This article explores the correlates of intimate partner violence (IPV) among rural, southern Latinas. A sample of 1,212 women in blue-collar work sites in rural North Carolina completed a questionnaire assessing IPV and other social, demographic, and health-related variables. Social and demographic correlates of IPV were examined. Adult lifetime prevalence of IPV in Latinas was 19.5%, similar to that of non-Latinas. As compared to Latinas who did not experience IPV and non-Latinas who experienced IPV, Latinas who experienced IPV were more likely to lack social support and to have children in the home. Agencies that provide services to victims of IPV in the rural South need to be prepared to meet the unique needs of Latina immigrants.

The United States leads the world in health care costs but ranks far below many developed countries in health outcomes. Finding ways to narrow this gap remains elusive. This article describes the response of one state to establish community health networks to achieve quality, utilization, and cost objectives for the care of its Medicaid recipients. The program, known as Community Care of North Carolina, is an innovative effort organized and operated by practicing community physicians. In partnership with hospitals, health departments, and departments of social services, these community networks have improved quality and reduced cost since their inception a decade ago. The program is now saving the State of North Carolina at least $160 million annually. A description of this experience and the lessons learned from it can inform others seeking to implement effective systems of care for patients with chronic illness. 1 Despite these high expenditures, the quality of care remains unsatisfactory. For example, only 27% of patients with hypertension have adequate blood pressure control, and only 17% of patients with coronary artery disease have cholesterol at levels suggested by national guidelines. 2 The United States ranks last in preventable deaths among 19 Organization for Economic Cooperation and Development (OECD) countries. 3 One reason for this quality gap is that, although the prevalence of chronic disease is increasing, our health care delivery system is based on a model that is best suited to episodic care for acute illnesses. Optimal delivery of chronic care and preventive services requires restructuring our health care system. In recent years, much research and discussion have focused on how best to adapt our system to chronic care and prevention. For example, the Chronic Care Model lays out several key elements of high-quality care for chronic diseases, including community resources, health care organization, self-management support, delivery system design, decision support, and clinical information systems. 4 More recently the concept of the patient-centered medical home has received widespread attention as a model to improve care. 5 Seven key principles outline the characteristics of the patient-centered medical home: a personal physician, physician-directed medical practice, a whole-person orientation, coordinated care, quality and safety, enhanced access, and a system of payment that refl ects the added value of a patient-centered medical home.Although these models have shown promise in controlled research settings and small demonstration projects, they have been diffi cult to disseminate widely. 6 One problem with implementation of models in indi- 362 CO M MUNI T Y C A R E O F NOR T H C A ROL INAvidual practices is that the current funding structure of health care is based on acute care. When practices are reimbursed on a fee-for-service basis for episodic care, fi nding the resources to redesign a practice, develop systems of care, and implement the elements of these new models of care can ...

As a specialty that provides comprehensive care, family medicine encompasses all aspects of women's health, including maternity care. Access to regular prenatal care and labor and delivery services are essential in preventing poor perinatal outcomes and improving early childhood development. Several studies over the past decade have reported declining contributions to maternity care by family physicians.

Family physicians provide access to maternity care for a disproportionate share of rural and urban underserved communities. This paper aims to determine trends in maternity care provision by family physicians and the characteristics of family physicians that provide maternity care. We used American Board of Family Medicine survey data collected from every family physician during application for the Maintenance of Certification Examination to determine the percentage of family physicians that provided maternity care from 2000 to 2010. Using a cross-sectional study design, logistic regression analysis was performed to examine association between maternity care provision and various physician demographic and practice characteristics. Maternity care provision by family physicians declined from 23.3 % in 2000 to 9.7 % in 2010 (p < 0.0001). Family physicians who were female, younger and US medical graduates were more likely to practice maternity care. Practicing in a rural setting (OR = 2.2; 95 % CL 2.1-2.4), an educational setting (OR = 6.4; 95 % CL 5.7-7.1) and in either the Midwest (OR = 2.6; 95 % CL 2.3-2.9) or West (OR = 2.3; 95 % CL 2.1-2.6) were the strongest predictors of higher likelihood of providing maternity care. While family physicians continue to play an important role in providing maternity care in many parts of the United States, the steep decline in the percentage of family physicians providing maternity care is concerning. Formal collaborations with midwives and obstetrician-gynecologists, malpractice reform, payment changes and graduate medical education innovations are potential avenues to explore to ensure access to maternity care.

Participants had performed most skills infrequently and rated themselves as being unable to perform them without assistance. Strategies to improve student experience and competence of procedural skills must evolve to improve the technical competency of graduating students because their current competency varies widely.

Large-scale health care quality improvement is feasible, when broadly supported by statewide leadership and community infrastructure. Practice-collected data and lack of a control group are limitations of the study design. Future priorities include maintaining improved sustainability for practices and communities. Our long-term goal is to transform all 2000 primary-care practices in our state.

Building a healthy research enterprise is central to family medicine's ability to provide the best possible care to patients and is important to the future of the discipline.1,2 Although family medicine benefits from the research of other clinical disciplines and from research in the basic and social sciences, its practitioners also need answers to clinical questions from studies involving family medicine's own patient populations and practice settings.3-6 Similarly, innovations in the organization of family physicians' offices and in the training of future family physicians depend on data from family medicine's health services and education researchers. Some observers within and outside the discipline have felt that family medicine does not carry out enough research [7][8][9][10] and that increasing financial and other pressures within its academic departments are making research more difficult. [11][12] Recognizing these concerns and the discipline's need for research, family medicine's national leaders have lobbied to support the discipline's researchers with more funding, training programs, and publishing venues. 1,[13][14][15][16] Whether family medicine's research enterprise is healthy and growing or succumbing to external pressures should be understood and monitored. The health of a discipline's research enterprisehaving a sizable and productive researcher workforce, committed and capable research institutions, This article was externally peer reviewed.

No abstract