The patient-centered medical home has become a prominent model for reforming the way health care is delivered to patients. The model offers a robust system of primary care combined with practice innovations and new payment methods. But scant information exists about the extent to which typical US physician practices have implemented this model and its processes of care, or about the factors associated with implementation. In this article we provide the first national data on the use of medical home processes such as chronic disease registries, nurse care managers, and systems to incorporate patient feedback, among 1,325 small and medium-size physician practices. We found that on average, practices used just one-fifth of the patientcentered medical home processes measured as part of this study. We also identify internal capabilities and external incentives associated with the greater use of medical home processes.T he patient-centered medical home model of health care delivery system reform was featured prominently in the Affordable Care Act of 2010. The model was developed by the primary care specialty societies in 2007. It has been endorsed by a broad coalition of purchasers, payers, providers, consumers, and other health care stakeholders. It emphasizes a robust system of primary care combined with practice innovations and new payment models.

OBJECTIVES: This study hypothesized that interpersonal workplace stressors involving sexual harassment and generalized workplace abuse are highly prevalent and significantly linked with mental health outcomes including symptomatic distress, the use and abuse of alcohol, and other drug use. METHODS: Employees in 4 university occupational groups (faculty, student, clerical, and service workers; n = 2492) were surveyed by means of a mailed self-report instrument. Cross-tabular and ordinary least squares and logistic regression analyses examined the prevalence of harassment and abuse and their association with mental health status. RESULTS: The data show high rates of harassment and abuse. Among faculty, females were subjected to higher rates; among clerical and service workers, males were subjected to higher rates. Male and female clerical and service workers experienced higher levels of particularly severe mistreatment. Generalized abuse was more prevalent than harassment for all groups. Both harassment and abuse were significantly linked to most mental health outcomes for men and women. CONCLUSIONS: Interpersonally abusive workplace dynamics constitute a significant public health problem that merits increased intervention and prevention strategies.

Prevalence estimates are given for the key pubertal milestones in children with normal BMI. Breast and sexual pubic hair development are premature before 8 years of age in girls with normal BMI in the general population. Adiposity and non-Hispanic black and Mexican American ethnicity are independently associated with earlier pubertal development in girls.

The results confirm the clinical suspicion that the risk of POVL is higher in cardiac and spine fusion surgery and show for the first time a higher risk of this complication in patients undergoing lower extremity joint replacement surgery. The prevalence of POVL in the eight most commonly performed surgical operations in the United States has decreased between 1996 and 2005. Increased odds of POVL with male gender and comorbidity index indicate that some risk factors for POVL may not presently be modifiable. The conclusions of this study are limited by factors affecting data accuracy, such as lack of data on the intraoperative course and inability to confirm the diagnostic coding of any of the discharges in the database.

OBJECTIVE -To evaluate the Diabetes Health Disparities Collaborative, an initiative by the Bureau of Primary Health Care to reduce health disparities and improve the quality of diabetes care in community health centers.RESEARCH DESIGN AND METHODS -One year before-after trial. Beginning in 1998, 19 Midwestern health centers undertook a diabetes quality improvement initiative based on a model including rapid Plan-Do-Study-Act cycles from the continuous quality improvement field; a Chronic Care Model emphasizing patient self-management, delivery system redesign, decision support, clinical information systems, leadership, health system organization, and community outreach; and collaborative learning sessions. We reviewed charts of 969 random adults for American Diabetes Association standards, surveyed 79 diabetes quality improvement team members, and performed qualitative interviews.RESULTS -The performance of several key processes of care assessed by chart review increased, including rates of HbA 1c measurement (80 -90%; adjusted odds ratio 2.1, 95% CI 1.6 -2.8), eye examination referral (36 -47%; 1.6, 1.1-2.3), foot examination (40 -64%; 2.7, 1.8 -4.1), and lipid assessment (55-66%; 1.6, 1.1-2.3). Mean value of HbA 1c tended to improve (8.5-8.3%; difference Ϫ0.2, 95% CI Ϫ0.4 to 0.03). Over 90% of survey respondents stated that the Diabetes Collaborative was worth the effort and was successful. Major challenges included needing more time and resources, initial difficulty developing computerized patient registries, team and staff turnover, and occasional need for more support by senior management. CONCLUSIONS -The Health DisparitiesCollaborative improved diabetes care in health centers in 1 year. Diabetes Care 27:2-8, 2004D iabetes care is a critical issue for the ϳ3,000 federally funded community health center delivery sites that provide primary care for 11 million medically underserved Americans (1,2). Nationally, African Americans and patients of lower socioeconomic status suffer disproportionately high morbidity from diabetes (3), and racial disparities in the quality of diabetes care are prevalent (4). Since community health centers are vanguard providers of indigent patients, interventions in the health-center setting are of particular interest to clinicians, administrators, and policymakers seeking to improve the care of the most vulnerable patients with diabetes (5-7).Providers in all settings frequently do not meet diabetes quality-of-care standards as outlined by the American Diabetes Association (8). Suboptimal care has been found in academic medical centers (9), private doctors' offices (10), managed care organizations (11), Medicare providers (4), and the Indian Health Service (12). Because health centers have fewer resources and more vulnerable patients (13), it might be assumed that their performance on these standards of care might be lower. However, rates of adherence to the standards in health centers have been as high as other providers or even better despite the extra challenges (14 -17). Nonet...