Clinical decision support directed to primary care patients and providers reduces cardiovascular risk: a randomized trial.

Objective: To test the hypothesis that use of a clinical decision support (CDS) system in a primary care setting can reduce cardiovascular (CV) risk in patients.

Materials And Methods: Twenty primary care clinics were randomly assigned to usual care (UC) or CDS. For CDS clinic patients identified algorithmically with high CV risk, rooming staff were prompted by the electronic health record (EHR) to print CDS that identified evidence-based treatment options for lipid, blood pressure, weight, tobacco, or aspirin management and prioritized them based on potential benefit to the patient.

Educating resident physicians using virtual case-based simulation improves diabetes management: a randomized controlled trial.

Purpose: To test a virtual case-based Simulated Diabetes Education intervention (SimDE) developed to teach primary care residents how to manage diabetes.

Method: Nineteen primary care residency programs, with 341 volunteer residents in all postgraduate years (PGY), were randomly assigned to a SimDE intervention group or control group (CG). The Web-based interactive educational intervention used computerized virtual patients who responded to provider actions through programmed simulation models.

Using simulation technology to teach diabetes care management skills to resident physicians.

Background: Simulation is widely used to teach medical procedures. Our goal was to develop and implement an innovative virtual model to teach resident physicians the cognitive skills of type 1 and type 2 diabetes management.

Methods: A diabetes educational activity was developed consisting of (a) a curriculum using 18 explicit virtual cases, (b) a web-based interactive interface, (c) a simulation model to calculate physiologic outcomes of resident actions, and (d) a library of programmed feedback to critique and guide resident actions between virtual encounters.

Voluntary reporting of health care personnel seasonal influenza vaccination rates and the impact of universal policies in Illinois hospitals.

Objective: In 2009, voluntary public reporting of hospital health care personnel (HCP) vaccination rates began in Illinois. We describe our experience over 3 influenza seasons and examine the impact universal policies have had on performance.

Methods: A secure website was used to report monthly HCP vaccination rates by each participating hospital.

Cost-effectiveness of an electronic medical record based clinical decision support system.

Background And Objective: Medical groups have invested billions of dollars in electronic medical records (EMRs), but few studies have examined the cost-effectiveness of EMR-based clinical decision support (CDS). This study examined the cost-effectiveness of EMR-based CDS for adults with diabetes from the perspective of the health care system.

Data Sources/setting: Clinical outcome and cost data from a randomized clinical trial of EMR-based CDS were used as inputs into a diabetes simulation model.

Impact of electronic health record clinical decision support on diabetes care: a randomized trial.

Purpose: We wanted to assess the impact of an electronic health record-based diabetes clinical decision support system on control of hemoglobin A(1c) (glycated hemoglobin), blood pressure, and low-density lipoprotein (LDL) cholesterol levels in adults with diabetes.

Methods: We conducted a clinic-randomized trial conducted from October 2006 to May 2007 in Minnesota. Included were 11 clinics with 41 consenting primary care physicians and the physicians' 2,556 patients with diabetes.

Leveraging improvement in quality and value in health care through a clinical performance measure framework: a recommendation of the American College of Physicians.

Policy maker efforts to evaluate the quality and costs of health care have stimulated a proliferation of disparate performance measures. This cacophony of performance measures creates confusion over which measures are applicable at which level of the health care system, limiting their effective application for accountability and improvements in patient care. The American College of Physicians (ACP) has created a clinical performance measurement framework to provide direction to policy makers and measure developers for future performance measure development and application.

Diabetes care quality: insurance, health plan, and physician group contributions.

Objective: To study the relative contributions of insurance product (commercial, Medicaid, Medicare), health plan, and physician group to quality of diabetes care.

Study Design: Cross-sectional observational study using data reported by Minnesota Community Measurement (MNCM) on care provided in 2005.

Methods: Individual performance rates for glycosylated hemoglobin (A1C) level <7%, lowdensity lipoprotein cholesterol (LDL-C) level <100 mg/dL, blood pressure <30/80 mm Hg, documented tobacco-free status, and aspirin use, as well as an all-or-none composite measure (Optimal Diabetes Care), were obtained from MNCM for 57 physician groups.

Multifunctional prenylated peptides for live cell analysis.

Protein prenylation is a common post-translational modification present in eukaryotic cells. Many key proteins involved in signal transduction pathways are prenylated, and inhibition of prenylation can be useful as a therapeutic intervention. While significant progress has been made in understanding protein prenylation in vitro, we have been interested in studying this process in living cells, including the question of where prenylated molecules localize.

The QUEST for quality: what are medical groups doing about it?

Background: It is important to know whether medical groups have quality improvement (QI) priorities, approaches, activities, and congruence that will allow them to achieve major improvements in quality of care.

