Focus On...

SMS working to improve patient safety

Raymond C. Zastrow, MD

‘Medical errors kill tens of thousands.” When the Institute of Medicine released its startling report, “To Err is Human: Building a Safer Health System” in November 1999, headlines like this one resonated across the country. The study reported that up to 98,000 deaths occur annually in hospitals throughout the United States because of medical errors—not necessarily recklessness on the part of physicians, nurses and other health care providers, but basic flaws in the way hospitals, clinics and pharmacies operate.



Author Affiliations: Doctor Zastrow is the SMS president. From Hartland, he specializes in anatomc and clinical pathology.


Corresponding Author: Please address correspondence to the Wisconsin Medical Society

Wisconsin Patient Safety Institute striving for positive outcomes

Catherine Frey

Patient safety, a basic tenet of quality healthcare practice, has been a focus of Wisconsin health care organizations for many years, though there has not always been a vigorous pursuit of the means to advance safety and reduce error. That began to change in 1999, when over 100 key community and health care leaders convened at the Medical College of Wisconsin in Milwaukee for the first Wisconsin Patient Safety Summit. Soon after, the Institute of Medicine (IOM) released its landmark report, To Err is Human, Building a Safer Health System, and in August of this year, the Wisconsin Patient Safety Institute, Inc. was formed. A private, not-for-profit organization, the Institute is dedicated to enhancing and promoting patient safety by advocating safe practices in health care organizations throughout Wisconsin.



Author Affiliations: Ms. Frey is Interim CEO of the Wisconsin Patient Safety Institute.

Corresponding Author: She can be reached at 608.283.5497; 800.762.8976 or via e-mail atpatientsafety@wismed.org

Patient Safety: Wisconsin physicians join forces, take innovative stepsto improve patient care

Marc Kennedy

Patient safety is by no means a new concept. By nature, physicians and other medical personnel strive to provide the best care possible, while health care entities have operated within the framework of risk management and quality improvement guidelines for decades. But when the Institute of Medicine published a blistering report that publicly quantified negative outcomes of medical errors, it was a watershed moment for health care providers across the country.


Author Affiliations: Special to WMJ

Corresponding Author: Please address correspondence to the Wisconsin Medical Society at 608.442.3800

Editorials

Controversial Report Renews Dialogue Among Health Care Professionals

Thomas C. Meyer, MD, WMJ Medical Editor

Seldom has a report of the Institute of Medicine made a greater impact on the health care industry than its 1999 “To Err is Human, Building a Safer Health System.” While several of its findings have been questioned, the Institute must surely be gratified by the response of health professionals in their search to reduce the hazards that patients may experience during encounters with the health system in this country. The demands of managed care that the diagnosis and management of patient’s problems be dealt with in the speediest and most efficient way possible must surely have contributed to the slips and oversights by various members of the health care team—and provided much of the disturbing data that surfaced in the report.


Author Affiliations: WMJ Medical Editor

Corresponding Author: Please address correspondence to the Wisconsin Medical Sociey at 608.442.3800

Wisconsin’s Community Health Centers:The Melting Pot of Medicine

John Khalil

Plato’s words from so many centuries ago seem to capture the essence of my summer SMS Foundation fellowship with the Wisconsin Division of Public Health (DPH). Based on my desire to work in the public health field in the future, I chose to spend most of my time in community health centers across the state. At each site, I saw families and individuals who were truly fighting daily battles. Some were homeless, while others spoke no English or had no means of transportation. The patients I met struggled with multiple addictions, disabilities, chronic health conditions, and were generally underinsured.



Author Affiliations: Mr. Khalil is recipient of the 2001 SMS Foundation Summer Fellowship in Government and Community Service. He is a student at the University of Wisconsin Medical School.


Corresponding Author: Please address correspondence to the Wisconsin Medical Society at 608.442.3800

Original Research

Prevalence of Elder Abuse in the United States: A Comparative Report Between the National and Wisconsin Data

Ihab Hajjar, MD, MS; Edmund Duthie, Jr, MD

This study is designed to calculate the prevalence of elder abuse in Wisconsin and the United States and to perform a geographic comparison of elder abuse prevalence by county in Wisconsin. The national data was obtained from the National Elder Abuse Incidence Study, and the Wisconsin data from the Department of Health and Family Services. The population statistics were obtained from the United States Census Bureau. The prevalence of elder abuse based on substantiated cases was 2.7 per thousand (236,479 cases) in the United States and 1.6 per thousand (2629 cases) in Wisconsin in 1996 (p<0.05). There was an increase in elder abuse prevalence in Wisconsin between 1990 and 1998. Larger metropolitan counties had the largest number of reported cases but more rural counties had the highest prevalence (14 per thousand in Vilas County) and the highest rate of increase in elder abuse prevalence (increase by 9.4 per thousand in Langlade County). This study shows that there are national and local geographic variations in the prevalence of elder abuse cases reported to Adult Protective Services. Further studies are needed to identify factors that led to these variations.



