Enhancing performance measurement: NCQA's road map for a health information framework. National Committee for Quality Assurance.

Measuring the quality of health care delivery is one of the most critical challenges facing US health care. Performance measurement can be used to track the quality of care that health plans and medical groups deliver, but effective performance measurement requires timely access to detailed and accurate data. In 1996, the National Committee for Quality Assurance (NCQA) commissioned a report to learn what actions would improve health plans' capacity to electronically report performance data for the Health Plan Employer Data and Information Set (HEDIS). Tracking clinical performance will require not just clinical data stored in information systems, but an integrated health information framework. Seven features are essential to this framework: (1) it specifies data elements; (2) it establishes linkage capability among data elements and records; (3) it standardizes the element definitions; (4) it is automated to the greatest possible extent; (5) it specifies procedures for continually assessing data quality; (6) it maintains strict controls for protecting security and confidentiality of the data; and (7) it specifies protocols for sharing data across institutions under appropriate and well-defined circumstances. Health plans should anticipate the use of computerized patient records and prepare their data management for an information framework by (1) expanding and improving the capture and use of currently available data; (2) creating an environment that rewards the automation of data; (3) improving the quality of currently automated data; (4) implementing national standards; (5) improving clinical data management practices; (6) establishing a clear commitment to protecting the confidentiality of enrollee information; and (7) careful capital planning. Health care purchasers can provide the impetus for implementing the information framework if they demand detailed, accurate data on the quality of care.

Effects of ifenprodil and baclofen on exercise-induced increase of myocardial oxygen demand in normotensive rats.

Central glutamatergic relays are known to be present in the central sympathetic pathways. Ifenprodil (an N-methyl-D-aspartate antagonist) and baclofen (a gamma-aminobutyric acid(B) agonist) are both modulators of these synapses; we previously reported their ability to reduce the cardiovascular responses induced by a central hypothalamic stimulation in rabbits. In this work, we investigated the actions of chronic treatments with these two drugs on the increase of myocardial oxygen demand induced by exercise in normotensive rats. Moreover, their effects on the baroreceptor heart rate reflex were observed. Male normotensive WKY rats were treated with placebo (two groups), baclofen, or ifenprodil for 14 days. They were then submitted to a progressively increased exercise test on a treadmill. In another three groups of animals, the same treatment was applied but, at the end, a baroreflex study was performed by the injection of phenylephrine (vagal component of the reflex) and of sodium nitroprusside (sympathetic component). Ifenprodil and baclofen reduced by nearly 50% the level of the increase of the rate x pressure product during exercise as compared with control rats. This effect appeared to be mainly due to a reduction of the hypertensive response. In the same conditions, neither baclofen nor ifenprodil significantly altered the baroreceptor heart rate reflex. The fact that these two drugs are capable of reducing the myocardial oxygen demand encourages us to test them in a model of myocardial ischemia associated with sympathetic hyperactivity.