary
A medical student shares her perspective on singling out subspecialties early on in one’s medical school journey and the pressure involved in making such decisions.

1. The patient-centered medical home neighbor: A primary care physician's view.
Sinsky CA.
Ann Intern Med. 2011 Jan 4;154(1):61-2.
Summary
The American College of Physicians' position paper on the patient-centered medical home neighbor (PCMH-N) extends the work of the patient-centered medical home (PCMH) as a means of improving the delivery of health care. The PCMH-N concept outlines expectations for co-management, communication, and care coordination, and broadens responsibility for safe, effective, and efficient care beyond primary care to include physicians of all specialties. In order to transform the US health care system through medical homes embedded in highly functional medical neighborhoods will require better staffing models; more robust electronic information tools; aligned incentives for quality and efficiency within payment and regulatory policies; and a culture of greater engagement of patients, their families, and communities.
 
2. The patient-centered medical home neighbor: A subspecialty physician's view.
Yee HF Jr.
Ann Intern Med. 2011 Jan 4;154(1):63-4.
Summary
To achieve the benefits of the patient-centered medical home (PCMH) model, the American College of Physicians has issued a policy paper to demonstrate that this model is supported by numerous specialties and subspecialties, recognizing the importance of building a strong medical neighborhood and providing a framework that will foster improvements in care at the interface of PCMHs and PCMH neighbors (PCMH-Ns). The author suggests specific improvements: innovative forms of interaction that do not depend on traditional office visits, but for which there are clear incentives;., recommended care coordination agreements which are better standardized for the sake of practicality; genuine dialogue between PCMH and PCMH-N practices.
 
3. Changes in barriers to primary care and emergency department utilization.
Cheung PT, Wiler JL, Ginde AA.
Arch Intern Med. 2011 Aug 8;171(15):1397-9.
Summary
In this research letter, Dr. Cheung and colleagues present data from an analysis of the National Health Interview Survey (NHIS) and changes in national barriers to timely primary care access from 1999 to 2009 and their association with ED utilization.  Their results suggest that limited access to primary care services is an increasingly important contributor to rising ED volumes.  They argue that “optimal health care delivery and attempts to limit ED utilization will likely require solutions beyond expanded health insurance coverage including improved access to primary care services through increasing the supply and availability of primary care providers.”
 
4. Safety-net providers and preparation for health reform: staff down, staff up, staff differently.
Katz MH.
Arch Intern Med. 2011 Aug 8;171(15):1319-20.
Summary
In this invited editorial, Dr. Katz reviews several submissions to the Archives of Internal Medicine, assesses the potential impact of health coverage expansion on safety-net providers, and raises the distinct possibility that health care reform will increase the need for safety-net providers, rather than shrink it.  In a system that has little excess capacity, he argues that efficient care teams working at the “top of their licenses” and aided by technology will be necessary.
 
5. How should we define health?
Huber M, Knottnerus JA, Green L, van der Horst H, Jadad AR, Kromhout D, Leonard B, Lorig K, Loureiro MI, van der Meer JW, Schnabel P, Smith R, van Weel C, Smid H.
BMJ. 2011 Jul 26;343:d4163. doi: 10.1136/bmj.d4163.
Summary
The authors present a new definition of health for our consideration, “Health as the ability to adapt and to self manage.”  They discuss the current WHO definition of health, and the definition that came from a conference of international health experts in the Netherlands. 
 
6. US physician practices versus Canadians: spending nearly four times as much money interacting with payers.
Morra D, Nicholson S, Levinson W, Gans DN, Hammons T, Casalino LP.
Health Aff (Millwood). 2011 Aug;30(8):1443-50. Epub 2011 Aug 3.
Summary
Small physician practices incur substantial costs in time and labor interacting with multiple insurance plans about claims, coverage, and billing for patient care and prescription drugs. Researchers surveyed Canadian physicians and administrators about time spent interacting with payers and compared the results with a national companion survey in the United States. They estimated physician practices in Ontario spent just 27 percent of the per physician per year spent in the US. If US physicians had administrative costs similar to those of Ontario physicians, the total savings would be approximately $27.6 billion per year. The results support the opinion shared by many US health care leaders interviewed for this study that interactions between physician practices and health plans could be performed much more efficiently.
 
7. Small and medium-size physician practices use few patient-centered medical home processes.
Rittenhouse DR, Casalino LP, Shortell SM, McClellan SR, Gillies RR, Alexander JA, Drum ML.
Health Aff (Millwood). 2011 Aug;30(8):1575-84. Epub 2011 Jun 30.
Summary
The PCMH model offers a robust system of primary care combined with practice innovations and new payment methods. Researchers provide the first national data on the use of medical home processes such as chronic disease registries, nurse care managers, and systems to incorporate patient feedback, among 1,344 small and medium-size physician practices. They found that on average, practices used just one-fifth of the patient-centered medical home processes measured as part of this study. They also identify internal capabilities and external incentives associated with the greater use of medical home processes.
 
8. Medical group responses to global payment: early lessons from the 'Alternative Quality Contract' in Massachusetts.
Mechanic RE, Santos P, Landon BE, Chernew ME.
Health Aff (Millwood). 2011 Sep;30(9):1734-42.
Summary
The largest insurer in Massachusetts, Blue Cross Blue Shield, began a program in 2009 that combines global payments (fixed payments for the care of patient populations during a specified time period) with large potential quality bonuses for medical groups. Groups are working to overcome numerous challenges, which include improving their data management capabilities; managing conflicting incentives in their fee-for-service contracts; and establishing cultures that emphasize teamwork, patient-centered care, and effective stewardship of medical resources. If the groups can succeed in reducing annual growth in health spending by half over the five-year contract, it could signal that even newly formed accountable care organizations can navigate a shift from fee-for-service to population-based payment models.
 
9. Single payer ahead--cost control and the evolving Vermont model.
Wallack AR.
N Engl J Med. 2011 Aug 18;365(7):584-5. Epub 2011 Jul 20.
Summary
Dr. Wallack concisely presents Vermont’s move towards a single-payer health system.
 
 
10. Too Little? Too Much? Primary care physicians' views on US health care: a brief report.
Sirovich BE, Woloshin S, Schwartz LM.
Arch Intern Med. 2011 Sep 26;171(17):1582-5.
Summary
In order to examine primary care physicians’ views about health care and its necessity in the US, researchers surveyed 627 primary care physicians nationally. They found that 42% of physicians believed that patients in their own practice received too much care, while 6% said their patients received too little. They also found that the most important factors leading physicians to practice too aggressively included malpractice concerns, clinical performance measures, and inadequate time spent with patients.