Author Affiliations: Doctor Hajjar is a Clinical Assistant Professor for the Division of Geriatrics at the University of South Carolina/Palmetto Health Alliance. Doctor Duthie is a Professor of Medicine for the Chief Division of Geriatrics/Gerontology in the Department of Int

Corresponding Author: Address reprint requests to: Ihab Hajjar, MD, MS, 9 Medical Park, Ste 230, Columbia, SC.

Trends in Malignant Melanoma Incidence and Mortality in Wisconsin, 1979–1997

Ralph P. Insinga, BA; Eric N. Reither, MA; Patrick L. Remington, MD, MPH; Laura Stephenson-Vine, BA

Objective—To explore trends in malignant melanoma incidence and mortality in Wisconsin from 1979 to 1997, by age, gender and time period. Comparisons are also made to US trends over this period.

Data—Incidence data for Wisconsin were provided by the Wisconsin Cancer Reporting System Bureau of Health Information, within the Wisconsin Department of Health and Family Services, while US data were extracted using SEER*Stat 3.0. Mortality data for both Wisconsin and the US were compiled using CDC WONDER.

Results—Wisconsin malignant melanoma incidence rates rose 25% from 1979 to 1998, compared to a US increase of 132%. For mortality rates, however, both Wisconsin (22%) and the US (15%) exhibited only modest increases. Between the mid-1980s and mid-1990s, the largest increases in both incidence and mortality (over 70%) occurred among males over age 65. In contrast, declines of 30% to 40% were found for males age 0-34. Patterns were less consistent among females.

Conclusions—Since the mid-1980s, malignant melanoma incidence in Wisconsin appears to have increased sharply among males and females over age 65, with a corresponding rise in mortality among males in this age group. These trends should be a source of concern for clinicians and policy makers alike. Because current evidence on the effectiveness of early treatment is inconclusive, it is especially important to take preventive measures now—such as educational and community-based interventions—to reduce future incidence.



Author Affiliations: Mr. Insinga, Mr. Reither, Dr. Remington, and Ms. Stephenson-Vine are from the Department of Population Health Sciences, University of Wisconsin-Madison, and the Bureau of Health Information, Wisconsin Department of Health and Family Services.

Corresponding Author: Address reprint requests to: Ralph Insinga, University of Wisconsin-Madison, Department of Population Health Sciences, WARF Building, Room 644, 610 Walnut St, Madison, WI 53705-2397.

Breast Cancer Screening in a Rural Wisconsin Community

Mukund Venugopalan; Eric W. Schmidt, MD

Background—Screening tests have been shown to play an important role in earlier disease stage detection of breast cancer. Aim—The aim of this study was to assess the acceptance of screening mammography in a rural community in Wisconsin. Methods—A cohort of 60 patients with breast cancer was analyzed retrospectively for disease stage, screening mammography, and patient compliance. Results—Of 60 patients with breast cancer, only 25 (42%) underwent screening mammography. Compliance was suboptimal among patients; especially poor in the elderly population. Conclusion—Promotional steps to increase acceptance of screening tests need to be emphasized especially in patients > 60 years in age to enhance early detection of breast cancer and prolong disease-free interval.



Author Affiliations: Mr. Venugopalan is with St. Louis University; Dr. Schmidt is with the Department of Medicine and Oncology, Burlington Memorial Hospital, Burlington, WI.

Corresponding Author: Address reprint requests to: Eric W. Schmidt, MD, Chief of Oncology, Department of Medicine, Burlington Memorial Hospital, 248 McHenry St, Burlington, WI 53105.

Increasing Incidence of End-Stage Renal Disease in Wisconsin: An Unintended Consequence of Increased Survival?

