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PubMed1995

Factors which influence the rate of receiving a routine second newborn screening test in Washington State.

This study was conducted to determine whether newborns from different ethnic and socioeconomic groups in Washington State are equally likely to have a routine second newborn screening (NBS) test and if there are identifiable factors associated with not having a second test. For many years, the standard of care for NBS in Washington has been that newborns should receive a routine second screening test at age 7-10 days. However, data collected by State Department of Health (DOH) staff for the past several years indicated that only about 80% of newborns receive a routine second NBS test. The data presented here suggest that identifiable factors (i.e., barriers) exist in accessing a routine second NBS test in Washington. Increased educational efforts targeting certain high-risk infants, their parent/caretakers, and primary care providers are apparently needed to ensure equal access to a routine second test.

Adult↗
PubMed2003

Orofacial cleft malformations: associations with maternal and infant characteristics in Washington State.

BACKGROUND: To characterize the prevalence of orofacial cleft malformations and investigate variations in prevalence according to maternal and infant characteristics, we analyzed a cohort of 298,138 live births delivered between 1987 and 1990 to residents of Washington State. METHODS: Infants with cleft defects were identified using a statewide, population-based birth defects registry. Information on infant and maternal characteristics was obtained from Washington State birth certificates. Multiple logistic regression analysis was used to measure the association between potential risk factors and orofacial clefts. Cleft lip with or without cleft palate (CL +/- CP) and cleft palate (CP) were analyzed separately, depending on the presence or absence of other defects. RESULTS: We identified 608 infants with cleft defects. The prevalences of isolated and non-isolated CL +/- CP were 0.87 and 0.30 per 1,000 live births, respectively. The prevalences of isolated and non-isolated CP were 0.34 and 0.54 per 1,000 live births, respectively. Compared with mothers aged 25-29 years, mothers aged < 20 years were twice as likely to have an infant with isolated CL +/- CP (RR = 2.0; 95% CI 1.3, 2.9). Compared to white mothers, black mothers were more likely to have an infant with non-isolated CL +/- CP (RR = 2.8; 95% CI 1.2, 6.6). CONCLUSIONS: The prevalences of orofacial clefts in Washington State in 1987-90 were similar to those of other states. This study is among the first to report a greater relative risk for isolated CL +/- CP among the infants of mothers < 20 years compared to older mothers.

Birth Certificates↗
PubMed2002

Acute toxicity of drainage ditch water from a Washington State cranberry-growing region to Daphnia pulex in laboratory bioassays.

High concentrations of organophosphorous insecticides resulting from cranberry bog applications were detected in the Grayland Drainage Ditch (GDD) system in Grayland, Washington State, during the 1994-1996 Washington State Department of Ecology Pesticide Monitoring Program. This drainage ditch system drains cranberry bogs and enters the Pacific Ocean via the North Cove and Supon Inlet. Concerns about the impact of these pesticides on human and environmental health led to this investigation of the potential impact on an indicator species, Daphnia pulex. To determine the toxic effects of multiple pesticides entering the GDD, standardized laboratory toxicity tests with D. pulex were conducted concurrently with the Washington State Department of Ecology pesticide sampling. Concentrations of three insecticides, diazinon, chlorpyrifos, and azinphosmethyl, were the highest ever detected in state waters. The GDD water was found to cause acute toxicity in 33% of the laboratory bioassays conducted. Regression analysis, however, detected a poor correlation between total insecticide detected and percentage mortality of D. pulex at the two drainage ditch sites studied, Grays Harbor County site and the Pacific County site. However, the relationship between mortality of D. pulex and detected concentrations of diazinon and chlorpyrifos were significant. Sampling schedules for chemical analysis and bioassay testing appear to be the primary reason that statistical analysis failed to correlate mortality with detected OP pesticide concentrations. Grab samples used in toxicity testing may over- or underestimate actual concentrations of contaminants present in the system being studied.

Agriculture↗
PubMed2003

Environmental control and limnological impacts of a large recurrent spring bloom in Lake Washington, USA.

