Collaboration in Pennsylvania: rapidly spreading improved chronic care for patients to practices.

Introduction: Pennsylvania's Improving Performance in Practice (IPIP) program is administered by the Pennsylvania (PA) chapters of the American Academy of Family Physicians, American College of Physicians, and American Academy of Pediatrics. The project has provided coaching, monthly measurement, and patient registry support for 155 primary-care practices that participate in the 3-year Pennsylvania Chronic Care Initiative led by the PA Governor's Office of Health Care Reform.

Methods: Practices participating in this case study are attending regional Breakthrough Series collaboratives and submitting monthly narrative and clinical outcomes reports.

Clinical outcomes in patients with suspected acute pulmonary embolism and negative helical computed tomographic results in whom anticoagulation was withheld.

Background: Helical computed tomography (CT) techniques for the diagnosis of pulmonary embolism have been refined over the past decade. Helical CT is widely used in the diagnosis of pulmonary embolism despite the lack of well-designed trials supporting this approach. Although helical CT correlates well with pulmonary angiography in detecting central emboli, critics argue that it misses more distal embolic events.