From the Editor
With our focus on themes reflecting the massive changes in our health care system over the past 40 years of the existence of the journal completed, we return to the many other interesting changes we need to address. Kate Laforge and her colleagues address a critical topic of how ambulatory care centers can develop tools and processes for identifying socioeconomic determinants of health. It is articles such as these, with their attendant results, that will push policy makers to incorporate socioeconomic status (SES) in a clinically and statistically valid manner. After serving on a National Quality Forum panel on this topic, I frankly never understood the reluctance of the federal government's Centers for Medicare & Medicaid Services to incorporate SES into its risk adjustment models such as the one for readmission.
Oregon has been one of the forefronts in health care transformation facilitated by the Accountable Care Act, Vimalananda and coauthors provide important research findings on patient, primary care physician, and specialist coordination—the true challenge in any effort to transform our health care system.
In separate articles, Saddi and Peckham followed by Macinko and colleagues continue our interest in ambulatory health care transformation occurring outside the United States with an article on primary care pay for performance in Brazil. Nelson et al provide a summary of a comparative study of urban and rural primary care medical home implementation. Pannatoni focuses that critical part of primary care medical home implementation pertaining to those patients with significant chronic illnesses. Kooienga explores our ongoing focus on the electronic health record in ambulatory care with an innovative article examining patient and staff perceptions of implementation. Ming and colleagues examine the ever important discharge planning process. I am continuously reminded by articles such as this and my own clinical practice of the many opportunities for improvement needed if patient-centered medical homes are ever to work. In this case, Ming focuses on the sadly unique perspective of providers.
As always we welcome your feedback, ideas for new theme issues, and comments of any sort.
—Norbert I. Goldfield, MD