Baylor Health Care System quality initiatives: a view from the HealthTexas Provider Network

F. David Winter, Jr., MD

From HealthTexas Provider Network, Baylor Health Care System, and Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas.

Corresponding author: F. David Winter, Jr., MD, 3434 Swiss Avenue, Suite 105, Dallas, Texas 75204.

A young woman rushes into a doctor's office, clutching her chest and groaning with pain. The pain began that morning, awakening her from sleep, and has increased over the past several hours. She spent the preceding day laboring in the yard but does not remember a strain or injury. The lady appears anxious and short of breath and has fine beads of sweat on her forehead. Her husband pleads for someone to do something.

This scenario is common in many physicians' offices. Her pain may be due to a heart blockage, a blood clot, or a muscle strain. Her problem will be dealt with expediently and with a high degree of success. Yet, the physician who solves the young lady's problem may miss a more serious condition. She could be harboring an early cervical cancer. She might have an early breast cancer. Or, she may step on a rusty nail next month and contract tetanus. Each of these problems must be considered and addressed early for optimal care. Unfortunately, our current systems often overlook preventive strategies in the face of acute illnesses.

Can we redesign our encounters with patients to ensure that appropriate preventive measures are consistently performed? It's a daunting task and one that can potentially distract the physician from focusing on the chief complaint of the patient--the reason the patient comes into the office in the first place. Additionally there are the pressures of managed care, coding documentation, and time constraints.

Preventive measures are important. The mortality rate of tetanus can be as high as 100%, for example, though it is preventable by the tetanus toxoid vaccine (1). Other vaccines are also as important for adults as they are for children. In fact, annual deaths from infections preventable by adult immunizations exceed those resulting from automobile accidents or AIDS (2).

Immunizations not only save lives, they save money. The pneumococcal vaccine is said to be one of the most cost-effective treatments in clinical medicine (3). The cost of the vaccine is trivial compared with the cost of hospital stays and office visits to treat a common pneumonia.

Early detection of disease is another case in which outcomes are improved and dollars are saved. We know that metastatic breast cancer is one of the most expensive diseases to treat in modern medicine and that the treatment is not always effective. Regular screening by mammography has been demonstrated to decrease mortality by 25% to 30% in women over the age of 50 (4). Yet, too many women delay or ignore recommended guidelines for mammograms, missing an opportunity for breast cancer to be diagnosed in an early, curable stage.

These issues are all addressed by the so-called quality movement. (BUMC Proceedings 2001;14:442-446)