This issue provides further tie-ins between quality and ambulatory care that may emerge as a consequence of the recent pronouncements by the Institute of Medicine (IOM) on quality. Unfortunately, I am not nearly as optimistic that the approach the IOM has taken will have much of an impact.

In the next issue, I will be writing a book review on the most important of the IOM's efforts, entitled "Crossing the Quality Chasm." In brief, the IOM effort focused on the need for leadership if quality is to come to the fore in the health care debate. The first recommendation that the IOM proposes in its executive summary is that "all health care constituencies [horizontal ellipsis] commit to a national statement of purpose for the health care system as a whole and to a shared agenda of six aims for improvement that can raise the quality of care to unprecedented levels." Somehow the issue of the uninsured and the impact of payment incentives played little role in their deliberations. However, I must try to be optimistic and hope that the articles in this issue of the journal will push forward the agenda that the IOM report attempts to encourage.

We have several regular features in this issue, including Mark Holt's reports from the Republic of Texas, Ray Carey's second in a series of articles on statistical methods in analyzing ambulatory care practice, and a report on what you as the health professional reader can do in the area of health and human rights.