How do people keep track of their money? In this paper we present a preliminary scoping study of how 14 individuals in the San Francisco Bay Area earn, save, spend and understand money and their personal and family finances. We describe the practices we developed for exploring the sensitive topic of money, and then discuss three sets of findings. The first is the emotional component of the relationship people have with their finances. Second, we discuss the tools and processes people used to keep track of their financial situation. Finally we discuss how people account for the unknown and unpredictable nature of the future through their financial decisions. We conclude by discussing the future of studies of money and finance in HCI, and reflect on the opportunities for improving tools to aid people in managing and planning their finances.

PURPOSELittle is known about reasons why a medical group would seek recognition as a patient-centered medical home (PCMH). We examined the motivations for seeking recognition in one group and assessed why the group allowed recognition to lapse 3 years later.METHODS As part of a larger mixed methods case study, we conducted 38 key informant interviews with executives, clinicians, and front-line staff. Interviews were conducted according to a guide that evolved during the project and were audiorecorded and fully transcribed. Transcripts were analyzed and thematically coded.RESULTS PCMH principles were consistent with the organization's culture and mission, which valued innovation and putting patients fi rst. Motivations for implementing specifi c PCMH components varied; some components were seen as part of the organization's patient-centered culture, whereas others helped the practice compete in its local market. Informants consistently reported that National Committee for Quality Assurance recognition arose incidentally because of a 1-time incentive from a local group of large employers and because the organization decided to allocate some organizational resources to respond to the complex reporting requirements for about one-half of its clinics.CONCLUSIONS Becoming patient centered and seeking recognition as such ran along separate but parallel tracks within this organization. As the Affordable Care Act continues to focus attention on primary care redesign, this apparent disconnect should be borne in mind.

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Background/Aims: Hopes are high for revitalizing primary care through transformation to a Patient-Centered Medical Home (PCMH) model. This model has been implemented in some capitated integrated delivery systems, but the transferability of PCMH to practices with a mixture of fee-for-service (FFS) and capitation contracts is uncertain. This study documents and analyzes how a transformation into a PCMH was achieved in a largely FFS multispecialty group practice in Northern California which has 30 clinics in three geographically distinct divisions. Division A was certified by NCQA at level 3 PCMH, Divisions B and C at level 2 PCMH. Methods: Multi-method case study includes qualitative data from semi-structured key informant interviews and quantitative data from medical records and administrative sources in 2005-2010. Key informants were purposefully sampled to capture experiences in all divisions and included executives, frontline physicians, nurse, health educators and medical assistants. We report on the interviews that were audio recorded, transcribed and analyzed thematically. We also present some initial quantitative findings on the association between the levels of NCQA PCMH certification and measures of process and outcomes of care. Results: Thirty-three key informant interviews have been completed to date. Four emerging themes are: [1] quality improvement efforts and responses to local market pressures pre-dated the national focus on PCMH;[2] successful implementation of some PCMH components occurred in a top-down fashion with physician champions; [3] dominant business line (FFS) presents disincentive for some PCMH components; and [4] organizational culture differences may affect how well certain initiatives are taken up and sustained. EHR data reveal that the level 3 PCMH division had the shortest wait time to a 3rd next available appointment for a longer visit (i.e., improved access), the highest proportion of patients with diabetes having their HbA1c measured every 6 months (improved process) and the highest proportion of patients with diabetes with their blood pressure under control (130/80) (improved outcomes). Discussion: We conclude that implementation of many PCMH components pre-dated the national focus on PCMH. Successfully implemented elements had organizational champions in practice cultures supportive of innovations. Some clinical process and outcome performance are consistent with the level of NCQA certification.