The state of quality reports: comparing states by their rankings.

Background: 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.

The Wisconsin Medical Society diabetes study.

Problem: Diabetes is a chronic and costly disease affecting approximately 330,000 people in Wisconsin. This study examined the association between use of clinical practice guidelines and outcomes of care.

Methods: Fourteen physicians from 3 diverse sites volunteered to recruit their adult patients with type 1 and type 2 diabetes who were in continuous care in 1999 and 2000.

Treatment of acute low back pain in Wisconsin: results of the State Medical Society's Medical Outcomes Research Project.

Background: Acute low back pain is the fifth most common reason for physician visits. Multiple treatment options are available, but not all physicians and patients are satisfied with the results. This study evaluated treatment outcomes from patients' perspectives using standardized measures.

Pediatric Asthma Study of the State Medical Society of Wisconsin.

Problem: Asthma management should follow evidence-based national guidelines. We compared patient self-reports of usual care to clinical practice guidelines.

Methods: Cross-sectional survey of parents of 245 children age 2-14 years with asthma seen by physicians at 13 practices in Wisconsin.

SMS Medical Outcomes Research Project Asthma Outcomes Study. Provider education the next step.

Since the initial meeting of the Asthma Study Group in the summer of 1996, the group worked with MORP staff to develop an outcomes instrument, define a study population, survey more than 800 adults with the diagnosis of asthma, and report the survey results back to the providers involved with those patients. After reviewing the survey results, the group developed an Asthma Toolkit aimed at providing reference materials for physicians and their staff and also useable materials for their patients with asthma. The Asthma Toolkit was produced through the efforts of the study group, the SMS MORP staff and the SMS Marketing and Communications Department.

Impact of generalized social anxiety disorder in managed care.

Objective: The authors determined the costs associated with generalized social anxiety disorder in a managed care setting.

Method: A three-phase mail and telephone survey was conducted from July to October 1998 in two outpatient clinics of a large health maintenance organization (HMO). The survey assessed direct costs, indirect costs, health-related quality of life, and clinical severity associated with generalized social anxiety disorder, both alone and with comorbid psychopathology.

Cost-effectiveness of systematic depression treatment for high utilizers of general medical care.

Background: Expanding access to high-quality depression treatment will depend on the balance of incremental benefits and costs. We examine the incremental cost-effectiveness of an organized depression management program for high utilizers of medical care.

Methods: Computerized records at 3 health maintenance organizations were used to identify adult patients with outpatient medical visit rates above the 85th percentile for 2 consecutive years.

Randomized trial of a depression management program in high utilizers of medical care.

Background: High utilizers of nonpsychiatric health care services have disproportionally high rates of undiagnosed or undertreated depression.

Objective: To determine the impact of offering a systematic primary care-based depression treatment program to depressed "high utilizers" not in active treatment.

Design: Randomized clinical trial.

Depression among high utilizers of medical care.

Objective: To determine the prevalence of unrecognized or unsuccessfully treated depression among high utilizers of medical care, and to describe the relation between depression, medical comorbidities, and resource utilization.

Design: Survey.

Setting: Three HMOs located in different geographic regions of the United States.

The total costs of illness: a metric for health care reform.

Systems thinking is a fundamental element of quality management and should be a fundamental element of health care reform. An implication of systems thinking is that one aim of health care should be to minimize the total costs of illness, not simply the direct medical expenditures. If we are to continue to improve health care over time, we should measure its impact on the total costs of illness to the patient, family, employer, and society.