Editorials

A look at health care quality and patient safety

Wisconsin Medical Journal

This issue of the Wisconsin Medical Journal features a variety of quality and patient safety initiatives taking place at the national, state, and local levels.


Author Affiliations: Wisconsin Medical Society

Corresponding Author: Wisconsin Medical Journal

Commentaries

Letters to the Editor

Letters

Letters to Editor

Author Affiliations: Letters

Corresponding Author: Letters

Original Research

Partners in Safety: Implementing a Community-based Patient Safety Advisory Council

Kathryn K. Leonhardt, MD, MPH; Deborah Bonin RHIA, CPHQ; Patti Pagel, RN, BSN

A recommended strategy for improving patient safety is patient-centered care, with the patient and provider functioning as partners to achieve health care goals. Objective: To implement a community-based advisory council where patients and providers can collaboratively develop interventions for safe medication use in the outpatient setting. Design, Setting, Participants: A descriptive study of the process used to implement a patient-provider advisory council in Walworth County, Wisconsin in 2005-2006. Participants included patients and health care professionals from Aurora Health Care and the community. Using formative research and community-based participatory programs, the Council developed medication safety interventions. Main Outcome Measure(s): Establishment of a community-based patient-provider council; development of interventions to improve medication safety in the outpatient setting. Results: The Walworth County Patient Safety Council was established in November 2005, with 11 patient and 12 provider representatives. The Council identified and developed multiple interventions for patients and health care providers. Conclusions: A community-based advisory council is an effective partnership model where patients, providers, and their community can collaboratively develop strategies for improving medication safety. As interventions are disseminated in Walworth County, their effectiveness on medication safety outcomes will be evaluated.

Author Affiliations: Aurora Health Care (Leonhardt, Bonin, Pagel).

Corresponding Author: Kathryn K. Leonhardt, MD, MPH, Patient Safety Officer, Aurora Health Care, 12500 West Bluemound Rd, Ste 301, Elm Grove, WI 53122; phone 262.787.2748; fax 262.787.2788; e-mail Kathryn.Leonhardt@aurora.org.

Preventing Early-onset Group B Streptococcal Sepsis: Efforts to Measure and Improve Compliance with Guidelines

Kenneth W. Merkitch, MD; Charles W. Schauberger, MD, MS; Becky A. Fruechte, RN

We describe strategies employed in achieving a high level of compliance with Centers for Disease Control and Prevention guidelines for the prevention of early-onset Group B streptococcal neonatal sepsis. Methods: This is a retrospective review of all deliveries at or beyond 37 weeks gestation at Gundersen Lutheran Medical Center to determine 1) whether and when cultures were obtained for group B Streptococcus, 2) whether antibiotics were administered, and 3) the timing of antibiotic treatment relative to delivery, following educational efforts to an integrated medical center’s departments of Obstetrics and Gynecology and Family Practice. Changes were made in prenatal records and admission order forms to facilitate compliance. Results: Cultures were obtained antenatally from 946 (99.0%) of the 956 women, with 87.4% (827) of these obtained between 35 and 37 weeks gestation. One hundred eighty-two (19.2%) of the women were colonized with group B Streptococcus. One hundred sixty of the 173 patients eligible for antibiotic prophylaxis (92.5%) received it. Discussion: Our rates of antenatal culturing and prophylactic antibiotic administration compared favorably with those previously reported. Our strategies for achieving high compliance with group B Streptococcus prevention protocols include educating and obtaining consensus from individuals providing obstetrical care and building reminders into physician and nurse workflows.


Author Affiliations: Gundersen Lutheran Medical Center (Merkitch, Schauberger, Fruechte)

Corresponding Author: Kenneth Merkitch, MD, Department of Obstetrics & Gynecology, Gundersen Lutheran Medical Center, 1900 South Ave, La Crosse, WI 54601; phone 608.782.7300; fax 608.775.6611; e-mail kwmerkit@gundluth.org.