Angela Russell; Patrick Remington, MD, MPH; Donn D’Alessio, MD; Peter Brazy, MD

End stage renal disease (ESRD) is an important and costly complication of diabetes, hypertension, and primary kidney disorders. We examined ESRD incidence trends in Wisconsin from 1982 to 1997 and assessed the progress in reaching the ESRD 2000 goal as stated by Healthier People in Wisconsin: A Public Health Agenda for the Year 2000. Since 1982, there has been nearly a three-fold increase in the incidence of ESRD in Wisconsin. The increase was most striking in persons with diabetes and among people age 65 and older. Furthermore, the increase was shared among all racial groups and both genders. Although better disease management reduces the risk of ESRD, it also reduces the risk of other causes of death such as heart disease and cancer. Thus, individuals may be living longer with other chronic diseases, thereby increasing the incidence of ESRD.



Author Affiliations: Authors are with the Wisconsin Public Health and Health Policy Institute, Department of Population Health Sciences, University of Wisconsin Medical School. Ms. Russell is a graduate student;. Doctors Remington and D’Alessio are Associate Professors.

Corresponding Author: Address reprint requests to: Patrick Remington, MD, MPH, Wisconsin Public Health and Health Policy Institute, Suite 760, 610 Walnut St, Madison, WI 53705-2397.

Burn Injury from Products in the Home: Prevention and Counseling

Amy L. Stockhausen, MD; Murray L. Katcher, MD, PhD

Each year in the United States, fire and burn injury is responsible for a high degree of morbidity and mortality. In 1996-1998, Wisconsin’s mortality rate from unintentional fire and burn injury (1.22 deaths/ 100,000 population) was similar to the average United States mortality rate for such injuries (1.40), and significant morbidity leads to hospitalization, invasive procedures, and psychological trauma. This article describes the common types of product-related burn hazards in the home, the injuries associated with these hazards, prevention measures, and the health professional’s important role in burn injury prevention.

Author Affiliations: Doctor Stockhausen is a Pediatric Resident, University of Wisconsin Children’s Hospital, Madison, WI. Doctor Katcher is Professor of Pediatrics and of Family Medicine, University of Wisconsin Medical School.

Corresponding Author: Address reprint requests to Murray L. Katcher, MD, PhD, University of Wisconsin, Department of Pediatrics, H6/4 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-4116.

Proceedings from the 2000 Wisconsin Primary Care Research Forum and 14th Annual WReN Meeting

John W. Beasley, MD

The 14th annual meeting of the Wisconsin Research Network (WReN), the 2000 Wisconsin Primary Care Research Forum, was held June 8-9, 2000 in Waukesha, WI. WReN, a statewide network of more than 600 primary care professionals interested in practice-based research, is organized under the auspices of the Wisconsin Academy of Family Physicians (WAFP) Research Committee, and is supported by the WAFP and the Wisconsin Institute of Family Medicine (WIFM). This 2-day conference is planned as a working meeting for the participants and includes presentations by invited speakers, original research presentations by primary health care professionals, and workshops related to conducting research in the office setting. The following abstracts represent presentations of original research.


Author Affiliations: Wisconsin Medical Society

Corresponding Author: Please address correspondence to the Wisconsin Medical Society at 608.442.3800

Your Practice

Building On ‘First Do No Harm’

Philip M. Farrell, MD, PhD, and Jeffrey Grossman, MD

To state the obvious, patient safety—the theme of this edition of WMJ—is a concept of utmost importance in medical practice. It is not a new notion: for centuries doctors have functioned by the credo to “first do no harm” to their patients. Unfortunately, this fundamental issue has not received adequate systematic attention for many decades. It is a difficult problem to address, as many factors appear to be involved, reflecting the complex technology, interactions and systems that characterize modern medicine.



Author Affiliations: Doctor Farrell is Dean, University of Wisconsin Medical School, and Vice Chancellor for Medical Affairs at UW-Madison. Doctor Grossman is Senior Associate Dean for Clinical Affairs and President and Chief Executive Officer of UW Medical Foundation


Corresponding Author: Please address correspondence to the Wisconsin Medical Society at 608.442.3800

Preventive Medicine for Doctors

Nathan A. Fishbach, JD

The term preventive medicine now may apply to physicians as well as patients. The Office of the Inspector General for the US Department of Health and Human Services (HHS) recently issued a document that outlines a compliance program for individual and small group physician practices. The adoption of such a program may enhance a practice’s operations as well as place it in a better posture when compliance issues arise.



Author Affiliations: Nathan A. Fishbach is a Milwaukee-based shareholder at Whyte Hirschboeck Dudek S.C., concentrating on complex litigation and compliance issues. For over 13 years, Mr. Fishbach was a federal prosecutor and civil litigator in the US Attorney’s Office

Corresponding Author: Please address correspondence to the Wisconsin Medical Society at 608.442.3800