Posts Tagged ‘health care’

Kaiser Permanente and UC enjoy common ground over decades

posted on October 3, 2013

By Lincoln Cushing, Heritage writer

Kaiser Permanente Marching Song

Jack Chapman, Kaiser Permanente Northern California Region’s director of education, adapted UC’s “Big C” fight song in 1972 to apply to the Health Plan.

Kaiser Permanente and the University of California are two major California-based institutions that share a long history of partnership. The collaboration started right after World War II with UC securing Health Plan coverage for its employees beginning in 1945, the year the plan opened to the public.

From the beginning, Permanente physicians joined UC for many medical research projects, and over the decades many have taken on professorships at UC campuses in Northern and Southern California. By all accounts, the partnership has been a fruitful one.

Professor touts KP care

A 1949 feature story in the Kaiser Permanente member newsletter Planning for Health pointed out that the University of California was the Health Plan’s fourth largest group, starting in 1945 with 59 members and reaching 1,961 members by 1949.[i]

The article included an interview with electrical engineering professor Charles F. Dalziel and his wife, who were early members of the university plan.

“During much of the period the family have been members of the group, Mrs. Dalziel has had many opportunities to evaluate the Plan in action. Like so many otherwise healthy children, their charming daughter, Isabelle, aged 8, is allergic.

“Mrs. Dalziel is enthusiastic in her comments on the results Permanente doctors have achieved in determining the child’s allergies and combating them,” the interviewer wrote.

Permanente educator adapts UC fight song

In 1972, Kaiser Permanente’s Jack Chapman wrote the “Kaiser-Permanente Marching Song,” an authorized adaptation of the UC Berkeley athletic fight song “The Big C.” Chapman was the first Kaiser Permanente Walnut Creek hospital administrator and later the Northern California regional director of training and management development.

Chapman’s first two lines:

“We are Kaiser-Permanente, finest plan in all the land
K-P stands for qual-i-ty and doing all we can.”

UC graduates lead Health Plan

"University of California is our Fourth Largest," Planning for Health, 1949-04Notable UC alumni include Eugene Trefethen, Jr., longtime Kaiser Industries president, James Vohs, longtime Health Plan president, Henry J. Kaiser’s son, Edgar F. Kaiser, and many others.

Edgar spent 3½ years at UC Berkeley majoring in economics. But in 1930, one semester short of graduation, he quit college and headed for Texas where he had been offered a chance to work as a pipeline construction superintendent.

His father gave him his blessing. “I talked it over with my father,” he once recalled, “and we agreed that I had learned about as much as I could in college, and that two months more of class work would not matter.”[ii]

Physicians join university faculty

Many Permanente physicians have associated with UC to teach and conduct research on various campuses. Morris Collen, MD, taught a public health course at UC Berkeley. Mark Binstock, MD, MPH, a Kaiser Permanente physician at Woodland Hills, was an assistant clinical professor at the UC Los Angeles School of Medicine in the 1990s. Monte Gregg Steadman, MD, was a lecturer at UC San Francisco.

UC Berkeley’s venerable Bancroft Library houses the Henry J. Kaiser Papers collection, a massive trove of Kaiser’s personal and business correspondence, memoranda, speeches, and papers. Kaiser’s documents from his Oakland, New York, and Hawaii businesses, principally from the period after World War II, are archived at the Bancroft.

The collection includes material on the Kaiser Industries corporation, the Kaiser Permanente Medical Care Program, the Kaiser Shipyards at Richmond, Calif., and other Kaiser industries.

UC’s Bancroft archives Health Plan pioneers’ interviews

UC Berkeley’s Regional Oral History Office staff has interviewed dozens of Kaiser Permanente pioneer physicians, administrators, and board members to document their roles in the development of this innovative health maintenance organization.

The initial interviews were conducted between 1984 and 1999 as the series: “History of the Kaiser Permanente Medical Care Program—Founding Generation.” A second series of interviews started in 2005 to look at Kaiser Permanente and the transformation of health care in the U.S. from 1970 to present.

 

Short link to this article: http://ow.ly/pvoLk



[i] “University of California Is our Fourth Largest,” Planning for Health, April 1949[ii] Obituary, New York Times, December 13, 1981

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KP Northern California marks half a century of stellar research

posted on August 14, 2012

By Lincoln Cushing
Heritage writer

Ellsworth Dougherty, MD, one of KP’s earliest researchers, studied the worm that eventually led to the mapping of the human genome. This photo is from a research trip he took to Antarctica circa 1959. KP Heritage Resources Archive photo

Kaiser Permanente (KP) has a well-deserved public reputation for providing top quality health care, but less known is the health plan’s long and illustrious record for conducting high-caliber medical research. KP is widely considered the leading non-university-based health research organization in the United States, with KP Northern California’s Division of Research amassing more than $100 million in 2011 to conduct research.

This research has a direct effect on health care in this country, influencing the way physicians care for patients and refining broader policies that support medical services. KP researchers, generally partnered with academic institutions, successfully compete for federal research grants, and develop lines of research whose results translate to improved patient outcomes at the local, state and national levels.

Centers for Disease Control and Prevention (CDC) Research Director Jeffrey Harris, MD, put it this way: “If you look at who the leaders in research are and who the folks are that have been doing research… to improve care, it’s a very short list.  And Kaiser Permanente is clearly at the top of that list.” [i]

This year, The Permanente Medical Group (TPMG), oldest of the eight KP regional medical groups, celebrates the 50th anniversary of the founding of its Division of Research (DOR). 

In the past five decades, KP researchers have conducted thousands of studies and helped to solve many medical mysteries – from the best way to cure pneumonia in the World War II shipyards, to making discoveries leading to the mapping of the human genome, to learning the most effective use of drugs to prevent heart attacks.

Gary Friedman, MD, led the Division of Research from 1991 to 1998. This image originally appeared in the KP Reporter, 1987.

The DOR (under its original name, Medical Methods Research, or MMR) was established September 21, 1961, by the Northern California medical group’s Executive Committee. Morris F. Collen, MD, one of the Health Plan’s founding members and a pioneer in the emerging discipline of medical informatics, led the group, which occupied offices in the old KP headquarters at 1924 Broadway in Oakland.

