Systems collaborate for a healthier community. A Community Health Advisory Board focuses on immunization

The Community Health Advisory Board (CHAB), Pierce County, WA, involves four healthcare systems--Franciscan Health System, MultiCare Medical Center, Group Health Cooperative of Puget Sound, and Good Samaritan Hospital--that have joined forces with other providers in an innovative attempt to better serve their community. An evaluation by representatives of New York University's Hospital Community Benefit Standard Program prompted St. Joseph Medical Center, Tacoma, WA, to bring major providers together in a coordinated effort that could reach community residents in need. At their first meeting in November 1992, CHAB members agreed on a purpose: to facilitate collaboration between healthcare providers throughout the county to develop programs and services that improve the health status of community residents. In January 1993 CHAB members selected a "quick success" project: a program aimed at increasing immunization levels to 90 percent for two-year-old children in the county. In February 1993 CHAB members committed the "best and brightest" to the Immunization Task Force, naming experts in planning, nursing, community health, education, and marketing. When the Immunization Task Force assessed the project, they realized that the "quick success" program would not be accomplished so quickly. CHAB has had to address underlying problems to make higher immunization levels sustainable. In March 1994 members will evaluate the immunization program's process, status, and structure; data on immunization levels; and the group's demonstrated ability to cooperate.     

Health services utilization reporting in respiratory patients. Pharmacy Medication Monitoring Program Advisory Board

Health services utilization information is important for outcomes research. This study assessed the reliability of self-reports of health services utilization in respiratory patients. Patients reported health services use and other information during three telephone interviews over 6 months. Reports of visits to general practitioners (GPs), specialists, emergency room (ER)/clinics, and hospital admissions were compared with corresponding fee service claims in the Ontario Health Insurance Plan administrative database in 83 subjects. Agreement between the two sources was calculated using observed agreement and estimated kappa. Substantial agreement was found for hospital admissions and visits to respiratory specialists. Agreement was moderate for GP visits and slight for ER/clinic visits. Patient self-report of ER use appeared unreliable and may be related to imprecise questionnaire wording and inadequately defined fee service codes. The findings emphasize the importance of the methods used to assess the reliability of patient self-reports used in outcomes research.