Analysis & commentary. Partnering private primary care practices with federally qualified health centers in the care of complex patients.

Federally qualified health centers and small primary care practices have many challenges in common: uninsured patients; growing numbers of chronically ill patients with complex needs; inadequate reimbursements by commercial health plans; and persistent staffing problems. Smaller primary care practices also face sizable barriers to participating in new delivery and payment models that are likely to proliferate in the wake of health reform. To help remedy primary care shortages in the context of implementing health reform, independent primary care providers could contract with nearby federally qualified health centers to provide comprehensive care management services for patients with complicated health problems.

Pittsburgh Regional Healthcare Initiative: a systems approach for achieving perfect patient care.

The Pittsburgh Regional Healthcare Initiative (PRHI) is an innovative model for health system change based on regionwide shared learning. By linking patient outcomes data with processes of care and sharing that information widely, PRHI supports measurable improvements in regionwide clinical practice and patient safety. In addition, through the redesign of problem solving at the front lines of care, PRHI helps health care organizations to evolve toward becoming sustainable systems of perfect patient care.

A region addresses patient safety.

The Pittsburgh Regional Healthcare Initiative (PRHI) is a coalition of 35 hospitals, 4 major insurers, more than 30 major and small-business health care purchasers, dozens of corporate and civic leaders, organized labor, and partnerships with state and federal government all working together to deliver perfect patient care throughout Southwestern Pennsylvania. PRHI believes that in pursuing perfection, many of the challenges facing today's health care delivery system (eg, waste and error in the delivery of care, rising costs, frustration and shortage among clinicians and workers, financial distress, overcapacity, and lack of access to care) will be addressed. PRHI has identified patient safety (nosocomial infections and medication errors) and 5 clinical areas (obstetrics, orthopedic surgery, cardiac surgery, depression, and diabetes) as ideal starting points.