The State of Quality Reports: Comparing States by Their Rankings

Richard G. Roberts, MD, JD; Donna Friedsam, MPH; John W. Beasley, MD; Cindy Helstad, PhD, RN; D. Paul Moberg, PhD

Public reports ranking physician competence and quality often yield conflicting results and create confusion. Methods: Bivariate Pearson correlation analyses were performed to compare states’ rankings of physician discipline and physician quality, as reported by the Medicare program and National Practitioner Data Bank. Medical boards were surveyed on their rates of complaints against physicians and ratio of actions to complaints. Results: For all states, there was a poor to negative correlation between state rankings of disciplinary rates and quality, as well as rates of complaints against physicians. As an example, Wisconsin ranked 50th out of the 50 states plus the District of Columbia (where 1 is most desirable and 51 is worst) in rates of “serious” licensure sanctions, but did well when ranked by Medicare quality (eighth out of 51) and the rate of NPDB adverse reports (second out of 51). Wisconsin had a low rate of complaints per physician, ranking second out of 35 responding states, and a high ratio of actions to complaints, ranking fourth out of 35. Conclusion: Conflicting conclusions among public reports on physician discipline and quality raise questions about their methods and validity. State rankings of physician discipline and quality should be viewed with caution.


Author Affiliations: Department of Family Medicine, University of Wisconsin School of Medicine and Public Health (Roberts, Beasley); University of Wisconsin Population Health Institute (Friedsam, Moberg); Wisconsin Medical Society (Helstad

Corresponding Author: Richard G. Roberts, MD, JD, Professor of Family Medicine, University of Wisconsin School of Medicine & Public Health, 777 S Mills St, Madison, WI 53715; phone 608.263.3598; fax 608.263.5813; e-mail richard.roberts@fammed.wisc.edu.

The Wisconsin Health Information Organization

Julie Bartels

The Wisconsin Health In-formation Organization (WHIO) is an information-sharing business entity focused on improving quality, affordability, safety, and efficiency in health care. It is intended to support both patients and health care professionals by delivering transparent and comparable data in an easy-to-access and easy-to-understand method. The information provided will support consumer and purchaser value-based health care buying decisions. Providers will be able to measure their own performance, introduce improvements, and track the results of those process improvements over time.



Author Affiliations: Ms Bartels joined WHIO as Executive Director in 2006. Bartels previously held senior leadership roles at Employer’s Health Insurance (Humana) and American Medical Security (United Health Care).


Corresponding Author: Ms Bartels

Medication reconciliation in Wisconsin: Insights from a local initiative

Justin Endo, MD; Kendra Jacobsen, MS

“The young physician starts life with 20 drugs for each disease, and the old physician ends life with one drug for 20 diseases.” —William Osler, MD This quotation likely resonates with many physicians, pharmacists, and others challenged each day with the complexities of medication management. In 2004, the Madison Patient Safety Collaborative (MPSC) formed a Medication Reconciliation Team. Two years later, even with a number of outspoken proponents, progress is difficult.



Author Affiliations: Madison Patient Safety Colaborative

Corresponding Author: Please address correspondence to: Kendra Jacobsen, MS, Madison Patient Safety Collaborative, 202 S Park St, Madison, WI 53715; phone 608.267.5889; fax 608.267.5645; e-mail kjacobsen@ madisonpatientsafey.org.

Crossing the quality creek

John Frey, III, MD

The Institute of Medicine (IOM) report, “To Err is Human: Building a Safer Health System,”1 represented a landmark shift in this country in the thinking about health care quality and safety. The report also brought safety in health care to the public’s attention in a very big way by documenting the types of errors that occur and, in general, how often they occur and why. The follow-up report, “Crossing the Quality Chasm: A New Health System for the 21st Century,” published 2 years later challenged the health care industry to reform itself to improve quality and safety.2 Much of what is reported in this issue of the Journal is a follow-up to those recommendations as quality is being addressed at a statewide or systems level in Wisconsin.



Author Affiliations: Medical Editor, Wisconsin Medical Journal


Corresponding Author: John Frey, III, MD

Are we ready for the proactive patient?

Susan Gaard, RN, MS

An informed patient is a safer patient. That is the belief of the WEA Trust, a not-for-profit insurer serving Wisconsin public school employees and their families. Encouraging Trust members to be vigilant partners with their health care professionals aligns strategically with our organization’s mission to optimize member health and well-being. The WEA Trust recognizes that members indeed play a critical role in their health care and have the ability to help reduce medical errors, improve health care outcomes and quality of life, and help reduce costs associated with miscommunication and error. This article describes what was learned from WEA Trust members as we designed and developed a member-focused educational campaign on health care quality and safety.



