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o A Summary of the National Community Health Advisor (CHA) Study, 1998 is available free from The Annie E. Casey Foundation, 701 St. Paul St., Baltimore, MD 21202; (410) 223-2890. The study’s purpose is to provide guidance to policy-makers and practitioners in areas that could improve the overall status of CHAs. CHA programs in underserved communities have been effective in linking individuals with health care systems, insurance coverage, and sources of continuous medical care. Benefits include:
• reduction of emergency room and hospital visits, length of stay, and complications of illnesses;
• availability of cost-effective, culturally competent services;
• focus on individual needs, such as obtaining nonmedical services that reduce barriers to medical care;
• trust between patient and provider, promoting timely use of medical services and compliance.
o The Federal Register has published a Draft Guideline for the Prevention of Surgical Site Infection (SSI), 1998 (63 Fed Reg 33,167-33,192 [June 17, 1998]). The document updates and replaces the previously published SSI Guideline and represents the third revision prepared by the Hospital Infection Control Practices Advisory Committee, the Hospital Infection Program, the National Center for Infectious Diseases, and the Centers for Disease Control and Prevention.
The first part of the guideline is an Overview that serves as background for the consensus recommendations. The Overview describes the epidemiology, definitions, microbiology, pathogenesis, and surveillance of SSIs. Part I also discusses SSI prevention measures such as antimicrobial prophylaxis, barrier precautions, sterilization practices, operating room environment, and surgical technique. Recommended strategies for the prevention of SSIs are found in Part II. The Guideline can be found on the Internet at www.wais.access.gpo.gov. You can also contact the CDC Fax Information Center at (888) 232-3228 and order document #370160. Once you reach the menu of options, press 2, 2, 3, 2, 2, 1, 5 to go directly to the guideline information.
o Vice President Al Gore’s Department of Health and Human Services report, The Challenge and Potential for Assuring Quality Health Care for the 21st Century, can be accessed on the Internet at http://www.ahcpr.gov/qual/21stcena.htm. The report illustrates how quality improvement efforts, including measurement and reporting, improve the delivery of care, reduce mortality and morbidity, and enhance the quality of life. In the last decade, states the report, federal and state governments, private employers, health insurers, health plans, health care professionals, labor unions, and consumer advocates have developed successful strategies to measure and improve the quality of health care. For example:
• The New York State Department of Health released data on the quality of heart bypass surgeries at all of the hospitals in that state. Use of these data has helped reduce mortality in bypass cases by 50% in five years.
• A Michigan hospital has reduced complications due to drug reactions in their cardiac care unit by 80%.
• At the LDS Hospital in Salt Lake City, a quality improvement program decreased adverse drug reactions related to antibiotics by 75%.
• An asthma program in Boston has achieved an 86% reduction in hospital visits and a 79% reduction in emergency room visits. In 1992, asthma led to 468,000 hospitalizations in the United States at an annual cost of $6.2 billion.
• The use of National Institutes of Health guidelines has led to a 100% increase in the use of a drug to prevent death among premature babies.
• Minnesota hospitals have increased the use of beta-blocker therapy to prevent second heart attacks, which are often fatal, by 63% through provider education and performance feedback.
o HHS Secretary Donna E. Shalala has released Healthy People 2010 Objectives: Draft for Public Comment, which proposes more than 500 national objectives for improving the health of Americans by the year 2010. First established in 1979 in a report prepared by the Office of the Surgeon General, the Healthy People concept is regularly revised, and Healthy People 2010 is the fourth iteration. The document is widely used as a strategic management tool by the federal government, states, and local communities. This latest incarnation, which succeeds Healthy People 2000, reflects recent advances in science and medicine, as well as emerging public health challenges.
Public comments can be submitted either through the Web site, http://web.health.gov/healthypeople/1998.htm, or by mail until Dec. 15. Comments can be mailed to the Office of Disease Prevention and Health Promotion, Attention: Healthy People 2010 Objectives, Hubert H. Humphrey Bldg., Room 738G, 200 Independence Ave. SW, Washington, DC 20201.
The final report will be issued January 2000. The first interim report on Leading Health Indicators for Healthy People 2010 is available from National Academy Press, 2101 Constitution Ave. NW, Box 285, Washington, DC 20055; (800) 624-6242; http://www.nap.edu.