Ten years earlier, Dr. Collen had met with Lester Breslow, MD, then a public health officer in San Jose who had recently completed a trial of “multiphasic screening.” This battery of thorough and efficient examinations was a practical solution to the problem of providing care to large populations despite the post-war shortage of physicians.

This approach was put to the test when labor leader Harry Bridges insisted that all members of the International Longshore and Warehousemens Union (ILWU) be given annual check-up exams as part of a negotiated care package with the Permanente Health Plan. Importantly, this exam approach provided a critical evidence base to empirically determine what screening methods are and are not clinically beneficial for patients.

Morris Collen, MD, was the first director of the Northern California research department, established in 1961. KP Heritage Resources Archive photo

In 1962, KP Northern California received its first grant from the U.S. Public Health Service to develop, automate, and evaluate the multiphasic exam. Within three years, the Health Plan’s Oakland and San Francisco clinics began offering automated multiphasic health testing (AMHT) to all members. In 1968 Dr. Collen dismissed some of the resistance to this use of technology:

“Many physicians are concerned that the computer is depersonalizing medical care,” he said. “Just the opposite is true. Because of the computer, the physician will have more individualized information about his patient—more complete and more accurate than he could possibly have gathered before.”[ii]

Antecedents to Permanente medical research

Even before the Health Plan went public in 1945, Henry J. Kaiser articulated research as one of its goals at the August 21, 1942, dedication of the Permanente Foundation Hospital in Oakland.  As KP historian Tom Debley observed:

Illustration for article on medical research, Kaiser Foundation Medical Care Program Annual Report 1968

“From prepaid dues it collected, the Permanente Foundation paid for the medical care of Health Plan members and accumulated funds for such charitable purposes as medical research and the extension of medical services to larger population. . .The idea that research would be a tool to bring advances in medicine to the plan’s dues-paying members thus was embedded in the medical care program from the outset.”[iii]

In 1943, founding physician Sidney R. Garfield received $25,000 from the Permanente Foundation to study new methods of curing syphilis[iv] and he launched the Permanente Foundation Department of Medical Research under the leadership of Franz R. Goetzl, PhD, MD. He also started the research journal Permanente Foundation Medical Bulletin, edited by Dr. Collen from 1943–1953.

The Department began to receive national recognition for outstanding work in the study of peptic ulcers, human appetite, and pain. By 1949 the name was changed to The Permanente Foundation Institute of Medical Research to clarify that the research was not only a department within the hospital.

 

Ernest Saward. MD, medical director of KP Northwest from 1945 to 1970, launched the region’s research center in 1964. KP Heritage Resources Archive photo

In late 1958, research involving basic medical sciences was shifted to the Kaiser Foundation Research Institute (KFRI), established by Kaiser Foundation Hospitals to coordinate long-term basic research projects supported by grants from sources other than the Kaiser Foundation Medical Care Program.[v] At first this just covered Northern California’s MMR and the Northwest research center (established in 1964.)

Today, all Kaiser Permanente regions – Hawaii, Georgia, Ohio, Colorado, Northwest, Northern and Southern California, and Mid-Atlantic States, conduct research under the auspices of the KFRI.

By 1961 KFRI’s domain included more than 50 long-range clinical research studies exploring such medical problems as cardiovascular and renal diseases, adenovirus infections, cancer, diabetes mellitus, and psychosomatic medicine. More than 70 staff physicians and residents conducted these investigations, often in collaboration with laboratories at nearby medical and scientific institutions.

Clifford H. Keene, MD, chief executive officer of Kaiser Foundation Hospitals and Health Plan, was named director of KFRI.[vi] A wing of Kaiser Foundation Hospital in Richmond was remodeled to bring together several disparate research projects under the KFRI umbrella.

Laboratory of Comparative Biology Annex, 1301 Cutting Blvd., Richmond, CA, October 1961. KP Heritage Resources Archive photo

These included a Laboratory of Comparative Biology (under Ellsworth C. Dougherty, PhD, MD) studying the basic physiology of microorganisms; a Laboratory of Medical Entomology (under Ben F. Feingold, MD) investigating the role of insects in causing human allergies; a Laboratory of Human Functions; a study of the Epidemiology of Human Cancer; and a Child Development Study and Blood Grouping project that investigated congenital abnormalities and childhood diseases.

KP Northern California research evolves

During the late 1960s Edmund Van Brunt, MD, a project director for MMR, piloted the San Francisco Medical Data System, a computer-based patient medical record system with a database that supported both patient care and health care delivery  research. By 1973, Health Plan members in San Francisco had a computerized “lifetime” medical record, and pivotal work was conducted to begin to understand the safety of prescription drugs.

But by the early 1970s researchers were forced into a different avenue of research when the Nixon Administration abruptly canceled the department’s funding. The loss of $500,000 per year led to shutdown of the hospital computer system in San Francisco, but the application of computers and databases in medicine and health research continued, supporting new investigators and new areas of research.In 1979 Dr. Van Brunt succeeded Dr. Collen as the second director of the research department (MMR), and in 1986 he changed the name to the current Division of Research (DOR) to more accurately reflect the expanded mission and scope of clinical and other types of research that were being conducted there. Recently he described his vision of the program:

Mary Belle Allen, a basic scientist, conducted her studies in the Richmond KP laboratory along with Ellsworth Dougherty, MD. This photo is from the KP Reporter, 1959

“[We] conducted high quality health services and biomedical research, epidemiologic and vital statistical analysis of the whole variety of medical care processes. . . of different collections of people drawn . . . from the Health Plan membership and by different collections of people . . . males, females, different ethnic groups, young and old.”

Van Brunt continued: “. . . The mission is to use these resources to conduct the kinds of health services research that we feel are important not just to the organization but important in a larger sense.”[vii] Dr. Van Brunt expanded DOR’s research agenda by adding a department of Technology Assessment headed by Director Emeritus Collen.