Author Affiliations: Ms Gaard is an independent consultant and health care quality advisor to the WEA Trust. Please address correspondence to sgaard@weatrust.com.

Corresponding Author: Susan Gaard, RN, MS

MetaStar: Wisconsin’s Quality Improvement Organization

Jay A. Gold, MD, JD, MPH; Kay Simmons, MA

MetaStar, Wisconsin’s health care quality improvement organization (QIO), is dedicated to ensuring the healthiest lives possible for citizens of Wisconsin. MetaStar itself, of course, does not deliver health care, so we accomplish our mission by partnering with the many other organizations, providers, and health care professionals who dedicate themselves to providing health care in our state. It is only through collaboration, sharing, and learning from one another that we can optimize the quality of health care to achieve the 6 aims enunciated by the Institute of Medicine1: safety, timeliness, effectiveness, efficiency, equity, and patient-centeredness.



Author Affiliations: Doctor Gold is senior vice president and principal clinical coordinator for MetaStar, Inc. Ms Simmons is vice president of communications. This material was prepared by MetaStar, Inc., the Quality Improvement Organization for Wisconsin, under a contract w

Corresponding Author: Jay A. Gold, MD, JD, MPH; Kay Simmons, MA

AMA Physician Consortium for Performance Improvement committed to quality

Cyril M. (“Kim”) Hetsko, MD

Providing patient care that is safe and of the highest possible quality is a central goal of every practicing physician. That is why matters of quality are also of utmost importance to the American Medical Association (AMA). The AMA began convening the Physician Consortium for Performance Improvement®, also known as the Consortium, in 2000. The Consortium is committed to improving the quality of care and patient safety by taking the lead in the development, testing, and maintenance of evidence-based clinical performance measures and measurement resources for physicians. These are not guidelines created by an insurance company, not best practices developed by some unknown panel and not efficiency measures created by third party payers. Rather, these are a national source of scientific, evidence-based measures developed by the profession: by physicians, for physicians, for the patients we serve.



Author Affiliations: Doctor Hetsko is an American Medical Association Trustee from Wisconsin and a member of the Executive Committee of the Physician Consortium for Performance Improvement.





Corresponding Author: Cyril M. (“Kim”) Hetsko, MD

Local pay-for-performance program progresses

Jennifer Close-Goedjen, MS; Thomas Hirsch, MD, MS

Dean Health Plan (DHP) is in its seventh year of the Practitioner Incentive Model (PIM), its home-grown pay-for-performance program (P4P). Dean’s P4P has progressed in scope, sophistication, and success over the years, with a primary focus on providing financial rewards for excellent care and service.



Author Affiliations: Ms Close-Goedjen is care management manager and Doctor Hirsch is vice president of Medical Affairs with Dean Health Plan, Inc., Madison, Wis

Corresponding Author: Ms Close-Goedjen

The Milwaukee Patient Safety Collaborative: When safety trumps competition

Kathryn Kraft Leonhardt, MD, MPH

For the past few years, health care organizations have been striving to identify and implement patient safety strategies that will transform our health care system. The literature is rich with recommendations for patient safety, but limited in evidence-based strategies that demonstrate true success in reducing errors and improving outcomes. Often working in isolation from one another, organizations struggle to identify effective solutions to the safety problems inherent in our current systems of care.



Author Affiliations: Doctor Leonhardt is chair of the Milwaukee Patient Safety Collaborative, and is Patient Safety officer at Aurora Health Care

Corresponding Author: Kathryn K. Leonhardt, MD, MPH, Patient Safety Officer, Aurora Health Care 12500 W Bluemound Rd, Ste 301, Elm Grove, WI 53122; phone 262.787.2748; fax 262.787.2788; e-mail Kathryn.Leonhardt@aurora.org. The Milwaukee Patient Safety Collaborative is suppor

Boldly measuring performance in health care

Bradley L. Manning, Jr, MD

This is an exciting, some might say intimidating, time to practice medicine. As physicians today, we have an unprecedented opportunity to change the way we practice, to provide our patients with the best possible care and the best possible outcomes.



