This issue of the Journal highlights a key challenge in ambulatory care—how do we measure change at the individual or group level using validated health status measures. Single- versus multi-item measures are a time-honored debate. The first 2 articles in this issue (Selim and Colleagues; John Wasson) provide companion perspectives on this critical question. One possible way of threading the needle is to consider single-item measures especially for large-scale evaluations of the effectiveness of outcomes interventions at the health system level. Multi-item measures may very well be the ticket for clinical trials needing very precise measures that can show even small differences of the impact of, for example, a pharmaceutical on a specific disease. Selim and coauthors and Wasson summarize the issues very comprehensively. The article by Fulton and coauthors addresses another important aspect of patient-derived information in the outpatient setting—the “experience”
The next articles (Lewis et al) address different aspects of community health interventions with a focus on community health centers and community health workers. The articles by Leung and another by Davis attempt to link in different ways the perennial challenges of connecting physical and behavioral health.
Singh and colleagues examine a value-based approach to palliative care—a critical issue that needs to be addressed in this burgeoning area in outpatient services. Singh has provided a robust analysis of the value of palliative care—if it is delivered in a clinically robust manner.
Lastly, we inaugurate in this issue a new feature—changes in health care delivery in the Trump era. Trump has had a track record that can and should be examined in his attempts to change health care in the United States. We welcome submissions in this regard and are particularly interested in publishing as much as possible on this topic.
—Norbert I. Goldfield, MD© 2019 Wolters Kluwer Health, Inc. All rights reserved.