In 1985 KP Northern California opened its first research clinic to support the heart disease research study CARDIA (Coronary Artery Risk Development in Young Adults). Within a year it was looking at a group of 5,115 black and white men and women aged 18-30 years in four centers – Birmingham, Chicago, Minneapolis and Oakland. Also in 1985, MMR began the Vaccine Study Center as a way of responding to numerous requests to use KP’s large population for vaccine efficacy studies.

The center currently operates 31 sites in Northern California and collaborates with KP’s Northwest, Hawaii, and Colorado regions and participates in several Centers for Disease Control and Prevention and National Institutes of Health studies.

Studies to better understand HIV/AIDS impact

During the AIDS crisis in the 1980s, DOR proved its worth in analyzing the impact of the disease. KP Northern California was second only to San Francisco County’s public health services in the number of people with AIDS it treated in the initial years of the crisis.  

Consequently, KP researchers knew how many patients were actively seeking treatment, but they didn’t know how many of its members were infected yet untreated.  Anonymous analysis of blood samples taken during routine checkups of 10,000 Kaiser Permanente patients in late 1989 told DOR researchers that 1 in 500 of its members was infected with HIV/AIDS.[viii]

Gary Friedman, MD, succeeded Dr. Van Brunt as director in 1991. During Dr. Friedman’s seven-year tenure, the DOR conducted important research on the etiology, prevention and early detection of cancers; on prevention and treatment of cardiovascular disease and diabetes; on the determinants of health care utilization; and on population approaches to chronic diseases.

Early research on the effects of socioeconomic status, race and ethnicity on health care and outcomes laid the foundation for the DOR’s ongoing involvement in health disparities research.

In 1994, KP Northern California became a founding member of the Health Maintenance Organization Research Network (HMORN), ushering in an era of large-scale collaborations seeking to integrate research and practice for the improvement of health and health care in diverse populations.

Long chain of clinician-researcher leaders

Joe Selby, MD, MPH, took the helm in 1998, and former research investigator Tracy Lieu, MD, MPH, was appointed director in 2012, continuing DOR’s unbroken line of leadership by clinician-researchers. 

Currently, 58 researchers and over 500 research staff continue DOR’s work in health care delivery research, outcomes research, clinical trials, epidemiology, genetics/pharmacogenetics (how individuals react to drugs), effectiveness and safety research, sociology, qualitative research (conducting patient interviews to better understand study data), and quality measurement and improvement.[ix]

Kaiser Permanente’s massive member database and consistent medical record keeping, maintain medical informatics as the cornerstone of KP research in fields such as cardiovascular disease, cancer, metabolic disorders, dementia, autism, infectious diseases, osteoporosis, maternal and child health, chemical dependency and mental health. Dr. Friedman, Division of Research scientist emeritus, touts KP data as offering “the best epidemiologic workshop in the world.”

KP Northern California research also leads or co-leads several national research collaboratives sponsored with federal funds involving multiple KP and non-KP organizations, including the Cardiovascular Research Network (CVRN), Cancer Research Network (CRN), Vaccine Study Datalink (VSD), Developing Evidence to Inform Decisions about Effectiveness (DEcIDE), Accelerating Change and Transformation in Organizations and Networks II (ACTION II), among others.

Overall, DOR has a remarkable history filled with contributions to the health of KP members and the broader community. DOR is committed to expanding its impact through better understanding of the underpinnings of risk factors and diseases, determining methods for effectively preventing and detecting these conditions, delineating the natural history of diseases, identifying ways to improve outcomes and the overall delivery and organization of health care.

 

Thanks to Alan Go, MD; Maureen Mcinaney; and Marlene Rozofsky Rogers at DOR for their contributions in the preparation of this article.

For an introduction to DOR research scientists and their work, please visit:
www.dor.kaiser.org 

For more information, including all of the published work of DOR authors, please visit The Morris F. Collen, MD Research Library, 2000 Broadway, Oakland, CA.

Also see “Something in the Genes: Kaiser Permanente’s Continuing Commitment to Research,” by Robert Aquinas McNally, Permanente Journal, Fall 2001
<http://xnet.kp.org/permanentejournal/Fall01/genes.html>

 short permalink to this article: http://bit.ly/RM39iE

 


[i] “Perspectives – Research,” [videotape] [Oakland (CA):] Kaiser Permanente MultiMedia Communications; 1998, quoted in “Research in Kaiser Permanente: A Historical Commitment and A Future Imperative,” Robert Pearl, MD, Permanente Journal, Fall 2001.

[ii]Kaiser Foundation Medical Care Program Annual Report 1968.

[iii] The Story of Dr. Sidney R. Garfield: The Visionary Who Turned Sick Care into Health Care, by Tom Debley, The Permanente Press, 2009.

[iv] Correspondence November 1, 1943 from E. E. Trefethen, Jr., Trustee of the Permanente Foundation, to Dr. Garfield; letter is an appendix to the Cecil C. Cutting Regional Oral History Office interview 1985 by Malca Chall, <http://www.oac.cdlib.org/view?docId=hb8p3006n8&brand=oac4&doc.view=entire_text>

[v]Kaiser Foundation Medical Care Program Annual Report 1961.

[vi]KP Reporter, September 1959.

[vii] Interview June 13, 2012 by Bryan Nadeau, Senior Producer Northern California Multimedia.

[viii]AIDS research among Kaiser’s quiet studies,”Carolyn Newbergh, Oakland Tribune, 10/8/1991.  The published medical research finding is: Hiatt RA, Capell FJ, Ascher MS.; Seroprevalence of HIV-type 1 in a northern California health plan population: an unlinked survey.; Am J Public Health. 1992 Apr;82(4):564-7.; PubMed PMID: 1546773; PubMed Central PMCID: PMC1694106.

[ix] http://www.hmoresearchnetwork.org/members.htm#dor

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KP early physician leader views health care future from 1966 vantage

posted on June 25, 2012

By Ginny McPartland
Heritage writer

Cecil Cutting, MD, led The Permanente Medical Group from 1957 until 1976. Kaiser Permanente archives photo

As we wonder and worry about the fate of health care in America, it’s interesting to look back at how Kaiser Permanente physician leaders saw the future just after the 20-year-old health plan got a firm foothold in the 1960s.