A series of statistical analyses were used to identify temporal and spatial patterns in the phytoplankton and nutrient dynamics of Lake Washington, an mesotrophic lake in Washington State (USA). These analyses were based on fortnightly or monthly samples of water temperature, Secchi transparency, ammonium (NH(4)), nitrate (NO(3)), inorganic phosphorus (IP), total nitrogen (TN), total phosphorus (TP), dissolved oxygen (DO), pH and chlorophyll a (chl a) collected during 1995-2000 from 12 stations. Lake Washington has a very consistent and pronounced annual spring diatom bloom which occurs from March to May. During this bloom, epilimnetic chl a concentrations peak on average at 10 microg/L, which is 3 times higher than chl a concentrations typically seen during summer stratified conditions. The spring bloom on average comprised 62% diatoms, 21% chlorophytes and 8% cyanobacteria. During summer stratification, diatoms comprised 26% of the phytoplankton community, chlorophytes 37% and cyanobacteria 25%. Cryptophytes comprised approximately 8% of the community throughout the year. Overall, 6 phytoplankton genera (i.e., Aulacoseira, Fragilaria, Cryptomonas, Asterionella, Stephanodiscus, and Ankistrodesmus) cumulatively accounted for over 50% of the community. These analyses also suggest that the phytoplankton community strongly influences the seasonality of NO(3), IP, DO, pH and water clarity. According to a MANOVA, seasonal fluctuations explained 40% of the total variability for the major parameters, spatial heterogeneity explained 10% of variability, and the seasonal-spatial interaction explained 10% of variability. Distinctive patterns were identified between offshore and inshore sampling stations. The results of our analyses also suggest that spatial variability was substantial, but much smaller than temporal variability.

Environmental Monitoring↗
PubMed2003

Surgeon experience with laparoscopic-assisted colorectal surgery in Washington State.

PURPOSE: To describe the current practice and opinions held by surgeons performing colorectal surgery in Washington regarding laparoscopic colorectal surgery. METHODS: After attempting to identify all surgeons with hospital privileges in colorectal surgery in Washington, a survey was sent to 303 surgeons. The survey asked about the surgeon's practice, volume of colon surgery in the preceding year, the number of laparoscopic colon resections ever performed, the surgeon's opinion on the future practice of laparoscopic colorectal surgery, and whether faced with the personal need to undergo colon resection at the present time, would the surgeon elect to have laparoscopic or open colon resection. RESULTS: In all 170 surveys were returned; 154 returned surveys were from surgeons who had performed at least one colon resection in the preceding year; 53 (34%) respondents had experience with fewer than 20 laparoscopic resections and 83 (55%) have never performed laparoscopic-assisted colectomy (LAC). Only 4 (3%) surgeons had performed more than 50 laparoscopic colon resections. Forty-five percent of respondents indicated that they would currently seek a laparoscopic resection for themselves to treat either a benign condition or an incurable malignancy, and 84% of respondents indicated they would have an open colectomy for a curable malignancy. CONCLUSIONS: The majority of surgeons performing colorectal resections in Washington have limited experience with LAC. Surgeon opinion regarding the role of laparoscopic colorectal surgery in clinical practice is mixed. We suggest a model for proctoring of LAC for surgeons interested in implementing laparoscopic colorectal resection into their practice.

Attitude of Health Personnel↗
PubMed2001

Managed care and perinatal regionalization in Washington State.

OBJECTIVE: To determine if an association exists between managed care penetration and perinatal deregionalization in Washington State. METHODS: The proportions of low birth weight (LBW) and very low birth weight (VLBW) deliveries were tabulated for each hospital in Washington State for the years 1989, 1993 and 1996. Level of perinatal care, degree of health maintenance organization (HMO) penetration, and maternal demographic characteristics including age, race, smoking, and Medicaid status were derived from state and national databases. Multiple linear regression analysis was performed for each hospital level to evaluate the association between change in proportion of LBW and VLBW deliveries and change in HMO penetration per hospital between each of the 3 years. RESULTS: From 1989 through 1993, the proportion of LBW deliveries significantly declined at level III hospitals and rose at level I and II hospitals. This trend reversed between 1993 and 1996. Very low birth weight deliveries demonstrated more limited and somewhat contrary results, significantly decreasing, then increasing in level I hospitals, and significantly increasing in level III hospitals from 1989 to 1993. After controlling for changes in maternal characteristics over time, changes in HMO penetration at the hospital level were not significantly associated with an increasing proportion of LBW or VLBW deliveries at nonlevel III hospitals. In some analyses, increasing HMO penetration actually was significantly associated with decreasing LBW and VLBW deliveries at nonlevel III hospitals. CONCLUSION: Despite continued growth in HMOs throughout the state, the trend toward deregionalization in Washington State noted in the early 1990s has not continued. At the hospital level, the increasing presence of HMOs is not significantly associated with perinatal deregionalization.

Adult↗
PubMed2002

Outcomes of planned home births in Washington State: 1989-1996.

