Spring 2000 - Volume 4 Number 2

Clinical Contributions

The James A. Vohs Award for Quality
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Bright Systems® Sheds Light and Lightens the Load at Pediatric Health Supervision Visits
Diane Fraser
This article complements the outline by Dr Gee et al of the 2000 Vohs award-winning project. It describes the actual workings of the system and personalizes some of the details with anecdotal examples. There is discussion of the underlying personal motivations for development of the system and historical aspects. The specific tools used are described, and examples of the project in action are given.

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Bright Systems®: A Total Quality Management Project to Improve Children's Health.
Northern California Region
This project targets the preventive health needs of almost 50% of Health Plan members, when children and their families are included. This article outlines the project in detail. The system emphasizes comprehensiveness and anticipation of needed counseling. Injury prevention and healthy behaviors are among the major foci of the effort. Results showed substantial improvements in quality of care as well as high patient and physician satisfaction. Potential cost savings are also discussed.

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The Childhood/Adolescent Immunization Program.
Colorado Region
This program assesses immunization status at every visit, operates tracking and audit systems, improves availability of protocols, and provides education to patients and staff. An "Immunization Tool Kit" is a key feature. Outcome data show that this low-cost program has been highly successful in achieving its goals. It achieved a first-place award from The American Association of Health Plans for "Innovative Quality Improvement."

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Achieving Positive Outcomes through Collaborative Pharmaceutical Care: The KPNW Medication Management Program
Northwest Region
Emphasizing lipid management and diabetic glucose control, this centralized program integrates management into the care delivery system. Tools include development of a list of those at risk, streamlining test ordering, group appointments, educational efforts, and nurse care management. Measured results include improved percentages of coronary disease patients with LDL cholesterol levels below 130 mg/dL, and improved glycemic control in diabetics. Substantial reductions in acute myocardial infarction rates and coronary disease mortality are predicted.

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Asthma Disease Management Program.
Colorado Region
This program included registry development, guideline dissemination, classes, and management by nurses of pediatric and adult asthma patients. Planned measures of the impact of the program are utilization, patient and physician satisfaction, appropriateness of medications and cost-effectiveness. The preliminary data suggest improved quality, satisfaction and utilization outcomes. Noteworthy among the results is reduced overuse of beta-agonist medication. Similar programs are rapidly becoming standard of care.

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Emergency Contraception Research and Demonstration Project.
Southern California Region
This project, a collaboration between Southern California Kaiser Permanente and others, evaluated the acceptability and feasibility of emergency contraception (EC, or "morning-after pills"). Aspects described include packaging and availability problems, education and training of staff, and ensuring adequate patient understanding. All objectives were met with high patient satisfaction and probable cost savings.

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The Breast Health and Cancer Detection Program.
Georgia Region
With a target population of all women in the Kaiser Permanente Georgia Region 50 years of age or older, this program includes attempts to improve member access, member and practitioner awareness, and practitioner adherence. The screening rates in the targeted group rose from 74% in 1996 to 84% in 1999 (p < 0.0001). Telephone calls and mailings to women overdue for mammography screening seemed to be especially effective. Reduced breast cancer morbidity and mortality are among the probable long-term expected results.

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Improvement of Cardiac Outcomes in Kaiser Permanente of Ohio.
Ohio Region
This project involved the use of reminder notices to practitioners caring for patients with coronary disease (CAD) as a means of improving care. The specific targets were four interventions proven beneficial for CAD; these were regular aspirin use, smoking cessation, cholesterol lowering, and use of beta-blocker drugs. Substantial increase in compliance was demonstrated as well as concomitant decrease in hospitalizations for CAD.

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Health Systems

Potential Abuses of Group Visits.
Edward B. Noffsinger, PhD; John C. Scott, MD

Since this exciting new model for patient encounters is spreading across the Program, this article will be extremely valuable to those Permanente Groups who are beginning their Group Visit programs.
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Understanding Today's Group-Visit Models
Edward B. Noffsinger, PhD; John C. Scott, MD

While there has been much written recently on group visits, this article may be the best overall discussion of this exciting new innovation.
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What does the STAR Survey mean to a Permanente Physician? Interview with David Glass, National Director of Market Research

This interview with David Glass, the National Director of Market Research, addresses this survey tool and the important information that it can provide to the Permanente Medical Groups.
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Editors' Comments

Healing Physicians: Physicians Healing
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A Word from the Medical Directors

Can Managing Cost Be Part of Managing Care?
Donald L. McGuirk, MD
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External Affairs

Primum Non Nocere: Safety, Medical Errors, and Congressional Intent.
Donald W. Parsons, MD
After the Institute of Medicine report on medical errors in hospitals, patient safety has become a hot political topic. Kaiser Permanente has been a leader in improving patient safety. Our integrated health care system and our previous track record give us an enviable position in being able to be a leader in improving patient safety.

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Kaiser Permanente's Response to JCAHO's Sentinel Event Standards: Our Significant Event Root-Cause Analysis Program Leads to Preventing Medical Errors
Ricki Stajer, RN, MA, CPHQ; Bud Pate, REHS
This article is one of Kaiser Permanente practical approaches to improving patient safety. Kaiser Permanente's policy on significant events is reviewed and how it meets the JCAHO policy regarding sentinel events. We have learned that blaming individuals has the effect of decreasing our ability to find the root cause of the significant event.

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Abstracts of articles authored or coauthored by Permanente clinicians
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Book Reviews

"The Back Pain Revolution"
Gordon Waddell, Alf L. Nachemson (Introduction), Reed B. Phillips (Introduction).
Review by Gary Stein, MD

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"God Unmasked; the Full Life Revealed,"
Ernest Lane, MD
Review by Albert Ray, MD

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Soul of the Healer

Cat's Hill
J. Richard Gaskill, MD

Peacock at the Window
J. Richard Gaskill, MD

A Bunker in the Storm


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