Cecil Cutting, MD, executive director of The Permanente Medical Group, told of his worst fears in a talk to a group of hospital administration graduate students at the University of Chicago on Nov. 17, 1966.

“Looking ahead, there seems little doubt but that our present ‘derangement’ of providing medical care is totally inadequate to absorb the onrush of the technological revolution that is now upon us, even if the rising personnel costs can be absorbed,” Cutting lamented.

“The tempo of the hospital has changed from a relatively easy-going, low cost charity institution to a competitive, high cost one, with third parties paying the costs and becoming ever more critical of hospital management,” Cutting said.

A 1935 Stanford Medical School alumnus, Cutting joined Sidney Garfield when he established a medical care program at the Grand Coulee Dam job site in the late 1930s. During the war, Cutting also took a leading role in Garfield’s Kaiser wartime shipyard program in Richmond, California.

1960s changes threatened traditional medical care delivery

Cutting was talking about the mid-1960s climate that included newly enacted government-paid Medicare-Medicaid programs for the elderly and poor, a flood of new medical technology, health care professionals’ demands for higher pay and a proliferation of union and company health plans for workers.

With the blessing of KP founding physician Sidney Garfield, Cutting laid out the problem: “Today we have many individual, unrelated, competitive hospitals seldom organized among themselves as a team, for the most part with unorganized staffs of physicians, serving an unknown population – a population unknown both in numbers and in health requirements.

“The consequences of continuing along our present path of complete disorganization are staggering and make the need to change methods of organizing medical care inevitable,” he told the group.

Kaiser Foundation Hospital in Oakland, circa 1966. Kaiser Permanente archives photo

Cutting warned that high technology was too expensive for an individual institution to purchase on its own. He said a system should be established in which medical facilities are designated as one of three types: a community preventive health center; a service hospital for routine care, such as trauma, appendectomy, hysterectomy, maternity, hernias, cancer surgery, pediatrics and psychiatry; and a “super-specialty” hospital.

‘Super-specialty’ hospital to optimize high technology use

The highly specialized treatment facility envisioned by Cutting (perhaps the precursor of a center of excellence) would be designed for handling neurological cases, open-heart surgery, megavoltage radiotherapy – the types of cases that required the most sophisticated equipment.

Here, specialists would take care of a sufficient number of patients referred from other facilities to optimize utilization of the equipment and highly skilled staff.

As it happened, Kaiser Permanente was in the process of developing such a system by this time, and Cutting could report its success to his audience. “In Northern California area the Kaiser Permanente program is working along these lines, though it is by no means a finished demonstration,” Cutting said.

“The (Kaiser Permanente) group practice-prepayment arrangement is, in itself, a step toward improving organization of medical care and undoubtedly makes accomplishment of further organization considerably easier to attain.”

Health assessment staff greet a longshoreman ready for his battery of tests, 1961. Kaiser Permanente archives photo

Health center concept proposed

The health center concept, which Cutting called “predictive and preventive medicine,” had already been developed and was in operation in KP Northern California.  “Forty thousand patients a year are being given an extensive health questionnaire (to complete), updated each year, and an automated battery of some 20 test measurements plus 18 laboratory procedures amounting to almost 1,000 different characteristics on each patient,” Cutting continued.

With this information, all recorded in a computer data base, KP physicians compiled knowledge of each patient’s changes from year to year. This information helped physicians to predict illness and to advise patients and their families about how to prevent chronic illnesses such as diabetes, heart disease and cancer.

Annual physicals usually include eye exams, as well as other preventive screenings. Kaiser Permanente archives photo.

Data compiled about whole populations, i.e. KP members, also helped researchers answer such questions as: Can treatment of asymptomatic patients with a slight increase in blood sugar prevent diabetes altogether or merely postpone the disease? With data from a questionnaire about a patient’s psychological state, researchers compared the effectiveness of psychiatric services versus medical office visits for reducing total visits for emotionally disturbed patients.

Too many specialists spoil the broth

Cutting complained to his audience that medical schools were turning out too many specialists, a trend that threatened basic medical care. “It would appear that the rush for super-specialization may be leaving behind an ever widening gap in well rounded, competent medical judgment.

“Though the individual episode of care may be superb, it certainly does little for the orderly development of efficient, economical medical care as a whole.”

In what must have surprised many, Cutting suggested that medical education should develop a new type of medical doctor: the preventive, predictive specialist. “Following the natural development of disease of entire families over long periods, alerted to early changes through the screening program, he becomes a health specialist.”

Today, both primary care and preventive medicine are specialties recognized by the American Board of Specialties.

A pilot Health Education Center opened in Oakland in 1967. Sidney Garfield, MD, champion of Total Health, stands next to the transparent woman, one of the center's displays.

Kaiser Permanente has advanced Garfield and Cutting’s ideas about preventive care and health appraisals in a variety of ways over the decades. KP physicians promoted healthy eating and exercise for the workers in the World War II Kaiser Shipyards, and they began offering preventive testing in the 1950s for members of the longshoremen union and other groups.

KP’s ‘Total Health’ concept emerges

In the 1970s, health education centers were established to teach patients how to stay well; Garfield’s Total Health Research Project launched in the 1980s led to the opening of special centers where  healthy patients received their routine care.

Centers for preventive medicine functioned within KP for many years, largely giving way to periodic screenings for particular diseases such as breast and colon cancer, heart disease, hypertension and diabetes. Healthy Living programs, an expansion of member health education, have flourished in the past decade offering many classes in good nutrition, exercise, smoking cessation and stress reduction.

Cutting ended his talk with a few wishes for the future: community institutes to teach people to preserve their good health, easily shared electronic medical records, and above all, cooperation among health organizations to provide a broad spectrum of care – from the preventive to the most complicated.

“When (all) care, whether in super-specialty hospitals, service hospitals, extended care, office or home, is correlated . . . I will begin to see hope,” he said.

http://tinyurl.com/7w5on3w

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Kaiser Permanente HealthConnect offers power to crack the quality nut

posted on April 11, 2012

By Ginny McPartland
Heritage writer

Kaiser Permanente's first stab at formal quality assessment, low-tech paper and typewriter hospital reviews by first woman hospital administrator Dorothea Daniels in 1962

Seventh in a series
In 1989, Southern California quality guy Sam Sapin, MD, made a prescient plea to KP leadership: invest in information technology to improve quality of care. Having worked on quality issues for decades, Sapin saw the need for a KP database to be shared among all regions.