OBJECTIVE: To determine whether there was a difference between planned home births and planned hospital births in Washington State with regard to certain adverse infant outcomes (neonatal death, low Apgar score, need for ventilator support) and maternal outcomes (prolonged labor, postpartum bleeding). METHODS: We examined birth registry information from Washington State during 1989-1996 on uncomplicated singleton pregnancies of at least 34 weeks' gestation that either were delivered at home by a health professional (N = 5854) or were transferred to medical facilities after attempted delivery at home (N = 279). These intended home births were compared with births of singletons planned to be born in hospitals (N = 10,593) during the same years. RESULTS: Infants of planned home deliveries were at increased risk of neonatal death (adjusted relative risk [RR] 1.99, 95% confidence interval [CI] 1.06, 3.73), and Apgar score no higher than 3 at 5 minutes (RR 2.31, 95% CI 1.29, 4.16). These same relationships remained when the analysis was restricted to pregnancies of at least 37 weeks' gestation. Among nulliparous women only, these deliveries also were associated with an increased risk of prolonged labor (RR 1.73, 95% CI 1.28, 2.34) and postpartum bleeding (RR 2.76, 95% CI 1.74, 4.36). CONCLUSION: This study suggests that planned home births in Washington State during 1989-1996 had greater infant and maternal risks than did hospital births.

Adult↗
PubMed1999

Hospitalization for motor vehicle injuries among American Indians and Alaska Natives in Washington.

OBJECTIVE: Little is known about the epidemiology of hospitalization for motor vehicle injury among American Indians and Alaska Natives (AI/ANs) in the Pacific Northwest. Current secondary data sources are inadequate to track this significant health problem. The purpose of this study was to determine the rate of hospitalization for motor vehicle injury in this population through linkage of Indian Health Service (IHS) patient registration data to a statewide hospital discharge database. METHODS: To create the numerator, IHS patient registration data were linked to Washington State hospital discharge abstracts from 1990 to 1994 for motor vehicle injury (ICD-9 E-codes 810-819). The denominator for this population was derived from the total number of IHS enrollees in 1992. Comparative numerator and denominator data for all residents were derived from the discharge database and Washington State intercensal population estimates, respectively. RESULTS: AI/ANs experienced a nearly two-fold higher rate of motor vehicle injury hospitalization (N = 588) compared to all residents [Incidence Ratio (I.R.): 1.82; 95% C.I. 1.52-2.19]. The greatest disparity in incidence rates occurred among 25-34 year olds (I.R. 2.18; 95% C.I. 1.53-3.10) and 35-44 year olds (I.R. 2.18; 95% C.I. 1.36-3.47). In-hospital mortality, severity of injury and length of stay were not different between the 2 groups. Median charges for American Indian hospitalizations were $6188 and the IHS was payer in, at most, 24% of hospitalizations. CONCLUSIONS: AI/ANs are at higher risk of hospitalization for motor vehicle injuries but, compared to all residents of Washington, appear to have similar severity of injuries and outcomes. Motor vehicle injury hospitalization among AI/ANs incurs substantial health care costs.

Accidents, Traffic↗
PubMed1998

Community occupational structure, basic services, and coronary mortality in Washington state, 1980-1994.

OBJECTIVE: Examine the association between county occupational structure, public expenditures, services availability, prevalence of risk factors, and coronary mortality rates, for 1980-1994, in Washington state. DESIGN: Washington's 39 counties were classified into three occupational structure categories: counties with the lowest percentages of the labor force in managerial, professional, and technical occupations were classified in category I; counties with the highest percentages were in category III. Directly age-adjusted coronary heart disease (CHD) mortality rates, aged 35-64 years, (from vital statistics and Census data), per capita expenditures (Washington Department of Revenue data), per capita services (U.S. Statistical Abstracts data), and the prevalence of CHD risk factors (BRFSS data) were calculated for each occupational structure category. RESULTS: CHD mortality rates and the prevalence of risk factors were inversely associated with occupational structure. Per capita expenditures for health, social, and employment services were 2.2 times, and for schools and recreation were 1.4 times higher in category III vs. I counties. Per capita numbers of child care, job training, employment services, exercise facilities, schools, and medical services were 1.5-6.4 times greater in category III vs. I counties. CONCLUSIONS: Strategies to improve community living conditions and decrease economic disparities between counties may be important to decrease geographic differences in premature CHD mortality.

Adult↗
PubMed2004

Aroma extract dilution analysis of cv. Meeker (Rubus idaeus L.) red raspberries from Oregon and Washington.

