Fischer HH, MacKenzie TD, Steele AW, Eisert SL, Moore SL, Durfee MJ. Assessing the Impact of a Dynamic Chronic Care Registry on the Quality of Care: Implementation Handbook. Prepared for the Agency for Healthcare Research and Quality. Published online 2009 May 27.

The implementation handbook describes the design, existing infrastructure, outcomes, lessons learned and recommendations derived from the implementation of a three-pronged intervention plan. This intervention was designed to improve the quality of care provided to adult diabetic patients currently receiving care at Denver Health through the use of information from an integrated diabetes registry. This handbook is intended for use within Denver Health for replication in similar programs using registries and for other institutions to decide whether their organization is suitably positioned for this intervention.

Eisert SL, Durfee MJ, Welsh A, Moore SL, Gabow PA, Mehler PS.  Changes in Insurance Status and Access to Care in an Integrated Safety Net Healthcare System.  J Community Health. Volume 34, Issue 2 (2009), Page 122. Published online 2008 Oct 21; DOI: 10.1007/s10900-008-9136-2.

This paper focuses on a cohort of uninsured patients that have accessed outpatient healthcare services in an urban safety net, evaluating the degree to which they switch insurance status and the impact this switching has on access to care. The results indicate that in an integrated safety net system, there is a high frequency of insurance status switching by the uninsured. Uninsured patients who switch to insured status were found to be more likely to visit specialty points of care and less likely to visit urgent points of care than the continuously uninsured. It is well documented that insurance coverage and continuity of care influence health status. Continuity of insurance coverage also has an impact on access to care for those receiving services within a safety net healthcare system.

Eisert SL, Mehler PS, Gabow PA. Can America's urban safety net systems be a solution to unequal treatment?J Urban Health. 2008 Sep;85(5):766-78. Epub 2008 Jun 14.

Eliminating disparities in care for racial and ethnic minorities remains a challenge in achieving overall quality health care. One approach to resolving issues of inequity involves utilizing an urban safety-net system to address preventive and chronic care disparities. An analysis was undertaken at Denver Health (DH), an urban safety net which serves 150,000 patients annually, of which 78% are minorities and 50% uninsured. Medical charts for 4,795 randomly selected adult patients at ten DH-associated community health centers were reviewed between July 1999 and December 2001. Logistic regression was used to identify differences between racial/ethnic groups in cancer screening, blood pressure control, and diabetes management. No disparities in care were found, and in most instances, the quality of care met or exceeded available benchmarks, leading us to conclude that treatment in urban integrated safety net systems committed to caring for minority populations may represent one approach to reducing disparity.

Gabow, P.A., Albert R., Kaufman L., Wilson M., Eisert SL.  Picture of health:  Denver Health uses 5S to deliver quality, safety, efficiency.  Industrial Engineer; 44-48, February 2008.

Concerns continue to grow with regard to American health care in terms of quality, safety, and cost. The public demands that health care institutions address these issues, but there are no simple solutions. As health care leaders consider approaches that would help solve these problems, it seems prudent to examine other industries that have addressed similar problems and use the approaches and tools that have allowed them to achieve success.