Winter 2003 - Volume 7 Number 1

Original Research

Care of Common Medical Conditions in a Managed Care Program for Uninsured Adults
David W Price, MD, FAAFP; Robert E Swaney III, MD, MSPH; Stanley Xu, PhD; Jennifer R Goodspeed, MSEd; John F Steiner, MD, MPH
This article describes a retrospective cohort study, its implications, and its limitations. The study was designed to examine change in utilization and clinical process and outcome of care for adult patients with common chronic health conditions within a managed care program implemented for uninsured adults.
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Clinical Contributions

Clinical Vignettes: Heart Failure
Anthony Steimle, MD, FACC
This Vignette uses a case history to illustrate a concise overview of the recently updated Care Management Institute's Heart Failure Management Guidelines. Emphasis is placed on the fact that heart failure can occur in the present of apparently normal systolic contractibility.

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Putting Heart Disease Guidelines Into Practice: Kaiser Permanente Leads the Way
Nan Pheatt, MPH, MT(ASCP); Ralph G Brindis, MD, MPH, FACC; Eleanor Levin, MD, FACC
With the generally poor implementation of management guidelines for coronary artery disease, this article reviews four programs, including one at Kaiser Permanente Northern California, that have improved implementation by changing the health care delivery system.

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Corridor Consult: How Shall We Manage Isolated Systolic Hypertension in Older Adults? Case Example and Suggestions
Ricardo A Soltero, MD; Dean A Kujubu, MD
A typical case of isolated systolic hypertension in an asymptomatic older adult is presented. The diagnosis and treatment suggestions are discussed.

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Special Feature

Remembering Martin Shearn, MD
This special feature honoring the late Martin Shearn, MD, a distinguished physician with TPMG, includes a personal account of the challenges of living with an Alzheimer's patient and a thoughtful discussion of art as a communication tool for dementia patients. Several of Dr Shearn's artworks are included in this issue.

Martin Shearn, MD

Martin A Shearn, MD

Arthur L Klatsky, MD
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A Tribute to Martin Shearn, MD
Edgar J Schoen, MD
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Living with Alzheimer's
Lori Shearn
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Artistic Expression with Dementia
Kate Scannell, MD
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16 Hands
Martin Shearn, MD

Health Systems

The Graying of Kaiser Permanente.
Richard D Della Penna, MD; Kate S Heumann, MPP
The changing demographics in America are reflected in Kaiser Permanente. This article discusses the methods Kaiser Foundation Health Plan and the Permanente Medical Groups are implementing to address this challenge.

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CPC Corner: Spending Time on the Other Side of the Doctor-Patient Relationship
Cheryle Sullivan, MD
Being transformed from doctor to patient created a potent environment for experiencing medical care from a new perspective. This article shares the valuable lessons learned through personal experience.

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Application of the Cooperative Health Care Clinic Model for Delivery of Complementary/Alternative Medicine (CAM) Care
Charles Elder, MD, MPH, FACP
A national survey suggests that CAM availability is an important consideration to consumers. This review of collected data demonstrates support of providing CAM care via an internal Cooperative Health Care Clinic.

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Fulfilling the Potential of Clinical Information Systems
Robert M Crane, MPA; Brian Raymond, MPH
Despite revolutionary predictions, Kaiser Permanente is one of a few health care delivery systems that has successfully implemented a Clinical Information System. This overview demonstrates how the benefits outweigh the roadblocks and offers some public policy suggestions to encourage broader implementation.

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Physicians as Leaders: The Physician as Leader
Phillip J Tuso, MD, FACP
Physicians play an important leadership role. This articles shares six universal and timeless characteristics of great leaders.

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The Sydney A Garfield Legacy--A Tradition of Caring
Edward Thomas, RN, MBA; Annie Wing, MBA
The mission of the Sydney A Garfield Memorial Fund, developed to honor Dr Garfield, is to continue his legacy of encouraging innovation and exploration of new models of care. This commentary describes the Fund's operation and current initiatives.

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Editorial Comments

Discovering a Remedy for Physician Work Stress--Making the Case for Team-Based Care and Physician Leadership in Group Practice
Lee Jacobs, MD, Associate Editor, Health Systems
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Reflections on Heart Failure
Arthur L Klatsky, MD, Associate Editor, Clinical Contributions
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Abstracts of articles authored or coauthored by Permanente clinicians
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Book Reviews

Success with Heart Failure: Help and Hope for Those with Congestive Heart Failure. 3rd edition
Marc Silver, MD
Review by Vincent J Felitti, MD
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Yoga and the Gentle Art of Healing: A Journey of Recovery After Breast Cancer
Susan Rosen
Review by Kathy Peterman, RN, MA
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Journal of Telemedicine and Telecare
Review by Vincent J Felitti, MD
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The Truth Will Set You Free: Overcoming Emotional Blindness and Finding Your True Adult Self
Alice Miller
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Soul of the Healer

Starry Night; Basque Series
Paul Ackerman, MD

 "You'll Never Get Off the Table"
Tom Janisse, MD
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Fishing Camp; Lake Millinocket, ME
Paul Ackerman, MD


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