Outpatient services are extremely labor intensive. Improving patient care is largely not a function of technology but in fact reflects an individual's ability (or inability) to empower himself or herself. Larson and colleagues, together with a number of comments, weave together the different roles of community and traditional outpatient medical care system. Patel and colleagues, Remmers and colleagues, and Angstman and colleagues in separate articles continue the conversation on community participation and individual empowerment with different takes on these key issues in national healthcare reform.

The last articles in this issue do not fall into a specific theme. Decker and colleagues continue a theme that we have often highlighted-changing patterns of care between specialists and primary care physicians. This time Decker and colleagues focus on diabetes care, a true epidemic in our times. Over the past decade, health centers have succeeded in obtaining more funds. Shi and colleagues continue the conversation comparing aspects of quality between US health center patients and non-health center patients.

We conclude with our regular features on ambulatory care management courtesy Goodspeed and irreverent observations on healthcare in the Republic of Texas from Holt.

-Norbert Goldfield, MD

Editor