This general themed issue of the journal reflects our primary foci these days-practice management in a coordinated care setting; community health workers; and health policy issues. Health professionals continue to explore what works and doesn't work in today's managed care world. This world is permeated by a digital infrastructure that has many opportunities for improvement. Thurber and colleagues have a rare title of their article that clearly describes their subject matter: The Common Attributes of Successful Care Manager Program for High-Need, High-Cost Persons. Pothapragada and colleagues examine the evolving role of community health workers, another critical part of the health care team, within a particular organizational framework. Sherman examines a similar question pertaining to community health workers in a different part of the country.
Vigilante and colleagues in combination with a commentary by Associate Editor John Wasson suggest a different approach to visit-based care. For a revised version of the "ambulatory health care visit" approach to be effective, the entire health care team including the case manager, community health worker, medical assistant nurse, physician all need to be engaged. Eden and colleagues examine the role of one specific type of frontline physician, the family medicine practitioner, in practice transformation.
As discussed in the last issue of the journal, leadership in any situation is key to success in any venture. Coleman and colleagues highlight the successes of health care leadership training program. As evidence of a successful program, 40% of participants went on to promotions or new jobs. The salient characteristics of this leadership training program are relevant for all organizations.
Health care organizations implement many aspects of the revamped patient encounter in an effort to avoid costly, and for the most part, unnecessary emergency department visits. Xin and colleagues examine important aspects of dissatisfaction and visits to the emergency department and/or urgent care settings. Austin and colleagues examine another potential intervention at the point of service-the use of outcomes information with primary care physicians. While a negative study, there are important lessons to be learned for future interventions, as many of us still are appropriately committed to incorporating outcomes measures in ambulatory practice. Kern and colleagues next examine the interesting and important issue of hospitalizations and "loyalty" to ambulatory care providers. This is an issue that I face, as the hospital that owns my practice is always full. The competing hospital down the road is often the preferred choice, at least for emergency department care, by my patients because the wait is always shorter. Related to hospitalizations, Cherrington and colleagues examine the relationship between Medicaid expansion and ambulatory care-sensitive hospitalizations. Several important policy issues are addressed throughout this issue from a practical perspective. Rounding out this issue, Wood and colleagues provide an important case study of accountable care organizations.
-Norbert I. Goldfield, MD
Editor