Cost implications to health care payers of improving glucose management among adults with type 2 diabetes.

Objective. To assess the cost implications to payers of improving glucose management among adults with type 2 diabetes. Data Source/Study Setting.

Cost implications of improving blood pressure management among U.S. adults.

Objective: To examine the cost-effectiveness of improving blood pressure management from the payer perspective.

Data Source/study Setting: Medical record data for 4,500 U.S.

The relationship between multimorbidity and patients' ratings of communication.

Background: The growing interest in pay-for-performance and other quality improvement programs has generated concerns about potential performance measurement penalties for providers who care for more complex patients, such as patients with more chronic conditions. Few data are available on how multimorbidity affects common performance metrics.

Objective: To examine the relationship between multimorbidity and patients' ratings of communication, a common performance metric.

Something in the Blood? A history of the autoimmune hypothesis regarding myasthenia gravis.

From the first descriptions of myasthenia gravis (MG) in the late nineteenth century, speculation about the cause of MG has centered on the possibility of some curare-like factor circulating in the blood. The transfer of transient myasthenic symptoms from a myasthenic mother to her newborn reinforced this speculation. However, it was not until 1960, when William Nastuk and coworkers noted that serum complement correlated with the clinical course in MG, and Arthur Strauss and colleagues described antiskeletal muscle antibodies in the sera of some MG patients, that a paradigm shift occurred from prior exclusive focus on the neuromuscular junction to a broader consideration of the relevance of immunological mechanisms in myasthenia.

The quality of ambulatory care delivered to children in the United States.

Background: Little is known about the magnitude of deficits in the quality of care delivered to children, since comprehensive studies have been lacking.

Methods: We assessed the extent to which care processes recommended for pediatric outpatients are delivered. Quality indicators were developed with the use of the RAND-UCLA modified Delphi method.

Can a chronic care model collaborative reduce heart disease risk in patients with diabetes?

Background: There is a need to identify effective practical interventions to decrease cardiovascular disease risk in patients with diabetes.

Objective: We examine the impact of participation in a collaborative implementing the chronic care model (CCM) on the reduction of cardiovascular disease risk in patients with diabetes.

Design: Controlled pre- and postintervention study.

The quality of obstructive lung disease care for adults in the United States as measured by adherence to recommended processes.

Background: The extent to which patients with obstructive lung disease receive recommended processes of care is largely unknown. We assessed the quality of care delivered to a national sample of the US population.

Methods: We extracted medical records for 2 prior years from consenting participants in a random telephone survey in 12 communities and measured the quality of care provided with 45 explicit, process-based quality indicators for asthma and COPD developed using the modified Delphi expert panel methodology.

The quality of pharmacologic care for adults in the United States.

Background: Despite rising annual expenditures for prescription drugs, little systematic information is available concerning the quality of pharmacologic care for adults in the United States. We evaluated how frequently appropriate pharmacologic care is ordered in a national sample of U.S.

Who is at greatest risk for receiving poor-quality health care?

Background: American adults frequently do not receive recommended health care. The extent to which the quality of health care varies among sociodemographic groups is unknown.

Methods: We used data from medical records and telephone interviews of a random sample of people living in 12 communities to assess the quality of care received by those who had made at least one visit to a health care provider during the previous two years.

Differences in education, knowledge, self-management activities, and health outcomes for patients with heart failure cared for under the chronic disease model: the improving chronic illness care evaluation.

Background: The objective of this study was to determine whether participation in a quality improvement (QI) collaborative for heart failure (HF) was associated with better interpersonal aspects of care and health outcomes.

Methods And Results: We conducted a cross-sectional telephone survey of patients in 6 organizations who participated in a QI collaborative for HF (participants, n = 387) and 6 comparable control organizations (controls, n = 414) and measured provider-patient communication, education received, knowledge of HF, self-management behaviors, satisfaction, and quality of life. The participant group patients were more likely to report their doctor and nurse discussed treatment options and reviewed self-management (P < .

How electric fish became sources of acetylcholine receptor.

The purpose of this communication is to describe the historical steps by which fish electric organs were eventually determined to be modified motor endplates and therefore a plentiful source of acetylcholine receptor. A brief description of the early history of electric fish concerned with the nature of the discharge will provide the background for studies of the anatomy, embryology, and physiology of electric organs in the nineteenth century that suggested that electric organs were derived from modified muscles. In the twentieth century, transmission between nerve and electric organ was shown to be cholinergic, and because of their size and abundant cholinergic nerve supply, the electric organs of Torpedo and Electrophorus were chosen by biochemists and molecular biologists as possible rich sources of acetylcholine receptor.

Does the collaborative model improve care for chronic heart failure?

Background: Organizationally based, disease-targeted collaborative quality improvement efforts are widely applied but have not been subject to rigorous evaluation. We evaluated the effects of the Institute of Healthcare Improvement's Breakthrough Series (IHI BTS) on quality of care for chronic heart failure (CHF).

