Volume 14, Issue 2
Spring/Summer 2002
|
|
Center News
by Joan DeClaire
Report from MacColl Institute features chronic-care successes
A report on better management of chronic disease—developed and edited
by staff from the MacColl Institute for Healthcare Innovation at Group
Health Center for Health Studies—was released May 16 at a meeting hosted by the
Institute of Medicine at the National Academy of Sciences in Washington,
D.C.
“Curing the System: Stories of Change in Chronic Illness Care”
chronicles the experiences of 12 very different organizations that have
redesigned systems to provide better care to patients with diabetes,
asthma, heart failure, depression, and other chronic illnesses. Included
in the report are two Seattle organizations—Seattle's Polyclinic and the
Senior Wellness Project, part of Senior Services of Seattle/King County,
Washington.
The changes these institutions made were based on the “Chronic Care
Model”—a model of care that was developed and tested at Group Health
by the MacColl Institute. The Institute staff members are now
disseminating this work as part of Improving Chronic Illness Care (ICIC),
a $25 million Robert Wood Johnson Foundation project housed at Group
Health. Experts believe that if these changes are adopted widely, they
could dramatically improve quality of care and control costs of chronic
disease care nationwide.
The work of ICIC is being disseminated nationally through initiatives
sponsored by the National Coalition on Health Care (NCHC), the nation's
largest alliance to improve the health care system, and the Institute for
Healthcare Improvement, an independent non-profit education and research
organization fostering quality improvement.
The colorful 40-page report released in May uses a magazine-style format
to profile organizations using the Chronic Care Model and its six
components: 1) a supportive health care organization; 2) delivery system
design; 3) decision support; 4) clinical information systems; 5) patient
self-management; and 6) community resources.
Printed copies can be obtained by calling the MacColl Institute at
206-287-2704 or sending an e-mail to actinfo@improvingchroniccare.org.
Top
Greg Simon wins national mental-health research awards
Greg Simon, MD, a Group Health Cooperative psychiatrist and Center for
Health Studies investigator, received two prestigious awards at the
American Psychiatric Association’s (APA) Annual Meeting in Philadelphia
on May 18.
Simon received the 2002 American Psychiatric Institute for Research and
Education/GlaxoSmithKline Senior Scholar Award, which is given in
recognition of outstanding contributions to the field of mental health
services research. He was also granted the “2002 Welcome Back Award”
sponsored by Eli Lilly and Company for his exceptional achievements in
improving the treatment of depression.
Much of Simon’s research has centered on identifying problems in
administering depression treatment and then implementing targeted
solutions to improve results. For example, his research has revealed that
in many clinical settings, patients are prescribed inappropriate doses of
medication, stop medication too soon, or don’t receive adequate
follow-up.
To solve these problems, Simon has developed systematic programs to
provide ongoing patient care after an initial diagnosis of depression.
Currently, he is researching the benefits of providing medication
monitoring, support, and counseling over the telephone as a way to make
talk therapy more accessible.
Simon’s research has been published in major medical journals,
influencing depression care worldwide. Within Group Health, he is
recognized for helping to design improved processes for depression care at
the primary care level.
“Greg is the sort of physician/scientist hybrid who comes along once in
a lifetime,” says Michael Quirk, PhD, director of Group Health’s
Behavioral Health Services. “He develops powerful new ideas, translates
them into research proposals that are funded and that are eventually
translated into improved care here at Group Health.”
Simon’s work was recognized in a resolution passed by the Washington
State Senate on March 12. Senator Pat Thibaudeau, Chair of the Senate
Health & Long Term Care Committee, introduced the resolution to
congratulate Simon for receiving the Welcome Back Award and to thank him
for “his advocacy and compassion” in addressing mental health issues.
Top
Study links gene to success of a hypertension treatment
University of Washington researchers affiliated with Group Health
Center for Health Studies (CHS) recently found that people with
hypertension who have a particular genetic variant were twice as likely to
avoid heart attacks and strokes if they took a diuretic medication.
The case-control study, conducted at Group Health, was published in the
April 3 edition of the Journal of the American Medical Association.
About 50 million Americans have high blood pressure; about 25 million take
medication for it.
"If these findings are confirmed in other studies, screening for
the adducin variant could identify hypertensive patients especially likely
to benefit from low-dose diuretic therapy," says Dr. Bruce M. Psaty,
a professor of medicine, epidemiology, and health services and co-director
of the UW's Cardiovascular Health Research Unit, and an affiliate
investigator at CHS.
The test for the adducin variant is now a research tool, and Psaty says
it’s not appropriate for clinical testing. Additional studies need to
define the risks and benefits of genetic testing.
Psaty and co-authors studied the alpha-adducin (pronounced A-dew-sin)
gene in the case-control study. Adducin is a protein linked to the inner
surface of cell membranes, and one adducin genetic variant (Gly460Trp) is
known to increase sodium retention by the kidney. High-salt diets, as well
as sodium retention, are one cause of high blood pressure.