Author Affiliations: Doctor Manning is a plastic surgeon in Madison, Wis, and president of the Wisconsin Medical Society

Corresponding Author: Bradley L. Manning, Jr, MD

Health system transformation: Aligning incentives for high quality, efficient, and high value care

Susan Nedza, MD, MBA, FACEP

A number of factors have converged to focus attention on the need for a paradigm shift in how we view the relationship between the individual and the health care system. This shift requires that the Centers for Medicare and Medicaid Services (CMS) focus not only on sickness or chronic illnesses, but also focus on rewarding health promotion and prevention. CMS has embarked on an agency-wide effort to transform Medicare and Medicaid programs to support health care systems that are safe, effective, efficient, patient-centered, timely, and equitable. In order to achieve this vision, CMS is committed to transforming our programs so that physicians and others are rewarded for providing high-quality and efficient care based on the needs of the individual patient.



Author Affiliations: Doctor Nedza serves as the Chief Medical Officer, Region V for the Centers for Medicare and Medicaid Services

Corresponding Author: Susan Nedza, MD, MBA, FACEP

The Promise of “eHealth”

Helene Nelson

Wisconsin’s physicians are motivated to lead the nation in delivering safe, high-quality and efficient health care. The Board on eHealth Care Quality and Patient Safety—which includes 4 physician leaders appointed by the Governor—has proposed a 5-year plan to help achieve this goal through better use of health information technology and health information exchange. The eHealth Plan can save lives, improve the health status of the people of Wisconsin, and achieve a better return on investment in health care.



Author Affiliations: Helene Nelson is the secretary of the Wisconsin Department of Health and Family Services and a member of the Cabinet of Governor Jim Doyle. She serves as chair of the Governor’s eHealth Care Quality and Patient Safety Board

Corresponding Author: Helene Nelson 1 W Wilson St, Madison, WI 53701; phone 608.266.9662; e-mail NelsoH@dhfs.state.wi.us.

In Pursuit of Excellence: The CheckPoint Journey

Charles Shabino, MD; Dana Richardson, RN, MHA

In March 2004, the Wisconsin Hospital Association launched CheckPointsm (www.wicheckpoint.org) to provide consumers with information on the quality and safety of hospital care, and to assist hospitals and physicians in quality improvement activities. Since its inception, the state average achievement for all CheckPoint measures has increased or maintained a high initial rate, with 99% of Wisconsin hospitals voluntarily participating. The current state average is greater than 90% or 90 points (scale 0-100 points) on 11 of the original 19 measures. Over the next 2 years, additional measures will be added that will expand the scope of information available on CheckPoint.



Author Affiliations: Doctor Shabino is senior medical director, Wisconsin Hospital Association and chair of the Wisconsin Quality Steering Committee. Ms Richardson is vice president of quality initiatives, Wisconsin Hospital Association

Corresponding Author: Dana Richardson, Wisconsin Hospital Association, PO Box 259038, Madison, WI 53725; phone 608.268.1824; fax 608.274.8554; e-mail drichardson@wha.org

The Wisconsin Medical Society and the health care quality landscape

Susan M. Wiegmann, PhD; Cindy P. Helstad, PhD, RN

Rising health care costs and medical practice variations that cannot be explained by patient demographics, medical necessity, or better outcomes have led to initiatives aimed at improving clinical quality and consumer decision-making. Measurement and reporting of health care quality and cost of care are being used to drive performance improvement initiatives that are expanding from hospital to ambulatory settings aimed at physician level performance measurement. Employers (purchasers), insurance companies, and the government (payers) are the major drivers of these initiatives.



Author Affiliations: Wisconsin Medical Society

Corresponding Author: Drs Wiegmann and Helstad are with the Wisconsin Medical Society. Please address correspondence to: Cindy Helstad, PhD, RN, Wisconsin Medical Society, 330 E Lakeside St, Madison, WI 53575; phone 866.442.3800; fax 608.442.3802; e-mail cindyh@wismed.org.

Case Reports

Independent physicians collaborate to improve quality

Patricia A. Ruff, BS, MS; Dennis J. Saran, MD

Waukesha Elmbrook Health Care, S. C. (WEHC) represents over 490 independent primary and specialty care physicians in southeast Wisconsin and has been dedicated to providing quality care for over 23 years. A significant portion of WEHC’s network is comprised of small practices with 1-2 physicians. These smaller practices typically do not have the time or resources to focus on quality improvement and have a limited number of patients for specific quality monitoring. These small practices also have a limited number of patients from any single health plan, which doesn’t allow for statistically valid quality monitoring. WEHC facilitates collaboration by providing support, resources, and pooled data to generate statistically sound measurements of the improvement process.



