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This project was designed to improve the colposcopy rate in an urban patient population with known abnormal Pap smears within 75 days of the test to rapidly identify and treat premalignant lesions. Using Plan-Do-Study-Act cycles, Lean techniques, and the electronic health record, the authors created a protocol to verify all Pap smears, then created a process whereby a phone-triage team contacted patients with abnormal Pap smears to educate them and schedule colposcopy. As a result, 100% of Pap smears were verified, compared with 95% prior to plan implementation. The mean time from Pap to colposcopy was 38.5 days, with 85% of patients having colposcopy performed after plan implementation, compared with 50% prior-a 70% improvement. If patients with medical contraindications were excluded, the percentage rose to 91%-an 82% improvement. Patient and provider satisfaction improved, staff and provider workload did not increase, and there was the potential for substantial economic savings.

Patient-reported outcomes (PROs) are quickly becoming a mainstay in assessing clinical outcomes and determining reimbursement. Because PROs are increasing in use and impact, it is increasingly important to be sure of their accuracy and precision. PROs are most commonly delivered via rating scale questionnaires. Poorly designed questions or rating scales may skew patient responses and prevent health researchers from achieving a clear picture.In this study, 17 PRO questionnaires used to evaluate the impact of cataracts on patients were found via an Entrez PubMed search. Ten of the 17 PROs were randomly selected and mailed to pre-cataract surgery patients of a specific medical center in South Australia. In all, 614 patients (45% response rate) returned at least 1 PRO; mean respondent age was 74.1 years and 56% were women. The 17 questionnaires included assessed various eyesight-related quality-of-life issues using rating scales. Questions focused on 4 separate concepts: difficulty, frequency, severity, and global ratings.Rasch analysis was used in this study. This validated method is used to assess rating scale function. Dysfunction can be classified into 3 categories: ordered thresholds (eg, "2nd" is not found between "1st" and "3rd"), evenness of categories (response choices either overlap or a gap exists), and scale range (the distance between the first and last categories is too small).Five of the 17 instruments reviewed were found to be dysfunctional. PROs with more response categories, a complicated layout, or containing conceptually similar response options were more likely to show disordered thresholds in the Rasch model. Difficulty questions showed more scale range than frequency questions, an indication that patients may articulate difficulty better than frequency.Patient-centered medical homes (PCMH) are a crucial topic in the current health care reform debate. The concept of using a defined health team to provide patient care is well agreed on, but the structure and implementation strategies of PCMH may vary greatly. Primary care physicians (PCPs) and their practices will need to undergo significant changes to implement the PCMH model. Alexander et al sought to collect and analyze qualitative data on PCP views of PCMH.Sixteen PCP practices were randomly selected from the Blue Cross Blue Shield of Michigan network. Face-toface interviews occurred at each practice with an average of 5 individuals, including physicians, nurses, practice managers, and medical assistants. PMCH policy issues discussed were categorized into 5 themes: misalignment of current reimbursement schemes, administrative burden, conflicting criteria for PCMH designation, workforce policy issues, and uncertainty of health care reform.Many respondents expressed agreement with the concept of PCMH but were concerned with the policy surrounding it. The authors identified 3 universal issues addressed by interviewees in each theme. Interviewees emphasized that current reimbursement schemes are based on volume, and spending time on PCMH goals ta...