“This would allow us to compare ourselves to each other,” Sapin told a gathering of KP quality professionals. He continued: “The data must be accurate, otherwise one loses credibility and effectiveness. The data must be timely, not two to three years old, because the environment changes quickly these days. . .We need to develop data that will show the outside world – the public, employers and legislators – how good we are.”

Twenty-two years later, KP is positioned to capture detailed patient data across all KP regions and to analyze it in many different ways to learn what’s working and what isn’t. With an abundance of data, KP can not only record adherence to best clinical practices, but also potentially figure out more precisely how treatment affects outcomes.

Halvorson’s big initiative to improve quality with data

In 2002 when George Halvorson took over Kaiser Permanente as president and CEO, the Care Management Institute was well on its way to performing the essential function of developing and sharing best practices among all KP physicians. But Halvorson, acutely interested and knowledgeable about medical information systems, was not satisfied that KP was on the path to develop a patient data system that would support his vision for quality improvement.

Telling the story of how rich data helps to achieve quality improvement. KP experts contributed to this book edited by Louise Liang, HealthConnect leader. See below*

He brought in Louise Liang, a physician, medical director and quality professional who had worked closely with Total Quality Management expert Donald Berwick at the Institute for Healthcare Improvement (IHI). She led the program-wide monumental task of finding an appropriate vendor, figuring out the best software and driving the implementation of KP HealthConnect, ultimately the data collection and interpretation system that would transform Kaiser Permanente’s ability to assess and improve quality.

In 2005, KP reorganized its quality management structure, creating the KP National Quality Committee (KPNQC), which took the place of the Medical Directors’ Quality Committee. The NPNQC oversees all quality activities for hospitals, outpatient clinics, and outside care for all KP regions.

Value of data to quality measurement

Fully implemented in 2010, KP HealthConnect has the capacity to generate comparable data across all KP regions, thus enabling physicians and other quality analysts to measure and compare quality results from all of KP’s facilities. KP HealthConnect also can use data to perform a much broader range of research to feed the CMI’s search for data to validate and refine Permanente best practices.

KP's current CEO George Halvorson

“Having data is extremely important,” Halvorson told the editors of the NCQA 20th anniversary report. “Whenever you have data you can reach conclusions and you can change process, you can re-engineer, you can make things better. But if you don’t have data, you don’t have any particular direction to go.”

He adds, “There is an evolution from process to outcomes, and measuring the mortality rate for different conditions is a wonderful measurement, sort of the ultimate definition of outcome. Measuring process is good, and a far better thing than not measuring quality at all, but organizations really need to focus on what happens to each person. How many people have failing kidneys is a great measurement.”

NCQA president validates KP success in quality improvement

In her 20-year assessment of NCQA’s success in improving quality of care, President Margaret E. O’Kane concludes: “Our hard work has led to many gratifying and exciting results. In Northern California, for example, Kaiser Permanente has demonstrated that aggressive management of patients with coronary artery disease (CAD) pays off in the most important ways: fewer deaths.

“CAD is the leading cause of death in every other county across the U.S., but for Kaiser (Permanente) patients in Northern California it is second. This confirms that when quality measurement and science meet, patients benefit,” she wrote.

KP’s electronic medical record system also makes it possible for physicians to access a patient’s full medical history anytime in any KP facility.

“You never ever have to make a clinical decision about a patient without information,” Andy Weisenthal, KP pediatrician and quality expert, told Charles Kenney, author of Best Practices: How the new quality movement is transforming medicine.” He adds, “I cannot tell you what that means to me as a doctor.”

Has Kaiser Permanente been successful in demonstrating its high quality of care? The abundance of accolades showered onto the KP medical care program over the past decade speaks for itself.

In the fall of 2011, KP received the highest rating in 11 effectiveness measures – more than any other health plan in the nation – in the 2011 NCQA’s Quality Compass results.

KP also won J.D. Power & Associates first place awards, as well as the prestigious Davies Award for KP HealthConnect, the patient data system.

KP also distinguished itself by garnering Medicare five-star awards in five regions, outstripping other health plans in California, Hawaii, Colorado and parts of the Northwest. Only nine Medicare plans in the country earned five stars for the overall 2012 Medicare star quality rating.

Next time: Sam Sapin: Southern California pediatrician’s career parallels KP’s quest for best quality

To learn more about KP current quality honors:

 http://xnet.kp.org/newscenter/pressreleases/nat/2011/091311himmsdaviesaward.html

http://xnet.kp.org/newscenter/pressreleases/nat/2011/101011ncqacaremeasures.html

http://xnet.kp.org/newscenter/pressreleases/nat/2011/101211medicarestarqualityratings.html

http://xnet.kp.org/newscenter/pressreleases/nat/2011/032311jdpower.html

*Louise Liang’s book is discussed in the Permanente Journal and is available on Amazon.com.

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Target of ecstatic Times Square kiss still adorable after all these years

posted on April 26, 2010

By Ginny McPartland
Where were you on August 14, 1945? Not born yet? Most of us weren’t. You may remember the day President Kennedy was shot (November 22, 1963), the night the Beatles were on Ed Sullivan (February 4, 1964), the day the Berlin Wall was doomed to come down (November 9, 1989). Or maybe for you the biggest day in history was the night Barack Obama was elected president of the United States (November 4, 2008).

Kiss felt around the world

But for the generation that endured World War II (and, for many, the Great Depression), the day the war finally ended has no competition for the most significant day in American, if not world, history. Those left of the Greatest Generation in 2010, 65 years after the war ended, are making a valiant effort to get across to the latest generation why we can’t forget WWII.

I met one of the WWII history ambassadors and an icon –Edith Shain – the other day in Oakland. Her claim to fame is the unscripted role she played in a spontaneous drama in Times Square on the day the war ended. Her shapely legs with a nice turn of the ankle were part of the attraction of the photo of a sailor and a nurse kissing as if there were no tomorrow. She was adorable then, and she’s adorable now.

