Improve the health of the people of Wisconsin by supporting and strengthening physicians' ability to practice high-quality patient care in a changing environment.

Volume 105, Issue 8 (December 2006)

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Wisconsin Medical Journal
A look at health care quality and patient safety
(full text PDF)

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.

Letters to the Editor

Paul D Nelson, MD, AAFP, CMD
Right story, wrong conclusions
(full text PDF)

Matthew Solverson, MD
Response to stem cell debate
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Jane M. Stark, MD, MPH
Of creation and stem cells…the rest of the story
(full text PDF)

Original Research

Kathryn K. Leonhardt, MD, MPH; Deborah Bonin RHIA, CPHQ; Patti Pagel, RN, BSN
Partners in Safety: Implementing a Community-based Patient Safety Advisory Council
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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.

Kenneth W. Merkitch, MD; Charles W. Schauberger, MD, MS; Becky A. Fruechte, RN
Preventing Early-onset Group B Streptococcal Sepsis: Efforts to Measure and Improve Compliance with Guidelines
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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.

Richard G. Roberts, MD, JD; Donna Friedsam, MPH; John W. Beasley, MD; Cindy Helstad, PhD, RN; D. Paul Moberg, PhD
The State of Quality Reports: Comparing States by Their Rankings
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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.

Julie Bartels
The Wisconsin Health Information Organization
(full text PDF)

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.

Justin Endo, MD; Kendra Jacobsen, MS
Medication reconciliation in Wisconsin: Insights from a local initiative
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“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.

John Frey, III, MD
Crossing the quality creek
(full text PDF)

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.

Susan Gaard, RN, MS
Are we ready for the proactive patient?
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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.

Jay A. Gold, MD, JD, MPH; Kay Simmons, MA
MetaStar: Wisconsin’s Quality Improvement Organization
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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.

Cyril M. (“Kim”) Hetsko, MD
AMA Physician Consortium for Performance Improvement committed to quality
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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.

Jennifer Close-Goedjen, MS; Thomas Hirsch, MD, MS
Local pay-for-performance program progresses
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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.

Kathryn Kraft Leonhardt, MD, MPH
The Milwaukee Patient Safety Collaborative: When safety trumps competition
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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.

Bradley L. Manning, Jr, MD
Boldly measuring performance in health care
(full text PDF)

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.

Susan Nedza, MD, MBA, FACEP
Health system transformation: Aligning incentives for high quality, efficient, and high value care
(full text PDF)

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.

Helene Nelson
The Promise of “eHealth”
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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.

Charles Shabino, MD; Dana Richardson, RN, MHA
In Pursuit of Excellence: The CheckPoint Journey
(full text PDF)

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.

Susan M. Wiegmann, PhD; Cindy P. Helstad, PhD, RN
The Wisconsin Medical Society and the health care quality landscape
(full text PDF)

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.

Patricia A. Ruff, BS, MS; Dennis J. Saran, MD
Independent physicians collaborate to improve quality
(full text PDF)

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.

Your Practice

Wisconsin Medical Journal
Index to Articles: 2006
(full text PDF)

Jay A. Gold, MD, JD, MPH; Kay Simmons, MA
The 100,000 Lives Campaign: Saving lives in Wisconsin and the nation
(full text PDF)

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.

Debbie Oswald
Five financial strategies to wrap up 2006
(full text PDF)

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.

Your Profession

Robert N. Golden, MD
Bringing a public health perspective to quality and patient safety
(full text PDF)

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.

Your Society

Terry L. Hankey, MD
A message to members about changes in our Wisconsin Medical Society
(full text PDF)

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.


The Wisconsin Medical Society, the Wisconsin Hospital Association, and MetaStar
Proceedings from the 2006 Wisconsin Quality and Safety Forum
(full text PDF)

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.