Research Design: We conducted a quasi-experiment in 4 organizations participating in the IHI BTS for CHF in 1999-2000 and 4 comparable control organizations.

Evaluation of a quality improvement collaborative in asthma care: does it improve processes and outcomes of care?

Purpose: We wanted to examine whether a collaborative to improve asthma care influences process and outcomes of care in asthmatic adults.

Method: We undertook a preintervention-postintervention evaluation of 185 patients in 6 intervention clinics and 3 matched control sites that participated in the Institute for Healthcare Improvement Breakthrough Series (BTS) Collaborative for asthma care. The intervention consisted of 3, 2-day educational sessions for teams dispatched by participating sites, which were followed by 3 action periods during the course of a year.

Measuring the effectiveness of a collaborative for quality improvement in pediatric asthma care: does implementing the chronic care model improve processes and outcomes of care?

Objective: To examine whether a collaborative to improve pediatric asthma care positively influenced processes and outcomes of that care.

Methods: Medical record abstractions and patient/parent interviews were used to make pre- and postintervention comparisons of patients at 9 sites that participated in the evaluation of a Breakthrough Series (BTS) collaborative for asthma care with patients at 4 matched control sites.

Setting: Thirteen primary care clinics.

Comparison of quality of care for patients in the Veterans Health Administration and patients in a national sample.

Background: The Veterans Health Administration (VHA) has introduced an integrated electronic medical record, performance measurement, and other system changes directed at improving care. Recent comparisons with other delivery systems have been limited to a small set of indicators.

Objective: To compare the quality of VHA care with that of care in a national sample by using a comprehensive quality-of-care measure.

A history of treatments for myasthenia gravis.

Much of the improvement in the treatment of myasthenia gravis (MG) over the past 125 years can be attributed to the effectiveness of general medical measures such as advances in respiratory care and the discovery of antibiotics. Although MG became the model of an antibody-mediated autoimmune disease in the 1970s (the most documented antigen being the muscle acetylcholine receptor at the neuromuscular junction), the pathogenesis of MG has not been the rationale for most treatments found to be useful for this disease. The serendipitous benefit of anticholinesterases for MG in the 1930s subsequently focused attention on the neuromuscular junction.

Profiling the quality of care in twelve communities: results from the CQI study.

Health care quality falls far short of its potential nationally. Because care is delivered locally, improvement strategies should be tailored to community needs. This analysis from the Community Quality Index (CQI) study reports on a comprehensive examination of how effectively care is delivered in twelve metropolitan areas.

Clinical evaluation and management of myasthenia gravis.

Myasthenia gravis (MG) is a syndrome of fluctuating skeletal muscle weakness that worsens with use and improves with rest. Eye, facial, oropharyngeal, axial, and limb muscles may be involved in varying combinations and degrees of severity. Its etiology is heterogeneous, divided initially between those rare congenital myasthenic syndromes, which are genetic, and the bulk of MG, which is acquired and autoimmune.

The role of Herman Hoppe of Cincinnati in the initial clinical recognition of myasthenia gravis.

One of the earliest papers describing a case of what came to be known as myasthenia gravis was written in 1892 in the German language by an American, Herman Hoppe, who at the time was an assistant in the Berlin polyclinic of the prominent German neurologist. Hermann Oppenheim. At Oppenheim's instigation, Hoppe published the pathology of a case that Oppenheim had diagnosed during life; he collected all the reported similar cases and tried to establish a symptom-complex, for which he was given credit in Oppenheim's great neurology textbook of 1894.

The quality of health care delivered to adults in the United States.

Background: We have little systematic information about the extent to which standard processes involved in health care--a key element of quality--are delivered in the United States.

Methods: We telephoned a random sample of adults living in 12 metropolitan areas in the United States and asked them about selected health care experiences. We also received written consent to copy their medical records for the most recent two-year period and used this information to evaluate performance on 439 indicators of quality of care for 30 acute and chronic conditions as well as preventive care.

Quality of health care for women: a demonstration of the quality assessment tools system.

Background: Consumers, purchasers, and regulators are seeking information on quality for a variety of purposes. To address these demands, methods are required that are flexible in meeting the information needs of different audiences.

Objectives: To test a new clinically detailed, comprehensive approach to quality measurement called Quality Assessment (QA) Tools.

Novel delta subunit mutation in slow-channel syndrome causes severe weakness by novel mechanisms.

We investigated the basis for a novel form of the slow-channel congenital myasthenic syndrome presenting in infancy in a single individual as progressive weakness and impaired neuromuscular transmission without overt degeneration of the motor endplate. Prolonged low-amplitude synaptic currents in biopsied anconeus muscle at 9 years of age suggested a kinetic disorder of the muscle acetylcholine receptor. Ultrastructural studies at 16 months, at 9 years, and at 15 years of age showed none of the typical degenerative changes of the endplate associated with the slow-channel congenital myasthenic syndrome, and acetylcholine receptor numbers were not significantly reduced.