Tiny Edith is traveling around America at age 91 to spread the word of the WWII legacy. Spokeswoman for “Keeping the Spirit of ’45 Alive” with actor Hugh O’Brien (Wyatt Earp), she’s stumping with the message that “we” have to stick together like Americans did during the four-year nightmare to defeat Adolph Hitler and Japanese imperialists.

Edith Shain, Ginny McPartland

As someone who soaks up everything I can about  WWII, I was excited to meet Edith. I was especially jazzed because Kaiser Permanente is also celebrating our 65th anniversary. The health plan, set up to take care of Richmond shipyard workers during the war, opened to the public in October of 1945. So our heritage work gels beautifully with the Spirit of ‘45 initiatives.

The day the world could breathe again

Edith Shain, 1945

Edith was a part-time nurse and student at New York University on the day President Harry Truman announced the Japanese had surrendered. She and a friend, at work in Manhattan at Doctors Hospital, took the subway to Times Square when they heard the news. Still wearing her nursing whites, Shain joined the crowd in expressing their impossible-to-describe exhilaration that the horrors of world war were over.

Amid the pandemonium, Edith was suddenly grabbed, embraced and passionately kissed by the unknown sailor who’d forgotten his manners in the heat of the moment. Alert photojournalist Alfred Eisenstaedt and naval photographer Lt. Victor Jorgenson seized the opportunity for the image of a lifetime. Jorgenson’s version was published the next day in the New York Times; Eisenstaedt’s shot appeared on Life magazine’s cover.

Eisenstaedt’s iconic photo has for six decades epitomized the unbridled jubilation of all Americans on that day in history. People surmised the sailor and the nurse were being reunited as a couple at war’s end. But actually, after the kiss the ecstatic sailor went looking for another thrill. “He went one way and I went the other,” Shain said in a 2005 NPR interview following the dedication of a 26-foot bronze statue replicating the famous kiss.
http://www.npr.org/templates/story/story.php?storyId=4799520

Sharing the lessons of a world at war

Edith left nursing after the war and became a teacher of small children in West Los Angeles. She took on the mission of education with a vengeance, and today she wants to teach all generations about the lessons of war.
She laments: “The younger generation knows nothing about the war.” She complains our current military actions in the Middle East are not justified and we shouldn’t be there. “In World War II, we were fighting for something.”

The “Spirit of’45” campaign is to bring attention to the war legacy by sponsoring numerous events through 2010 to culminate with special events nationwide on August 14. The organization is asking people to write letters to their representatives in Congress to designate a day in August to commemorate World War II veterans. The group has set up a Web site for veterans and other people to share their war stories.
www.spiritof45.org

Permanente marks 65 years as public health plan

Permanente’s first years after the war were rough. We had a small membership so it was difficult to keep the enterprise going. Things picked up in 1950 when the longshoremen’s union, the retail clerks, cannery workers and other small groups brought an influx of members. Through these 65 years, the health plan has grown to 8 million-plus members in eight states – California, Oregon, Washington, Hawaii, Georgia, Ohio, Maryland (and Washington D.C.) and Colorado.

We will be marking the milestone along with our partners at the Rosie the Riveter National Park in Richmond, especially during the Home Front festival in October. With the park service, we are developing educational displays and other interpretive materials to highlight our shared history and the war legacy.
http://nps.gov/rori

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Replacing ‘Sick Care’ with ‘Health Care:’ Dr. Sidney Garfield’s Ideas in the National Reform Dialogue

posted on April 5, 2010

By Tom Debley, Director, Heritage Resources

It was fascinating to me to research and write a book about the life of Kaiser Permanente’s founding physician, Sidney R. Garfield, but it has become even more so to observe how visionary he was in his time as discussion continues in the wake of President Obama’s signature on health care reform.

Dr. Sidney R. Garfield, a surgeon, co-founded prevention-focused Kaiser Permanente with industrialist Henry J. Kaiser.

A month ago, I wrote a blog about Harvard Business School Professor Clayton Christensen, who argued in the pages of Business Week that health care needs business models like Kaiser Permanente—health care systems in which doctors and insurers are on the same side of the ledger as the patient. I observed that this was an idea Dr. Garfield put forward as the model for Kaiser Permanente in a speech in Portland, Oregon 65 years ago Sunday (April 4).

This Monday (April 5), I was struck by a quote in an article by Robert Pear in the New York Times.

“We don’t have a health care system in America,” said Senator Tom Harkin, the Iowa Democrat who chairs the Senate health committee. “We have a sick care system. If you get sick, you get care. But precious little is spent to keep people healthy in the first place.”

First Lady Eleanor Roosevelt, visiting World War II Home Front patient, asked Dr. Sidney R. Garfield to tell her about prevention-focused medical care.

Harkin’s statement is an interesting juxtaposition with an event exactly 67 years earlier—April 5, 1943—when First Lady Eleanor Roosevelt visited a World War II Kaiser Industries shipyard worker, a woman with a seriously injured left leg, as shipyard manager Edgar F. Kaiser looked on in Vancouver, Washington.

Whatever Mrs. Roosevelt heard about Dr. Garfield’s focus on injury and illness prevention efforts as he built the largest civilian medical care program on the Home Front of World War II, she was immediately intrigued. Returning to the White House, she dictated a note to Dr. Garfield, “I am interested in getting medical care, both preventive and curative, at the least cost to the people. What is your program on the preventive side?”

“Your expression of interest in preventive medicine is rather closely allied with our thoughts for medical care,” Dr. Garfield responded in a letter detailing his ideas.

What Dr. Garfield did on the Home Front is, of course, one of the historical stories told at the Rosie the Riveter / World War II Home Front National Historical Park in Richmond, Calif.

Dr. Garfield spent his whole professional life on these ideas. It was not easy, but his vision was central to the evolution of Kaiser Permanente as—in Dr. Garfield’s words—a “total health” system of care.

In the first 15 years of toil after World War II, Dr. Garfield’s big frustration was how challenging it was to move from a “sick plan” to a “health plan,” but he never gave up. His big breakthrough came 50 years ago next month, and I will write about that story in a blog in May.

