Margaret E. O'Kane on healthcare accreditation. Interview by Wanda Bishop and Kevin C. Park.

Since 1990, Margaret E. O'Kane has served as president of the National Committee for Quality Assurance (NCQA), an independent, not-for-profit organization whose mission is to improve the quality of healthcare everywhere. Under O'Kane's leadership, NCQA has developed broad support among the employer and health plan communities; today many Fortune 100 companies will do business only with NCQA-accredited health plans. About three quarters of the nation's largest employers use Health Plan Employer Data and Information Set (HEDIS) data to evaluate the plans that serve their employees. O'Kane was named Health Person of the Year in 1996 by the journal Medicine & Health. She also received a 1997 Founder's Award from the American College of Medical Quality, recognizing NCQA's efforts to improve managed care quality. In 1999, O'Kane was elected a member of the Institute of Medicine. In 2000, she received the Centers for Disease Control and Prevention (CDC) Champion of Prevention award, the agency's highest honor. CDC names a Champion of Prevention infrequently and only when an individual has made a truly notable contribution to advancing preventive healthcare. O'Kane began her career in healthcare as a respiratory therapist and has a master's degree in health administration and planning from Johns Hopkins University.

Modified AFLP technique for rapid genetic characterization in plants.

The standard amplified fragment-length polymorphism (AFLP) technique was modified to develop a convenient and reliable technique for rapid genetic characterization of plants. Modifications included (i) using one restriction enzyme, one adapter molecule and primer, (ii) incorporating formamide to generate more intense and uniform bands and (iii) using agarose gel electrophoresis. Sea oats (Uniola paniculata L.), pickerel-weed (Pontederia cordata L.), Bermudagrass (Cynodon dactylon L.) and Penstemon heterophyllus Lindl. were used to determine the ability to generate adequate resolution power with both self- and cross-pollinated plant species including cultivars, ecotypes and individuals within populations. Reproducibility of bands was higher in all the AFLP experiments compared to random amplified polymorphic DNA (RAPD). Formamide with or without bovine serum albumin improved band intensities compared to dimethyl sulfoxide and the standard reaction mixture with no organic solvents. Comparison between RAPD and modified AFLP using sea-oats population samples proved that modified AFLP exhibits (i) a low number of faint bands with increased specificity of amplified bands, (ii) a significantly higher number of polymorphic loci per primer, (iii) less primer screening time, (iv) easy scoring associated with fewer faint bands and (v) greatly enhanced reproducibility. The technique described here can be applied with a high degree of accuracy for plant genetic characterization.

NCQA requirements: friend or foe?

In this time of intensified cost-containment pressures and low funding for behavioral healthcare services, organizations are particularly sensitive to externally imposed requirements that add expense and administrative burden. As a tradeoff, the contribution of such requirements to the overall quality of behavioral health services is vitally important. The requirements of the National Committee for Quality Assurance (NCQA) have stimulated many intensely felt reactions among a wide range of managed behavioral healthcare stakeholders, undoubtedly because of the substantial impact those requirements are creating. The reactions portrayed in this dialogue section, from representatives of the payor, purchaser, provider and consumer communities and from NCQA itself, indicate the ambivalence stakeholders have toward the quality-assurance movement.

Making the grade: update on report card initiatives for 1997.

Report cards for healthcare services are increasingly in the news, offering the hope that objective information on the quality of health plan and providers services will eventually enable purchasers and consumers to make selections based on true value. Following is a series of five brief articles that review ongoing report card initiatives in private and public sectors of the behavioral healthcare system. The first four articles review actual report cards designed to hold organizations--particularly managed care--accountable for the quality of their services. The last article reviews research on performance measurement across all segments of the behavioral healthcare industry.

Use of a 24-hour recall diary to assess exposure to environmental tobacco smoke.

Methods to assess exposure to environmental tobacco smoke need to be valid and relatively easy to use. We therefore explored the use of a 24-h environmental tobacco smoke exposure-recall diary by comparing data from the 24-h diary with questionnaire responses and levels of salivary cotinine--a biochemical marker of environmental tobacco smoke exposure. A total of 875 nonsmokers at five Rhode Island worksites participated in the study. Twenty-five percent of the participants lived with smokers, and 96% had regular exposure to environmental tobacco smoke at work. Individuals who lived with smokers reported more exposures in the 24-h diary, both outside of work and during work hours, compared with those who had no smokers in their household. The correlation between saliva cotinine concentrations and the exposures recorded in the diary was weak (r = .10). Brief instruments for assessment of environmental tobacco smoke should be viewed cautiously, and use of this 24-h recall diary is not recommended.

Knowledge and use of lifting techniques among a group of undergraduate student nurses.

As part of a nursing degree course, one of the authors (M.K.) gathered data on the knowledge and use of lifting techniques among a group of undergraduate student nurses. A 17-item questionnaire was administered to one cohort of 19 third-year students. The results show that while they were aware of lifts recommended by the RCN and by other researchers, they reported that they frequently used lifts not recommended by the above sources during their medical placement. This behaviour seemed to mirror the practices of ward staff. Possible explanations for the knowledge-practice gap are offered.

Exposure to environmental tobacco smoke in naturalistic settings.

BACKGROUND: Exposure to environmental tobacco smoke (ETS) has been identified as a risk factor for chronic disease among nonsmokers. Results of epidemiological surveys suggest that the majority of nonsmokers have regular ETS exposure. However, little is known about the topography of exposure. METHODS: An exposure diary was used by 186 nonsmokers to self-monitor ETS exposure over a 7-day period. Subjects also completed a questionnaire that assessed their patterns of ETS exposure. RESULTS: The primary source of ETS exposure was the workplace, except when there was a smoker in the household, in which case the household was the primary source. The presence of a smoker in the household resulted in higher levels of exposure both at work and in other locations when compared with subjects without household exposure. Subjects' assessments of exposure on the questionnaire were consistently lower than their self-monitored levels. This finding suggests that general exposure ratings underestimate exposure. CONCLUSIONS: This study provides a new understanding of the patterns of ETS exposure and may help guide the development of policies and interventions designed to reduce ETS exposure.