WIHI - A Podcast from the Institute for Healthcare Improvement

If blood pressure (BP) control could be improved, many deaths from cardiovascular and renal disease could be prevented. The Chronic Care Model was used to design an intervention that empowered patients to be more involved in their own care using home BP monitoring, a patient shared electronic medical record, and Web-based pharmacist assistance. The group of patients that received BP monitors and training to use an existing patient website (with encouragement to send their BP numbers to their physician) had a modest decrease in systolic blood pressure, but BP control did not significantly improve. The group that received BP monitors, web training, and web-based pharmacy assistance had greater decreases in BP and were almost two times as likely to have controlled BP.

People with symptoms of depression are more likely to engage in diabetes-producing health behaviors, including eating more, exercising less, and smoking more. As a consequence, they were more obese. People with elevated symptoms of depression had a 42 percent increased risk of developing type 2 diabetes over 3 years. This was partially explained by unhealthy behaviors. People with treated type 2 diabetes had a 52 percent increased risk of developing depressive symptoms over 3 years. This suggests that individuals with diabetes should be monitored for development of depression.

Which way forward for the quality improvement and patient safety movements? Join IHI's President and CEO, Donald Berwick, for a series of conversations with Senior Communications Strategist, Madge Kaplan. Each monthly installment offers Dr. Berwick's latest thinking on the major issues of the day and how health care professionals, health care leaders, and patients and families can bring about significant reform.

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Adding a single screening ultrasound examination to screening mammography in women at increased risk of breast cancer with at least heterogeneously dense breasts increases the cancer detection rate from 50% to 78%. The risk of a biopsy for a benign lesion in our series was 1 in 40 for women undergoing mammography vs. 1 in 10 for women undergoing mammography combined with ultrasound screening. Using the standardized technique and interpretive criteria developed for this study, other radiologists and facilities with similar equipment and experience should expect similar results.

Which way forward for the quality improvement and patient safety movements? Join IHI's President and CEO, Donald Berwick, for a series of conversations with Senior Communications Strategist, Madge Kaplan. Each monthly installment offers Dr. Berwick's latest thinking on the major issues of the day and how health care professionals, health care leaders, and patients and families can bring about significant reform.

Reducing LDL-C and SBP to lower targets resulted in regression of carotid atherosclerosis and decrease in LV mass in individuals with type 2 diabetes. Clinical event rate was low in both groups and did not differ. Longer term follow-up will be necessary to determine whether the aggressive targets result in favorable risks/benefits. More emphasis should be placed on reaching conventional targets for both LDL-C and SBP in diabetic patients. More trials are needed that evaluate targets for lipids and BP rather than specific treatment regimens.

Which way forward for the quality improvement and patient safety movements? Join IHI's President and CEO, Donald Berwick, for a series of conversations with Senior Communications Strategist, Madge Kaplan. Each monthly installment offers Dr. Berwick's latest thinking on the major issues of the day and how health care professionals, health care leaders, and patients and families can bring about significant reform.

Which way forward for the quality improvement and patient safety movements? Join IHI's President and CEO, Donald Berwick, for a series of conversations with Senior Communications Strategist, Madge Kaplan. Each monthly installment offers Dr. Berwick's latest thinking on the major issues of the day and how health care professionals, health care leaders, and patients and families can bring about significant reform.