In the meantime, if you are interested in learning more about Dr. Garfield, my book, “The Story of Dr. Sidney R. Garfield: The Visionary Who Turned Sick Care into Health Care,” is available from the publisher, The Permanente Press, as well as from Amazon.com in both book form and on Kindle.

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Harry Bridges and Sidney Garfield: Synergistic Collaboration

posted on March 31, 2010

Harry Bridges at ILWU meeting 1960

By Ginny McPartland
During the Cold War, the average American scorned any ideas that even hinted at socialism. Going against mainstream politics in the 1950s was fraught with danger.

Henry J. Kaiser and Sidney Garfield, MD, took their licks from the conservative medical establishment for their nontraditional ideas of health care. They were called “socialist” even though both were adamantly opposed to “socialized medicine.”  

Their contemporary– and sometimes collaborator — militant labor leader Harry Bridges was accused of being a communist, which he was not, as he fought hard and dangerously for bargaining power for dock workers.  

Marking the 20th anniversary of Bridges’s death this month brings to mind the groundbreaking 20th century achievements of these working class heroes. Despite the opposition, they didn’t back down.  

For Harry Bridges, elevating the worker to the bargaining table was a lifetime passion. His heart was with the “working stiff” who was considered almost like property of the employer before unions. “The basic thing about this lousy capitalist system,” Bridges declared, “is that the workers create the wealth, but those who own it, the rich, keep getting richer and the poor get poorer.” 

Born in Australia in 1900, Bridges was inspired by Jack London’s books to go to sea. He jumped ship on his first job because he disagreed with the skipper on the treatment of the seaman. He landed in San Francisco and soon began to organize the waterfront workers.  

His work culminated in 1934 in the San Francisco dock workers strike that resulted in the death of two men, casualties of police bullets. Union members refused to work until they could negotiate higher wages and a method of getting work on the docks without having to pay a kickback. The strikers won and Harry Bridges was set for 40 years as the president of the International Longshoremen and Warehousemen’s Union (ILWU) starting in 1937.  

“A Working Class Hero Is Something to Be” — John Lennon

By 1950, the ILWU had become a strong advocate for its members, and its leadership worked to spread unionism to other industries. The ILWU pioneered health and welfare benefits for its members. 

Enter Sidney Garfield: 
After the War when the Richmond shipyards closed, Kaiser and the Permanente doctors were ready, willing and able to take care of people. Both men had track records of providing affordable care to the working man. The health plan had been opened up to the public in 1945 but the enrollment was small. 

Enter Harry Bridges: 
It was a marriage with great potential. Bridges needed a health plan for his members and Henry Kaiser needed health plan members. Instant symbiosis.
  

In many ways, the goals of the two organizations converged. Bridges wanted all of his workers to have a health assessment and screenings to prevent disease. Kaiser Permanente’s Garfield saw how to accomplish the “multiphasic” examinations for all twenty thousand workers and later set up a way of collecting the results, at first on paper, and then in KP’s pioneering computerization of medical records. In effect, the ILWU members were guinea pigs for what has grown and expanded into KP’s electronic medical records prowess.  

Young Harry Bridges aboard ship about 1920.

Along the way, Bridges helped Kaiser Permanente by writing editorials in the ILWU newsletter supporting the health plan physicians. In 1953 Bridges assailed the San Pedro Community Hospital in Los Angeles for refusing privileges to KP doctors. In 1954, he criticized the American Medical Association for trying to block group medicine. “Group medicine is here to stay,” he wrote. 

In turn, Permanente physicians at times provided medical care on credit for striking ILWU members. Henry Kaiser was in favor of unions. In 1954, Kaiser said problems can be averted “simply by genuine recognition that the right of collective bargaining . . . is sound, essential human relations. I agreed a long time ago that unions are here to stay.” 

In 1965, Kaiser received the AFL-CIO’s highest honor for his achievements in voluntary medical care, housing and labor relations. Previous winners included former President Harry Truman and former First Lady Eleanor Roosevelt.  

To view Arlo Guthrie’s tribute to Harry Bridges on Youtube: http://tinyurl.com/y87jt34
 

Top photograph by Otto Hagel, from Men and Machines, 1963; reproduced by permission of the Center for Creative Photography; © 1998 The University of Arizona Foundation
Ship photo courtesy of ILWU Archives, Anne Rand Research Library, International Longshore and Warehouse Union, San Francisco

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Richmond Shipyard Workers Suffered Their Own Casualties of War

posted on September 4, 2009

In 1942, eighteen year-old Lucille “Penny” Price joined the shipyard workforce with little idea what lay ahead for her. Read on to hear a poignant account of what those days were like and the daunting challenges Penny faced.

Building warships was a dangerous enterprise. Workers in the Richmond shipyards during World War II learned the hard way how easy it was to be injured when working at a furious speed to fulfill orders for sorely needed war vessels.

Richmond shipyard workers 1943

Richmond shipyard workers 1943

The odd mix of people who converged at the Kaiser shipyards added to the complexity and worry associated with the safety of workers of all levels of skill and socialization. The majority of them had little or no experience building ships.

There were black and white men and women from the agrarian southern states and other parts of the country. There were native San Francisco Bay Area women and men. There were men who had medical conditions that totally disqualified them from serving in uniform (Class 4F). There were handicapped workers.

Risky Business
Injuries minor and major were common. In fact, working in a shipyard was one of the most dangerous jobs in the wartime industries, more risky than the manufacture of tanks, aircraft, and explosives. The shipyards of America reported an average of 33 disabling injuries per million hours worked in 1943. (This compared favorably to the iron and steel foundries whose average accident rate was 40 injuries per million hours worked.) About 700 shipyard workers were killed during 1943 and 1944 in accidents in the nation’s shipyards.*

Some injuries were purely accidental, some were from carelessness, and others were simply vicious.

