Adverse drug events in the ambulatory setting substantially increase the healthcare costs of elderly persons.

A child-focused QI initiative around PPPM can succeed in a multisite general academic medical center. Key success factors for this effort included accountability, multidisciplinary core leadership, housewide training in a novel educational evidence-based framework, and use of data and champions to promote nurse and physician engagement. Future work will focus on sustaining and monitoring change.

Background: Medical homes are widely viewed as a partial answer to the problems of inadequate care quality and patient experiences plus excessive healthcare costs, even though there is very limited evidence about whether they can affect these issues. We evaluated the relationship between degree of medical home-ness and measures of quality and patient satisfaction among 21 primary care clinics certified as level III medical homes by the National Committee for Quality Assurance (NCQA). Methods: We used the research version of the NCQA certification survey to measure the degree to which each clinic exemplified the medical home, with scores (0-100) overall as well as for each of five domains from the Chronic Care Model. These scores were then tested for associations with clinic-specific performance measures, cost data, and patient satisfaction. Results: Despite common NCQA level III attainment, we found considerable variance in scores among these clinics. Total and domain mean scores ranged from 58.6 to 81.8 with SD of 15.0-41.2 on medical home measures. Mean composite diabetes outcome rates ranged from 16.4-41.9%. Clinic-level correlations were highest for Delivery System Redesign and Healthcare Organization domains, and among the five specific components of the composite diabetes measure, blood pressure <130/80 was highest. Mean rate of "Definitely would recommend this office" was 83+5.6% with highest correlation with Decision Support. Conclusions: Even within the same medical group, individual clinics all certified as high level medical homes have substantial variance in care quality and patient satisfaction. Further analyses will be done for costs of care and for other performance measures and will adjust for patient factors in order to clarify how well aspects of the medical home that are assessed in the current certification process are associated with quality, cost, and satisfaction.

Graduate medical education (GME) has undergone a phenomenal transformation aimed at aligning medical education and the learning environment with educational outcomes and quality patient care. The Accreditation Council for Graduate Medical Education (ACGME) has challenged faculty to adapt novel teaching methodologies. However, there are limited studies about motivational factors that impact pediatric graduate medical educators. This article brings an insight to these motivators from the perspectives of teaching and clinical pediatric educators at an academic teaching hospital. Key words: Graduate Medical Education • GME • Pediatrics • Medical Educators • Clinical Teachers • Motivators • Incentives • Hospital • Faculty Copyright © 2018 Fuller et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.