The James A Vohs Award for Quality--The Eighth Annual Permanente Journal Special Issue
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This year's Vohs award winners represent attempts to reduce adverse medical events by early diagnosis through more effective screening. We are proud to present both projects in this issue.

"Controlling High Blood Pressure" (Mid-Atlantic States)

Identification of individuals with elevated blood pressure (BP) and control of hypertension (HTN) becomes an ever-higher public health priority. The prevalence of sequelae of increased BP, which include heart attack, stroke, heart failure, and renal failure, is progressively higher with increasing pressure levels. Thus, definitions of "HTN" are arbitrary and have fallen over the decades. The leaders of the Kaiser Permanente (KP) Mid-Atlantic States Region set a goal of raising the proportion of HTN patients with good control from 41% in 2001 to 63% in 2004. This goal was met among 9119 members with documented HTN.

The components of the program start with training and implementing a BP measurement competency validation program for clinical assistants, nurses, and other providers. No new expensive equipment needed to be purchased. Along with assuring accurate and standard BP measurement, automated BP tracking capability and practitioner awareness of HTN as a health risk factor were developed. Operational changes included mandatory BP checks in primary and specialty care, and creation of a user-friendly electronic database.

Teams were able to focus on a "comprehensive conceptualization of HTN" and that a "holistic approach" has driven actions for individual members and member populations not previously taken.

Operation Innovation: Moving Breast Cancer Screening, Detection, and Treatment to an Entirely New Care and Service Level (Southern California)

On the basis of the evidence that "early and prompt breast cancer screening, detection, diagnosis, and treatment can save lives," Operation Innovation was conceived and implemented by a multidisciplinary group of physicians, health care professionals, bargaining unit staff, and administrators. The two major components of the program were Mammography Outreach and Timely Diagnosis of Breast Cancer.

Outreach efforts were directed at KP member women aged 50-69, enrolled continuously for two years, with no mammogram in the last 18 months. The new program involved: 1) targeted motivational telephonic messages and personalized communications, 2) identification of nonresponders/nonacceptors for focused outreach efforts, and 3) outlying KP facility screening access through a mobile mammography service. These interventions increased the screening mammography rates from 79.1% to 89.8%, the latter being the highest in the Southern California Region.

In July 2003, in the Riverside Service Area, time from initial suspicion of breast cancer to diagnosis had a median number of days of 19, with 32% diagnosed within the recommended target of 14 days from the initial suspicious findings. New processes were designed to reduce the wait time, unnecessary anxiety, and number of "sleepless nights" patients experienced. The 2004 year-end results showed 79% of patients diagnosed within 14 days, with a median of nine days.

Multidisciplinary collaboration was a key feature. Results include more timely and effective care and service, improved patient outcomes, and enhanced member satisfaction.

The Vohs Award

The James A Vohs Award for Quality was established when Mr Vohs retired from 17 years as President, CEO, and Chairman of the Boards of Kaiser Foundation Health Plan, Inc, and Kaiser Foundation Hospitals. The award is presented for the project(s) that best represents an effort to improve quality through documented institutionalized changes in direct patient care, with potential for transfer to other locations.

Nominations need approval by the Division President and Medical Director and applications are due September 1st each year. Selections are announced at the December Board of Directors meeting. Awardees receive no money. Winners and runners-up are invited to present their projects at a reception hosted by the Boards of Directors, Division Presidents, and other Program Officers.