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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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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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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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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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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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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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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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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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