Methods: Simultaneous surveys were sent to medical and administrative leaders of 18 medical groups, 84 of their constituent clinics, and their primary care physicians providing the majority of the primary care in the Minneapolis/St. Paul metropolitan area.

Making quality measurement work.

Minnesota's medical groups and health plans are working together to continue the tradition of health care excellence in Minnesota. The collaborative approach of the Minnesota Community Measurement Project will provide Minnesota medical practices with better quality-of-care information than has previously been available.

Paying for quality improvement: compliance with tobacco cessation guidelines.

Background: Identification and treatment of routine tobacco use in medical practice is an effective intervention but is not used consistently. A study was conducted at HealthPartners, a large network-model health plan in Minnesota, to determine the effect of an outcomes recognition strategy that involved bonus funds and the rates at which network physicians document that tobacco users are identified and advised to quit.

Methods: Audits of 14,489 ambulatory patient records from 19-20 medical groups were conducted to determine the proportion of charts from each medical group that demonstrated identification of smoking status and counseling to encourage quitting at the most recent office visit in each year.

Population-based incidence of pertussis among adolescents and adults, Minnesota, 1995-1996.

To estimate the incidence of pertussis, a prospective study was done among members of a managed care organization in Minneapolis/St. Paul, Minnesota. Of 212 patients 10-49 years old enrolled from January 1995 through December 1996, 8 were found to be culture positive, 10 were found to be positive by polymerase chain reaction assay, 13 had a > or =2-fold increase in IgG or IgA to pertussis toxin (PT), and 18 had IgG to PT in a single serum specimen > or =3 SD above the mean of an age-matched control group.

Failure of a continuous quality improvement intervention to increase the delivery of preventive services. A randomized trial.

Context: Although there has been enormous interest in continuous quality improvement (CQI) as a measure to improve health care, this enthusiasm is based largely on its apparent success in business rather than formal evaluations in health care.

Objective: To determine whether a managed care organization can increase delivery of eight clinical preventive services by using CQI.

Design: Primary care clinics were randomly assigned to improve delivery of preventive services with CQI (intervention group) or to provide usual care (control group).

Clinician satisfaction with a preventive services implementation trial. The IMPROVE project.

Object: To discover how attempts to increase the delivery of preventive services affect clinician satisfaction.

Methods: The IMPROVE project was a randomized clinical trial conducted in 44 clinics in and around Minneapolis-St. Paul, Minnesota.

Performance failure of an evidence-based upper respiratory infection clinical guideline.

Background: We evaluated an upper respiratory infection (URI) clinical guideline to determine if it would favorably affect the quality and cost of care in a health maintenance organization.

Methods: Patients with URI symptoms contacting 4 primary care practices before and after guideline implementation were compared to ascertain what proportion of all patients with respiratory symptoms were eligible for treatment in accordance with the URI guideline; what proportion of eligible patients were managed without an office visit; and what proportion of eligible patients were treated with antibiotics, before and after guideline implementation.

Results: A total of 3163 patients with respiratory symptoms were identified.

The case of the missing clinical preventive services systems.

Objective: To examine the presence and comprehensiveness of organized processes and systems in a sample of primary care clinics shown to have high variation in rates of providing preventive services.

Design: Survey study.

Setting: 44 primary care clinics recruited for a scientific trial of a quality improvement intervention to improve preventive services.

IMPROVE: bridge over troubled waters.

Background: The original collaborative project was described in a 1995 Journal article titled "Competing HMOs Collaborate to Improve Preventive Services." IMPROVE (IMproving PRevention through Organization, Vision, and Empowerment) was a large randomized controlled trial using continuous quality improvement to implement clinical systems to improve the delivery of adult preventive services in primary care settings. The project was funded by the Agency for Health Care Policy and Research and initiated as a collaboration between two health maintenance organizations (HMOs) in the Twin Cities: Health Partners and Blue Plus.

Genital tract tuberculosis with peritoneal involvement: MR appearance.

The MR appearance of a case of genital tract tuberculosis is reported. The finding of a large amount of loculated fluid containing septations and debris on ultrasound along with bilateral hydropic fallopian tubes and a thickened omentum on MRI permitted the diagnosis to be suggested preoperatively. With increasing prevalence, such unusual manifestations of tuberculosis will be seen more frequently.

Mechanism of action and impact of a cystitis clinical practice guideline on outcomes and costs of care in an HMO.

Background: A study was conducted in 1995 at five primary care clinics of a staff-model health maintenance organization in the Midwest to assess the impact of a cystitis clinical guideline and to help elucidate the guideline implementation process.

Methodology: Two hundred one eligible women with uncomplicated cystitis were treated in a three-month period before the guideline, and 241 similar cases were treated in a three-month period after the guideline. Nursing supervisors and clinic managers at each clinic were interviewed about how the cystitis guideline was implemented at each clinic.