Health care's quality improvement imperative.

In health care, as quality improves, costs tend to decline. The goals of excellent care and affordable costs are not mutually exclusive. Borrowing quality improvement techniques from manufacturing industries, physicians and other health care professionals are achieving breakthroughs in improving the quality and reducing the cost of care. Quality improvement continues the tradition of scientific inquiry in medicine and places new emphasis on accountability to the customers of health care: patients and payers. By examining processes, clinicians look at the delivery of care across different treatment modalities and rely on the insights of employees involved at every stage of the processes. Intermountain Health Care is one American health care organization that has experienced significant success in improving quality and reducing cost through the use of quality improvement methods.

Parker discusses vision. Interview by Donald E. L. Johnson.

What special challenges face a major multi-hospital network as it enters the 1990s, offering care to diverse communities? What problems will its CEO have to deal with in an era of cutbacks and change? Scott S. Parker, president and chief executive officer of Intermountain Health Care, Inc., (IHC), a not-for-profit health care delivery system of 24 hospitals in Utah, Idaho, and Wyoming, plus an array of other medical facilities and services, discusses the challenges and accomplishments with Donald E. L. Johnson, publisher of Health Care Strategic Management. In the following interview, he talks about strategies and opportunities among many other topics.

Multihospital systems form a cooperative for sharing services.

Ten regional multihospital systems pool resources, exchange ideas, share services, and engage in joint purchasing.

Response of asthmatics to isoprenaline and salbutamol aerosols administered by intermittent positive-pressure ventilation.

The bronchodilator and cardiac effects produced by aerosols of 0.5% isoprenaline and of 0.25, 0.5, and 1% salbutamol administered in 40% oxygen by intermittent positive-pressure ventilation were compared in 24 asthmatic patients. Isoprenaline and salbutamol in concentrations of 0.5% were equipotent in peak bronchodilator effect; salbutamol was superior in total bronchodilator effect and duration of average effect, but the peak bronchodilator effect occurred earlier after isoprenaline. Significantly greater tachycardia was produced by 0.5% isoprenaline than by the same concentration of salbutamol. The 0.25, 0.5, and 1% concentrations of salbutamol had about the same peak bronchodilator effect, but there was a stepwise increase in total effect and duration of average effect in relation to the concentration used. A similar stepwise increase in heart rate was also noted, but with all concentrations this was significantly less than with 0.5% isoprenaline. It was concluded that a 0.5% solution of salbutamol, which provided maximal bronchodilatation without important tachycardia, was therapeutically superior to the other three treatments.

Bronchodilator effect of oral salbutamol in asthmatics treated with corticosteroids.

In a double-blind trial the effect on ventilatory function of oral salbutamol (in two different doses) and a placebo were studied in 12 patients with chronic asthma receiving regular maintenance treatment with prednisolone. Salbutamol in a dose of 4 mg four times daily, given for a period of four weeks, produced a sustained and statistically significant increase in peak expiratory flow rate over the pretreatment recordings. This effect was not observed with a lower dose of salbutamol (2 mg four times daily) or with a placebo. Salbutamol in the higher dose would seem to be an effective and safe oral bronchodilator that can be recommended for the treatment of mild or moderate asthma. The duration of treatment in this study was, however, limited to four weeks, and it is not known whether effective bronchodilatation would be maintained if the drug were given for longer periods.