“It Wasn’t All Beer and Skittles…”
An eighteen-year-old Oakland girl, Lucille “Penny” Price, joined the shipyard workforce in October 1942. She made good money as an electrician and considered the wartime work a great opportunity. She sums up the experience in this casual understatement: “It wasn’t all beer and skittles.”**

Price, an electrician in Yard 3, was almost scared away from the shipyards when she witnessed a fatal accident on her first night of work. A guide was taking a group of new employees, including Price, on an orientation tour when they heard “beep, beep, beep,” the sound of a crane in motion. “The guide was telling us that when you hear that sound you get the heck out of the way and stay away,” Price recalled. But some other workers didn’t heed the warning sound, and as the crane lifted a heavy sheet of steel aboard a ship, one of the cables broke and the load slipped and killed several of them.

“I tell you I was ready to run, and so were the other people in our group of electricians,” she said.

Price was quickly reassigned to the relative safety of the electrical shop to give her time to get over the shock. She stuck it out and by Christmas was wiring C-4 transporters and LSTs (landing ship, tanks) and continued to work in the yards until early 1945. During her tenure there, she would experience many injuries herself.

Threatened by Male Counterparts
Now 84 years old and living in Windsor, Calif., Price recalls the time a “chauvinist” kicked a ladder out from underneath her and caused her to fall over a stack of pipes. The man who made her fall was fined and fired, never to work again in the shipyards. Penny was taken to the shipyard Field Hospital where she was treated for two cracked ribs.

Price also recalls that men also liked to sneak up on her while she was working from a plank stretched across the open deck with six floors below. “They’d make the board vibrate and that scared the hell out of me.”

Male shipyard workers’ poor treatment of their female counterparts was not uncommon. “When women managed to enter jobs that seemed still to be the prerogatives of men, they were sometimes mistreated; “harassed” is the word we would use nowadays,” said Columbia University professor http://www.columbia.edu/cu/history/fac-bios/Kessler-Harris/faculty.html Alice Kessler-Harris in an interview on PBS.

“Men often played tricks on women by sending them for tools that did not exist. Men also sexually harassed women by whistling and cat-calling to them as they worked. Most of the resistance and hostility towards women workers disappeared as the novelty of women workers wore off, the labor shortage got worse, and women proved themselves, according to Susan M. Hartmann, http://history.osu.edu/people/person.cfm?ID=695 author of The Home Front and Beyond: American Women in the 1940s.

Victim of Double Pneumonia—Before the Days of Penicillin
Penny Price was also a victim of double pneumonia that developed after she was caught in a dark corner on the same level as a dozen hostile workmen during an air raid warning drill. Price had been doing some wiring by herself above the shaft alley when the “whoop, whoop” of the siren came and the lights went out. She huddled in a space near a boiler for two hours, shaking with fear as the burly workers made comments like: “Wait ‘til I get my hands on that little chick over there.”

Lucille "Penny" Price 1943

Lucille "Penny" Price 1943

When the drill was over, her leaderman, Charlie Ryder, swooped her up from the spooky pit. She couldn’t stop shivering, so her coworkers gave her coffee to warm her up. “To this day, I can’t stand the smell of coffee with cream in a paper cup.” She “upchucked” the coffee that night at home and returned to work the next day thinking she was fine. But the shaking returned, and she was taken to the field hospital where they took a chest X-ray and diagnosed double pneumonia.

This was in March 1943 before penicillin was available to civilians. At the Oakland hospital where our doctors were perfecting the treatment of pneumonia, she was given a “horrendous” clear liquid (probably horse or rabbit serum) every few hours. That liquid along with oxygen therapy cured her of the mysterious pneumonia.

Penny Price today

Penny Price today

During the war, Permanente physician Morris Collen experimented with the treatment of pneumonia as he managed a large number of shipyard cases. By the end of the war, Collen had published his findings and earned a national reputation as a pneumonia guru. His prestige was such that he was able to get some of the first civilian penicillin in 1944 to save the lives of the 7-year-old daughter of a shipyard worker in Vancouver, Wash., and a young man in a Richmond yard.

Hospital Visits—Much Too Frequent
Throughout her time at the shipyards, Penny Price was injured numerous times and was a frequent visitor to the First Aid Station and the Field Hospital. “I was in and out of the Field Hospital like a yoyo,” she said. She frequently cut herself using a linoleum knife to cut electrical cable. She vividly recalls the inside-out eyelid treatment administered when she got bits of steel mesh from the cable in her eyes. She also recalls that when working around fiberglass she sometimes got particles down her neck that irritated like a thousand flea bites.

Her most serious injury was caused by an accidental explosion that knocked her down from the ship’s superstructure onto the deck below where workers were using acetylene torches to shrink the deck. As a result of the fall, she suffered burns and an injury to her knee when it struck a bolt on the deck. She was burned so badly that she had to return for treatment for nine months before her leg was healed. “I still have scars on my leg to this day,” she said. She returned to work after a short hospital stay wearing a splint on her knee wound.

Price remembers an inspector coming around to urge the workers to follow the Maritime Commission safety rules to avoid injuries. “He’d show us a glass eye and say ‘do you want one of these?’” We’d shudder, and he would say: ‘then, wear your goggles!”

Safety Program Launched in 1943
In 1943, the U.S. Maritime Commission launched a safety program that ultimately reduced the injuries per million hours worked in the shipyards to 23.2 in 1944. “The work of the (commission) was of value in two ways – by allaying fears that working in a shipyard was more dangerous to life and limb than working somewhere else, and by making this true through insistence on a high standard of protection and precaution,” wrote Frederic Lane in his 1951 book Ships for Victory.

*Of the 655 reported private shipyard fatalities in the nation during 1943 and 1944, vehicles or loads striking workers was the second most common type of accident (25 percent) after falls (39 percent). Half of the “strike by” accidents involved cranes.

**’Beer and skittles’ is shorthand for a life of indulgence spent in the pub. Skittles, also known as Ninepins, which was the pre-cursor to ten-pin bowling, has been a popular English pub game since the 17th century. This definition is according to the Phrase Finder, a United Kingdom Web site: www.phrases.org.uk/meanings/230200.html.

— Ginny McPartland

You can watch a lecture about Dr. Sidney R. Garfield’s long quest for health care reform by Tom Debley to the Commonwealth Club of California.

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