The Time Is Now: A Plan to Redesign Family Medicine Residency Education.

A new graduate medical education program in family medicine is urgently needed now. We propose an innovative plan to develop community-based, community-owned family medicine residency programs. The plan is founded on five guiding principles in which residencies will (1) transition to independent, community-owned organizations; (2) sustain comprehensiveness and generalism; (3) emphasize collaborative learning and interprofessional education; (4) develop local educators with national guidance; and (5) share resources, responsibilities, and learning. We describe actionable steps to begin the process of transforming residencies and strengthening primary care. As community-based and locally-run organizations, residencies will gain self-determination in how time is allocated, budgets are spent, and teams function. Building on the momentum of the National Academy of Medicine's 2021 primary care implementation plan and recommendations by family medicine organization leaders, we propose a Decade of Family Medicine Residency Transformation. We encourage individuals and organizations spanning disciplines, health care systems, and communities, to join forces to reimagine and recreate the preparation of outstanding personal physicians dedicated to individual and community health and well-being.

A step at a time.

In this issue of Families, Systems, and Health are two articles that inch us on our winding way forward as we try to help people become healthier. This article takes stock of where we are now, starting from the start, equipped with three of our foundational guiding principles, and sighting our polestar to see what our best next moves might be. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Nomination of Parinda Khatri for Don Bloch Award, 2020.

This article focuses on Parinda Khatri, PhD, who was nominated for the annual Don Bloch Award. This award is the quintessential organizational award for members who have advanced the field of collaborative care, and who show intellectual, behavioral, and relational qualities. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A Plan for Useful and Timely Family Medicine and Primary Care Research.

BACKGROUND AND OBJECTIVES: Our nation's health care system is changing. Nowhere is this more evident than in primary care, where fundamental improvements are necessary if we are to achieve the Triple Aim. Such improvements are possible if we can put useful and timely information into the hands of stakeholders to enable practical decision-making. To do this, family medicine and primary care researchers need to (1) build on our substantial current research foundation, (2) increase the relevance and pace of our research, (3) reconceive the research workforce to engage new partners, (4) disseminate findings more rapidly into the hands of those who can take action, and (5) build a "question-ready" research infrastructure to make this possible. Family medicine researchers face exciting opportunities: technical capacity to generate and manage large amounts of data; clinic- and system-level networks for testing innovations; digital health technologies for real-time and asynchronous monitoring and management of risk factors and chronic diseases; the know-how to make fast, local improvements in our systems of care; partnerships beyond those traditionally engaged in research that can multiply our capacity to generate new knowledge; and new methods for creating generalizable knowledge from the study of local efforts. This is a historic time for family medicine research. Now is the time to build on our past work, accelerate the pace, and capitalize on emerging opportunities that open an incredibly bright future.

Inspiration and instruction: Commentary on C. J. Peek's study of Don Bloch's legacy.

Comments on the article "Don Bloch's vision for Collaborative Family Health Care: Progress and next steps" by C. J. Peek (see record 2015-25290-002). C. J. offers us a breathtaking, magnificent gift, itself made from gifts. He has taken something good-Don's seminal contributions- and by showing them off in their properly revealed context, like a stone in a setting, has multiplied their value and created something new in its own right. Make no mistake: this article is a work of serious research, conducted according to the methods of the longest-running research tradition of all-historical research, and specifically, comparative historical research (Turner, 2014).

Behavioral health integration: an essential element of population-based healthcare redesign.

The fundamental aim of healthcare reform is twofold: to provide health insurance coverage for most of the citizens currently uninsured, thereby granting them access to healthcare; and to redesign the overall healthcare system to provide better care and achieve the triple aim (better health for the population, better healthcare for individuals, and at less cost). The foundation for this improved system will rest on a redesigned (i.e., sufficiently comprehensive and integrated) system of primary care, with which all other providers, services, and sites of care are associated. The Patient-Centered Medical Home (PCMH) and its congeners are the best current examples of the kind of primary care that can achieve the triple aim, if they can become sufficiently comprehensive and can adequately integrate services. This means fully integrating behavioral healthcare into the PCMH, a difficult task under the most favorable circumstances. Creating functioning accountable care organizations is an even more daunting task: this requires new principles of collaborating and financing and the current prototypes have generally failed to incorporate behavioral healthcare sufficient to meet even the basic needs of the target population. This paper will discuss (1) the case for and the difficulties associated with integrating behavioral healthcare into primary care at three levels: the practice, the state, and the nation; and (2) how this looks clinically, operationally, and financially.

Overcoming early barriers to PCMH practice improvement in family medicine residencies.

BACKGROUND AND OBJECTIVES: Residency programs face inevitable challenges as they redesign their practices for higher quality care and resident training. Identifying and addressing early barriers can help align priorities and thereby augment the capacity to change. METHODS: Evaluation of the Colorado Family Medicine Residency PCMH Project included iterative qualitative analysis of field notes, interviews, and documents to identify early barriers to change and strategies to overcome them. RESULTS: Nine common but not universal barriers were identified: (1) a practice's history reflected some negative past experiences with quality improvement or routines incompatible with transformative change, (2) leadership gaps were evident in unprepared practice leaders or hierarchical leadership, (3) resistance and skepticism about change were expressed through cynicism aimed at change or ability to change, (4) unproductive team processes were reflected in patterns of canceled meetings, absentee leaders, or lack of accountability, (5) knowledge gaps about the Patient-centered Medical Home (PCMH) were apparent from incomplete dissemination about the project or planned changes, (6) EHR implementation distracted focus or stalled improvement activity, (7) sponsoring organizations' constraints emerged from staffing rules and differing priorities, (8) insufficient staff participation resulted from traditional role expectations and structures, and (9) communication was hampered by ineffective methods and part-time faculty and residents. Early barriers responded to varying degrees to specific interventions by practice coaches. CONCLUSIONS: Some barriers that interfere with practices getting started with cultural and structural transformation can be addressed with persistent attention and reflection from on-site coaches and by realigning the talents, leaders, and priorities already in these residency programs.

Attending to the whole person in the patient-centered medical home: the case for incorporating mental healthcare, substance abuse care, and health behavior change.

The foundation of the U.S. healthcare system is faulty, and the consequences have become inescapable (Committee of Quality of Health Care in America, 2001). We are first among nations in spending on healthcare, whether measured in absolute dollars, per capita expenditures, or proportion of our national budget. Yet our citizens are the least healthy in the developed world. (Anderson & Hussey, 2001) Our nation's healthcare system is simply not a high-quality system. This shortfall is serious enough to cause tens of thousands of unnecessary deaths each year and to compromise our capacity for further economic growth (Anderson & Hussey, 2001; Anderson, Frogner, Johns, & Reinhardt, 2006; Macinko, Starfield, & Shi, 2003), yet it ramifies into so many of our political, financial, and social institutions that change is difficult and fraught with serious unintended consequences.