In This Issue: A Diversified Portfolio
======================================

* Kurt C. Stange

The diversity of articles in this issue reflects the variety of family medicine and its interactions with patients, communities, and health care systems.

Three empirical studies1–3 and a thoughtful editorial4 bring to light the prevalence, mediators, mutability, and meaning of shared decision making around prostate cancer screening.

A rigorous study by Ornstein and colleagues helps us to understand chronic illness, not as a competing demand for preventive service delivery, but as an accompaniment and opportunity for integrated care.5

A pragmatic clinical trial led by Pace and colleagues assessed the effect of the Americans In Motion—Healthy Intervention (AIM-HI) project to promote physical activity, healthy eating, and emotional well-being. Among program completers in 24 family practices, there are impressive improvements, but no differences between 2 different implementation approaches.6

In another group-randomized trial, Dietrich et al successfully transport a research-based intervention to a health care plan setting. They examine both the reach and outcomes of a telephone outreach intervention designed to increase colorectal cancer screening among publicly insured urban women, delivered by Medicaid Managed Care Organization staff.7

Safety is an important and underevaluated outcome in primary care practices. Hoffmann et al evaluate the impact of multiple factors on perceptions of a safety climate in primary care practices.8

Avoidance of unnecessary hospitalization is an outcome of high-quality primary care, but the mechanisms by which primary care clinicians understand how to avoid hospitalizations for ambulatory care–sensitive conditions has not been elucidated. Freund and colleagues show us the strategies identified by German primary care physicians.9 This article is featured in this issue’s *Annals* Journal Club.10

Kozhimannil and Fontaine illuminate a nationally representative sample of pregnant women to describe the diversity of their care sources and trends in family physician care.11-

Finally, an essay by two female physicians provides a different perspective on childbearing. Miura and Boxer share their personal stories of postponing motherhood in the pursuit of successful medical careers and reflect on the consequences of their decisions.12

We welcome your reflections at [http://www.annfa-mmed.org](http://www.annfa-mmed.org).

*   © 2013 Annals of Family Medicine, Inc.

## References

1.  Feng B, Srinivasan M, Hoffman JR, et al. Physician communication regarding prostate cancer screening: analysis of unannounced standardized patient visits. Ann Fam Med. 2013;11(4):315–323.
    
    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6ODoiMTEvNC8zMTUiO3M6NDoiYXRvbSI7czoyMzoiL2FubmFsc2ZtLzExLzQvMzAyLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

2.  Wilkes MS, Day FC, Srinavasan M, et al. Pairing physician education with patient activation to improve shared decisions in prostate cancer screening: a cluster randomized controlled trial. Ann Fam Med. 2013;11(4):324–334.
    
    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6ODoiMTEvNC8zMjQiO3M6NDoiYXRvbSI7czoyMzoiL2FubmFsc2ZtLzExLzQvMzAyLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

3.  Han PKJ, Kobrin S, Breen N, et al. National evidence on the use of shared decision making in prostate-specific antigen screening. Ann Fam Med. 2013;11(4):306–314.
    
    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6ODoiMTEvNC8zMDYiO3M6NDoiYXRvbSI7czoyMzoiL2FubmFsc2ZtLzExLzQvMzAyLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

4.  Ferrer RL, Gill JM. Shared decision making, contextualized. Ann Fam Med. 2013;11(4):303–305.
    
    [FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6ODoiMTEvNC8zMDMiO3M6NDoiYXRvbSI7czoyMzoiL2FubmFsc2ZtLzExLzQvMzAyLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

5.  Ornstein SM, Jenkins RG, Litvin CB, Wessell AM, Nietert PJ. Preventive services delivery in patients with chronic illnesses: parallel opportunities rather than competing obligations. Ann Fam Med. 2013;11(4):344–349.
    
    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6ODoiMTEvNC8zNDQiO3M6NDoiYXRvbSI7czoyMzoiL2FubmFsc2ZtLzExLzQvMzAyLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

6.  Pace WD, Lanigan AM, Staton EW, et al. Effectiveness of 2 methods of promoting physical activity, healthy eating, and emotional well-being with the Americans in Motion—Healthy Interventions approach. Ann Fam Med. 2013;11:(4):371–380.
    
    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6ODoiMTEvNC8zNzEiO3M6NDoiYXRvbSI7czoyMzoiL2FubmFsc2ZtLzExLzQvMzAyLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

7.  Dietrich AJ, Tobin JN, Robinson CM, et al. Telephone outreach to increase colon cancer screening in Medicaid managed care organizations: a randomized controlled trial. Ann Fam Med. 2013; 11(4):335–343.
    
    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6ODoiMTEvNC8zMzUiO3M6NDoiYXRvbSI7czoyMzoiL2FubmFsc2ZtLzExLzQvMzAyLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

8.  Hoffmann B, Miessner C, Albay Z, et al. Impact of individual and team features on patient safety climate: a survey in family practices. Ann Fam Med. 2013;11(4):355–362.
    
    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6ODoiMTEvNC8zNTUiO3M6NDoiYXRvbSI7czoyMzoiL2FubmFsc2ZtLzExLzQvMzAyLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

9.  Freund T, Campbell SM, Geissler S, et al. Strategies for reducing potentially avoidable hospitalizations for ambulatory care–sensitive conditions. Ann Fam Med. 2013;11(4):363–370.
    
    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6ODoiMTEvNC8zNjMiO3M6NDoiYXRvbSI7czoyMzoiL2FubmFsc2ZtLzExLzQvMzAyLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

10. Avoiding hospitalizations for ambulatory care–sensitive conditions. *Annals* Journal Club. Ann Fam Med. 2013;11(4):iii.
    
    [FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6ODoiMTEvNC9paWkiO3M6NDoiYXRvbSI7czoyMzoiL2FubmFsc2ZtLzExLzQvMzAyLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

11. Kozhimannil KB, Fontaine P. Care from family physicians reported by pregnant women in the United States. Ann Fam Med. 2013; 11(4):350–354.
    
    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6ODoiMTEvNC8zNTAiO3M6NDoiYXRvbSI7czoyMzoiL2FubmFsc2ZtLzExLzQvMzAyLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==) 

12. Miura LN, Boxer RS. Women in medicine and the ticking clock. Ann Fam Med. 2013;11(4):381–382.
    
    [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6ODoiMTEvNC8zODEiO3M6NDoiYXRvbSI7czoyMzoiL2FubmFsc2ZtLzExLzQvMzAyLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==)