This issue continues our series on new ways of stabilizing healthcare costs, new trends in quality improvement in ambulatory care and empowering patients. VanDeusen Lukas and colleagues add significantly to our understanding of factors that impact the dissemination of innovation in ambulatory services. Tantau adds to the discussion with a commentary on the VanDeusen Lukas article. Cheung and colleagues tie quality improvement into perceived impact, on the part of community health center CEOs, of quality improvement on the financial bottom line of their respective organizations. Wasson and colleagues expand our understanding of consumer engagement/patient empowerment-an increasing focus of our journal. Becker and Douglass extend our conversation on patient engagement with a look at the attractiveness of the ambulatory physical environment and its impact on quality of care. Candib and colleagues extend our understanding of patient engagement with a case study look at attempts of a community health center to improve patient health via an interesting alliance with the local YWCA.

We next continue debates begun in the last issue. Schoenbaum and colleagues, from a variety of institutions, including the Commonwealth Fund, comment on the payment proposal for primary care physicians published in the last issue of the journal. The authors of this initial article, including myself, respond to Schoenbaum's commentary.

We need to explore a variety of approaches to improving both the reliability and validity of the information we collect to, for example, improve payment for primary care physicians. Miller and colleagues report on the relationship between outpatient claims data and patient reports, while Naessens expresses concerns about using outpatient claims data for a variety of quality and payment purposes. My perspective on the reliability/validity issue is simple: until the health system uses a data element for payment purposes, there will always be challenges in the completeness of the data-collection process.

Continuing the discussion format, Apolone responds to commentaries on his article on pricing of pharmaceuticals, a critical issue confronting ambulatory care management. Lastly, our routine features from the Republic of Texas, together with our Human Rights column, are enclosed.

Norbert Goldfield, MD, Editor