The official journal of the National Association for Healthcare Quality

Diversion of Controlled Substances: A Catalyst for Change
Kathy Hulse, BSN RN CPHQ; Liz Edmundson, BSN RN; Robin Carroll, MS RD LD
Abstract: A quality improvement team was formed in response to a controlled substance diversion by an employee. The team’s objectives were to track controlled substances throughout the institution and to design a system that would eliminate inappropriate access to controlled substances without negatively affecting patient care. The team utilized flow charts, staff interviews, and auditing tools to identify weaknesses within the current system. Subcommittees were formed to evaluate access and to develop an education campaign. It is the institution’s responsibility to keep patients and staff safe by designing, implementing, and monitoring systems to appropriately control access to controlled substances.

Diabetes Preventive Care and Non-traumatic Lower Extremity Amputation Rates
Michael E. Moreland, MSW; Amy M. Kilbourne, PhD MPH; Joseph B. Engelhardt, PhD; Rajiv JAin, MD; Jian GAo, PhD; DAvid S. Macpherson, MD MPH; Ali F. Sonel, MD FACC FACP; Guibo Xing, PhD
Abstract: Clinical performance monitoring data on processes of care from a 3-year period were used to assess whether preventive foot care was associated with improved health outcomes in diabetes mellitus patients. Preventive foot care as well as sensory and pedal-pulse examinations were associated with reduced rates of lower extremity amputation. It is believed that an administrative focus, resource direction, and improvement in process monitoring will lead to better patient outcomes. External review measures can be used by administrators and clinicians to determine trends in quality of care and patient outcomes and to provide feedback on prevention efforts.

Pamela K. Scarrow, CPHQ
Abstract: Suzanne F. Delbanco, PhD MPH, is the first executive director of The Leapfrog Group, founded by the Business Roundtable. The Leapfrog Group’s goal is to mobilize employer purchasing power to initiate breakthrough improvements in the safety, quality, and overall value of healthcare for American consumers. The group’s growing consortium of more than 155 Fortune 500 companies and other large private and public healthcare purchasers provides health benefits to more than 34 million Americans; these companies spend more than $62 billion on healthcare annually. Dr. Delbanco is a member of the National Committee for Quality Assurance Purchaser Advisory Council and a board member of Bridges to Excellence. Before joining The Leapfrog Group, she was a senior manager at the Pacific Business Group on Health (PBGH), where she worked on the quality team. Prior to joining PBGH, she worked on reproductive health policy and the changing healthcare marketplace initiative at the Henry J. Kaiser Family Foundation. She has also consulted on health insurance coverage in the temporary employment industry and on the first statewide survey in California of MediCal beneficiaries, and worked as a community liaison for Kaiser Permanente during the establishment of one of California’s first County Organized Health Systems. She holds a PhD in public policy from the Goldman School of Public Policy and a MPH from the School of Public Health at the University of California, Berkeley.

Breast Cancer Care 
William M. Butler, MD FACP; Joan E. Cunningham, PhD; Douglas Bull, MD; Tommy Cupples, MD; Paul Guerry, MD; James C. Reynolds, MD; C. Alden Sweatman MD FACS
Abstract: A community hospital-based program was developed to improve breast cancer care in the community. A consensus was developed for what should be optimal care; a database was established to document the care being delivered in the community; and the data were analyzed to document changes in practice patterns over time. The major clinical benefits to patients included a significant improvement in needle biopsy rates, decreased utilization of second operative procedures, increased breast conservation surgery, conformity to guidelines for adjuvant chemotherapy administration, and a sizable increase in discovery of small breast cancers by screening mammography.

Quality-of-Care Review of Optometric Records
Mort Soroka, PhD; Lauren Feldman, MPA; Trafford Crump, MPA
Abstract: As managed care organizations (MCOs) move into the realm of vision care, the issue of quality measurement has grown in relevance. This article assesses the inter-rater reliability of a medical record review instrument of a managed vision care plan. This study attempts to duplicate the continuous quality improvement initiative set forth by these MCOs. Twenty examiners, using the review instrument developed by the respective MCO, independently rated the records of 29 patients. Although the reviewers rated more than 86% of all records similarly, statistical analysis and further investigation deemed the instrument inconsistent and thus unreliable in its measurement.

Using the Quality Improvement Committee to Establish Accountability and Yield Results
Jon Beaty, LCSW CPHQ; Christy L. Beaudin, PhD LCSW CPHQ FNAHQ
Abstract: Healthcare organizations can respond effectively and efficiently to the needs of consumers and the demands of customers, accreditation agencies, and regulators by implementing a comprehensive quality improvement (QI) program. Using committees with cross-departmental representation, the QI program can facilitate review, analysis, prioritization of opportunities for improvement, and the facilitation of positive change. This article provides an example of how a managed behavioral healthcare organization responded to consumer needs and marketplace demands by using such an approach.

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