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ImportanceThe patient-centered medical home (PCMH) model holds promise for improving primary care delivery, but it has not been adequately tested in teaching settings.Design, setting, and participantsWe implemented an intervention guided by PCMH principles at a safety-net teaching clinic with resident physician providers. Two similar clinics served as controls.Main outcomes and measuresUsing a cross-sectional design, we measured the effect on patient and resident satisfaction using the Consumer Assessment of Healthcare Providers and Systems survey and a validated teaching clinic survey, respectively. Both surveys were conducted at baseline and 1 year after the intervention. We also measured the effect on emergency department and hospital utilization.ResultsFollowing implementation of our intervention, the clinic’s score on the National Committee for Quality Assurance’s PCMH certification tool improved from 35 to 53 of 100 possible points, although our clinic did not achieve all must-pass elements to qualify as a PCMH. During the 1-year study period, 4676 patients were exposed to the intervention; 39.9% of these used at least 1 program component. Compared with baseline, patient-reported access and overall satisfaction improved to a greater extent in the intervention clinic, and the composite satisfaction rating increased from 48% to 65% in the intervention clinic vs from 50% to 59% in the control sites (P = .04). The improvements were particularly notable for questions relating to access. For example, satisfaction with urgent appointment scheduling increased from 12% to 53% in the intervention clinic vs from 14% to 18% in the control clinics (P

In this paper, we provide a simulations-based demonstration of a hybrid electricity market that combines the distributed competitive advantages of decentralized markets with the system security guarantees of centralized markets. In this market, the transmission service provider (TSP) guides an electricity market toward the optimal power flow (OPF) solution, even when maximizing its own revenue. End users negotiate with each other to determine an energy price and then submit separate bids for transmission to the TSP. The TSP returns with prices for transmission, allowing end users to respond. In simulations, this hybrid-decentralized market approaches the near-optimal results of fully coordinated and constrained markets. Additionally, this market exhibits properties that remove incentives for the TSP to withhold capacity. This hybrid market leads a market toward the optimum while allowing the TSP and the end users to act out of self-interest. Index Terms--Coordination, decentralization, electricity markets, multilateral energy transactions, transmission markets, transmission pricing, transmission service providers.

Government supported digitalization initiatives with high expectations have motivated scholars from differing cultures to work together. Often, however, such collaboration results in critical and annoying ethical conflicts. Three examples are depicted. A key introduction to Chinese ethics is followed by discussion of major differences in ethical concepts between Western society and Chinese society. Chinese, instead of focusing on actions (task or matter) focus on relationships. We recommend rethinking Chinese ethics concepts as part of a discussion of communication ethics in general. In addressing virtual reality and communication ethics, we believe some vital conclusions might be reached in the understanding of ethical problems raised by information technology. [ABSTRACT FROM AUTHOR]