This issue provides a range of articles relevant to ambulatory managers and researchers in ambulatory care services. Whittle and colleagues from the Veterinary Affairs system in Wisconsin provide yet another perspective on scheduling appointments and their relationship to missed and cancelled appointments.

The next 2 articles highlight quality improvement activities and their relationship to organizational characteristics (Braun et al) and the importance of leadership and staff perceptions (Chin et al).

Disease management continues to be ever present-despite the relatively thin layer of evidence supporting the manner in which it is currently being implemented. Garnick and Merrick author the next 2 articles that relate to the use of disease management, particularly for mental health services.

As a researcher and one who is interested in implementing payment system reform, I am most interested in looking at outcomes. Volume for me is a process measure. However, we should continue to examine this issue from a research perspective, and the next article does exactly that with respect to ambulatory care procedures and their relationship to outcomes such as hospitalizations.

Despite our efforts to improve coordinated care services (and thus have fewer unnecessary visits to the emergency department), the challenge of inappropriate emergency department visits remains. Redstone and colleagues provide an update on this vexing problem.

I continue to be interested in submissions on architectural design questions in ambulatory care. Zilm and colleagues analyze disaster planning and architectural design issues in ambulatory facilities.

With respect to our regular features, we provide a health policy update from the Republic of Texas. We are also pleased to provide our readers with the next installment in our regular ambulatory management feature by Drs Goodspeed and Lee.

Norbert Goldfield, MD

Editor