Author Affiliations: Ms Ruff is the Executive Director of Waukesha Elmbrook Health Care S.C. Doctor Saran maintains a full-time pediatric practice at Pediatric Health Care, S.C. and serves as the Secretary and Medical Director for Waukesha Elmbrook Health Care, S.C.

Corresponding Author: For more information about WEHC go to www.wehc.net.

Your Practice

Index to Articles: 2006

Wisconsin Medical Journal

Index

Author Affiliations: Wisconsin Medical Journal

Corresponding Author: Wisconsin Medical Journal

The 100,000 Lives Campaign: Saving lives in Wisconsin and the nation

Jay A. Gold, MD, JD, MPH; Kay Simmons, MA

It is well known that some life-saving medical interventions remain underused. If such practices were employed whenever they were indicated, many lives could be saved. MetaStar has worked for years with Wisconsin physicians and health care professionals to increase the rates at which some of these interventions are offered. However, making changes 1 person or 1 hospital at a time is slow and fragmented, and patients continue to be harmed despite the best efforts of good, dedicated health professionals. That is why the Institute for Healthcare Improvement (IHI) and numerous national partners launched the 100,000 Lives Campaign nationwide on December 14, 2004.



Author Affiliations: Doctor Gold is senior vice president and principal clinical coordinator for MetaStar, Inc. Ms Simmons is vice president of communications. This material was prepared by MetaStar, Inc., the Quality Improvement Organization for Wisconsin, under a contract w

Corresponding Author: Jay A. Gold, MD, JD, MPH; Kay Simmons, MA

Five financial strategies to wrap up 2006

Debbie Oswald

The end of the year is the ideal time to take stock of your finances and make last-minute adjustments to maximize your tax savings for the year. Here are some strategies to help ensure you have a happy New Year.



Author Affiliations: Debbie Oswald is a financial consultant with SVA Planners, Inc., the registered investment advisory affiliate of Suby, Von Haden & Associates, S.C. For more information, contact Wisconsin Medical Society Insurance and Financial Services, Inc., at 866.442.

Corresponding Author: Debbie Oswald

Your Profession

Bringing a public health perspective to quality and patient safety

Robert N. Golden, MD

Five years ago, when the Wisconsin Medical Journal last featured the theme of quality and patient safety, my predecessor’s message in the Dean’s Corner focused on the efforts of the Madison Patient Safety Collaborative (MPSC), in which the University of Wisconsin School of Medicine and Public Health (SMPH) and UW Health are deeply involved. In the intervening years, this group has continued to work hard on many aspects of quality and patient safety in our community.



Author Affiliations: Dean, University of Wisconsin School of Medicine and Public Health


Corresponding Author: Wisconsin Medical Society 330 E. Lakeside St Madison, WI 53719

Your Society

A message to members about changes in our Wisconsin Medical Society

Terry L. Hankey, MD

We can do better! We have a wonderful, strong organization of physicians here in Wisconsin. In many ways, we are the model for other medical societies throughout the nation. But, as so often happens even in successful organizations, times change, people change and issues change, and without a major effort to keep up with the changes, the organizations fall behind.



Author Affiliations: Chair, Wisconsin Medical Society Governance Task Force


Corresponding Author: Chair, Wisconsin Medical Society Governance Task Force

Other

Proceedings from the 2006 Wisconsin Quality and Safety Forum

The Wisconsin Medical Society, the Wisconsin Hospital Association, and MetaStar

The Wisconsin Medical Society, the Wisconsin Hospital Association, and MetaStar partnered on the 2006 Wisconsin Quality and Safety Forum held October 16-17 in Stevens Point. A highlight of the forum was the showcase of quality and safety projects from health care organizations around the state. We are pleased to publish shortened versions of these projects in this issue of the Wisconsin Medical Journal.


Author Affiliations: The Wisconsin Medical Society, the Wisconsin Hospital Association, and MetaStar

Corresponding Author: The Wisconsin Medical Society, the Wisconsin Hospital Association, and MetaStar