Several projects originating in health departments were also described. First, in Phoenix, Arizona, a diabetes intervention focused on training pharmacists because they were seen as a point of entry for patients into the health care system.

California has several interesting projects as well. The state has had success in increasing the rates of mammography for breast cancer screening in lower-income women. In fact, low-income women in California actually have higher screening rates than other women because of the resources spent on this effort.

The issue of targeted data was also a theme for discussion regarding best practices. Targeted data can serve as a kind of compass or GPS system to let one know if an intervention is working or if there are problems. In this way, these interventions are data-driven public health policies. In California, for example, health department personnel used such data to drive dramatic improvements in mammogram rates for poor women.

Clancy’s breakout group also discussed the concept of being a member of a team. The team concept itself requires knowledge of and experience with cross-cultural communication.

Lewin described a program at an Indian Health System care facility that required physicians to go out into the community to where people live. In this way, they had to travel to the reservation in order to see the environment in which people lived and the circumstances of their lives.

Several tensions within the quality improvement community were discussed. First, can quality improvement be attained “one disease at a time”? Second, there is the tension between disease-focused efforts and person-focused efforts. And finally, what are the potential spillover effects from any quality improvement effects?