Diuretics are currently recommended as first-line drug therapy for
hypertension by the U.S. Joint National Committee on the Prevention,
Detection, Evaluation and Treatment of High Blood Pressure. Diuretics
lower blood pressure by making the kidney excrete sodium. The idea for the
study arose from the observation that diuretics and the adducin variant
have opposing effects on sodium handling by the kidney.
This study was funded by grants from the National Heart, Lung and Blood
Institute and the American Heart Association.
Top
Ed Wagner leads draft of IOM report on health consequences for the
uninsured
Americans without health insurance are more likely to have poorer
health and die prematurely than those with insurance, according to a
report released May 21 from the National Academies' Institute of Medicine.
The report’s authors—led by Ed Wagner, MD, director of the MacColl
Institute for Healthcare Innovation at Group Health Center for Health
Studies—concluded
that uninsured patients with colon or breast cancer face up to a 50
percent greater chance of dying from these conditions than patients with
private coverage. Uninsured victims of trauma also are more likely to die
from their injuries. Being uninsured for even a year appears to lower a
person's general health.
“Too often uninsured Americans don’t gain access to care until their
medical problems are severe,” says Wagner, “When uninsured adults do
get care, they’re frequently unable to afford ongoing treatment of their
chronic health problems, including needed specialty care or effective
medications.”
Differences in access to effective care are most striking for people with
chronic illnesses, including cancer, heart disease, diabetes, and HIV
infection—conditions for which early diagnosis and effective treatment
can profoundly improve quality of life and survival, Wagner adds.
The report focused on the roughly 30 million—one in seven—working-age
Americans without health insurance.
The full report, entitled Care Without Coverage: Too Little, Too Late,
is available at www.national-academies.org.
It is the second of six that will constitute an extensive review of
research into who lacks health insurance and why. The series will also
examine the personal, social, and economic consequences of having no
insurance. The committee's final report will identify strategies for
addressing the problems of the uninsured in the United States. The ongoing
study is sponsored by the Robert Wood Johnson Foundation.
Top
Proper patient positioning may improve breast cancer detection,
study finds
Proper positioning during mammograms makes a significant difference in
doctors’ ability to find breast cancer, according to a recent study led
by Stephen Taplin, MD, senior investigator at Group Health Center for
Health Studies (CHS).
The study—the first of its kind—was published in the April 2002 issue
of the American Journal of Roentgenology, a major medical journal
for radiologists. Researchers found that the chances of missing a cancer
during mammography are more than twice as high when poor positioning
occurs. Proper positioning allows visualization of the muscle behind the
breast, the entire breast, and the nipple.
Moreover, Taplin and colleagues found that a woman’s position during the
screening may have more impact in detecting breast cancer than other
measures of image quality, such as breast compression, radiation exposure,
and even the sharpness and contrast of the mammography film.
“Proper positioning depends on cooperation between the technologist and
the patient during the screening,” explains Taplin. “When the
technologist asks a woman to lean in so more of her breast can be seen on
the film, it really does make a difference.”
Breast positioning has improved since the study data was collected (1988–1993), according to Edward Sickles, MD, professor of radiology at
the University of California San Francisco School of Medicine. “We have
learned more effective positioning maneuvers, and these have been widely
taught over the past several years,” Sickles says. In fact, federal
guidelines passed in the mid-1990s now call for more education about
breast positioning.
“Still, the field has never developed specific criteria that measure
whether positioning is being done correctly,” says Taplin. “This study
came up with such criteria and then determined how many missed cancers
were associated with mammograms where the criteria were not met. This had
not been done before.”
Taplin emphasizes that the study shows only a correlation between
positioning and cancers missed. There’s no evidence of a direct cause
and effect. Still, he believes that more training for technologists may
improve outcomes.
“One implication of this study is that people in health care need to
consider how well they are using the technology and what they can do to
improve it,” he added. “We won’t get the outcomes we want unless we
optimize the technology.”
The CHS study should encourage further research into the link between
breast positioning and clinical outcomes, according to Stephen A. Feig, MD, of Mount Sinai School of Medicine’s Department of Radiology. In a
commentary that accompanies the article, Feig wrote that the study should
also “encourage efforts to further ensure proper image quality in
(radiology) practices and around our nation.”
The study included 152 women who were diagnosed with breast cancer within
two years after a negative mammogram. When the women’s mammogram films
were reviewed and scored according to a measurement tool developed for the
study, the researchers found that women with missed cancers were more than
twice as likely to have mammograms that did not meet the new positioning
criteria. Problems with other quality measures—such as breast
compression, radiation exposure, and image contrast—were rare.
The study is part of a large breast-cancer screening research program at
Group Health, which is funded by a five-year, $4.3 million grant from the
National Cancer Institute. The study was conducted by scientists from CHS,
the FDA, the University of Washington’s Department of Family Medicine,
and the Fred Hutchinson Cancer Research Center.
Top |
|
|
search
