In This Issue: New Concepts for Diabetes and Chronic Disease Management ======================================================================= * Kurt C. Stange This issue of *Annals* brings into view new ways of understanding chronic illness care1 and efforts to improve the quality of care.2–4 It identifies a possible new diabetes risk factor that is easily visible on physical examination, rather than requiring an expensive or invasive test.5,6 Research in this issue shows that the electronic medical record is not a panacea for improving chronic illness care7 and discovers a novel typology of 3 ways that high-performing practices achieve high-quality care.8 Four of these studies take place in practice-based research networks (PBRNs),1,5,7,8 and an additional study characterizes the increasing capacity of PBRNs.9 This research shows that amidst the growing recognition of the potential of PBRNs by outside investigators and by the National Institutes of Health Roadmap,10,11 there is a concomitant need to foster bottom-up participation12 by PBRN members to avoid unbalancing the partnerships that create the power of the PBRN to generate relevant, applicable new knowledge.13 Four of these articles debunk popular theoretical frameworks for understanding disease management and practice improvement, and propose more robust alternatives.2–4,7 By helping us to think differently, these authors provide hope for getting out of the current rut of large resource investment for small improvements. Other important research in this issue uses a novel method to discover that the treatment effect size people desire is greater than the actual effect of popular treatments for upper respiratory tract infections.14 A clinical trial assesses the impact of an ingenious and intrepid intervention for adolescent mothers.15 An essay illustrates that self-importance can get in the way of effective leadership.16 ## TRANSITION OF EDITORIAL TEAM The *Annals* is pleased to welcome Deborah Cohen, PhD, to the editorial team as an associate editor. Dr Cohen, an assistant professor in the Department of Family Medicine at Robert Wood Johnson Medical School, is a communication scientist with expertise in applying qualitative methods to understand communication in health care settings. She led the Robert Wood Johnson Foundation’s Qualitative Research Guidelines Project ([http://www.qualres.org](http://www.qualres.org)) and is principal investigator of the evaluation for the Prescription for Health project. Also with this issue, Benjamin Crabtree steps down as associate editor. We extend our deep thanks to him for his vital role in establishing and developing the *Annals*. He has tirelessly worked with authors to improve their work and with the editorial team to set the direction for the *Annals*. Dr Crabtree will continue his internationally recognized work in qualitative research methods and understanding health care systems as complex organizations. With Dr Cohen’s expertise, the *Annals* will continue to be a home for strong qualitative and mixed methods research. We encourage readers to participate in the *Annals* Journal Club6 and to share your insights by joining the *Annals* online discussion at [http://www.AnnFamMed.org](http://www.AnnFamMed.org). * © 2007 Annals of Family Medicine, Inc. ## REFERENCES 1. Parchman ML, Pugh JA, Romero RL, Bowers KW. Competing demands or clinical inertia: the case of the elevated hemoglobin A1c. Ann Fam Med. 2007;5(3):196–201. [Abstract/FREE Full Text](http://www.annfammed.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiYW5uYWxzZm0iO3M6NToicmVzaWQiO3M6NzoiNS8zLzE5NiI7czo0OiJhdG9tIjtzOjIyOiIvYW5uYWxzZm0vNS8zLzE5NC5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 2. Solberg LI. Improving medical practice: a conceptual framework. Ann Fam Med. 2007;5(3):251–256. 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