The aromas of cultivar Meeker red raspberry from Oregon and Washington were analyzed by aroma extract dilution analysis. Seventy-five aromas were identified [some tentatively (superscript T)] by mass spectrometry and gas chromatography-retention index; 53 were common to both, and 22 have not been previously reported in red raspberry. Twenty-one compounds had an equivalent odor impact in both: 2,5-dimethyl-4-hydroxy-3-(2H)-furanone, hexanal, 4-(2,6,6-trimethyl-1-cyclohexen-1-yl)-3-buten-2-one, (E)-beta-3,7-dimethyl-1,3,6-octatrieneT, 6,6-dimethyl-2-methylenebicyclo[3.1.1]heptaneT, 1-(2,6,6-trimethyl-1,3-cyclohexadien-1-yl)-2-buten-1-one, ethanoic acid, (Z)-3-hexenalT, 3-methylmercaptopropionaldehyde, (Z)-3-hexenol, 2,6-dimethyl-2,7-octadien-6-ol, butanoic acid, ethyl 2-methylpropanoate, (E)-2-hexenal, hexyl formateT, 2,3-butanedione, heptanalT, thiacyclopentadieneT, cyclohexane carbaldehydeT, (E)-3,7-dimethyl-2,6-octadien-1-olT, and 4-(p-hydroxyphenyl)-2-butanone. Oregon Meeker had 14 odorants with higher flavor dilution (FD) factors than Washington Meeker: 4-(2,6,6-trimethyl-2-cyclohexen-1-yl)-3-buten-2-oneT, 1-octanol, 5-isopropyl-2-methylcyclohexa-1,3-dieneT, 7-methyl-3-methylene-1,6-octadieneT, ethyl hexanoate, 3-methylbutyl acetateT, ethyl propanoate, 4-(4-hydroxy-3-methoxyphenyl)-2-butanoneT, 2-methylbutanoic acid, 1-octen-3-ol, ethyl cyclohexane carboxylateT, 2-methylthiacyclopentadieneT, (Z)-3-hexenyl acetateT, and 4-(2,6,6-trimethyl-2-cyclohexen-1-yl)-3-buten-2-olT. Washington Meeker had 16 odorants with higher FD factors than Oregon Meeker: 5-ethyl-3-hydroxy-4-methyl-2-(5H)-furanoneT, dimethyl sulfideT, 2-ethyl-4-hydroxy-5-methyl-3-(2H)-furanoneT, 1-hexanolT, ethyl 2-methylbutanoate, 3,7-dimethyl-1,6-octadien-3-yl acetateT, methyl hexanoate, phenyl ethanoic acidT, neo-allo-3,7-dimethyl-1,3,6-octatrieneT, 2-nonanoneT, 2-(4-methylcyclohex-3-enyl)propan-2-olT, phenylmethanolT, 5-octanolideT, 2-phenylethanol, 1-isopropyl-4-methylenebicyclo[3.1.0]hexaneT, and 2-undecanone.

Fruit↗
PubMed2002

Multilocus population structure of Tapesia yallundae in Washington State.

Population genetic structure of the fungal wheat pathogen Tapesia yallundae in Washington State was determined using genetically characterized amplified fragment length polymorphic (AFLP) markers and mating-type (MAT1-1 or MAT1-2). Segregation and linkage relationships among 164 AFLP markers and MAT were analysed using 59 progeny derived from an in vitro cross. Alleles at 158 AFLP loci and the mating-type locus segregated in a 1:1 ratio. Ten unlinked markers were chosen to determine genetic and genotypic diversity and to test the hypothesis of random mating and population differentiation among five subpopulations of T. yallundae representative of the geographical distribution of wheat production in eastern Washington. Among 228 isolates collected, overall gene diversity was high (h = 0.425) and a total of 91 unique multilocus genotypes (MLG) were identified, with 32 MLG occurring at least twice. The overall population genetic structure was consistent with random mating based on the segregation of mating-type, index of association (IA), parsimony tree length permutation test (PTLPT) and genotypic diversity analyses. However, clonal genotypes were found within each subpopulation and were also distributed among the five subpopulations. No significant differences in allele frequencies were found among the five subpopulations for all 10 loci based on contingency table analysis (G2) and Wier & Cockerham's population differentiation statistic theta (theta = -0.008, P = 0.722). T. yallundae appears to consist of a large homogeneous population throughout eastern Washington with both sexual and asexual reproduction contributing to the observed population genetic structure despite no report of sexual fruiting bodies of T. yallundae occurring under natural field conditions.

Ascomycota↗
PubMed1998

Medical waste treatment and disposal methods used by hospitals in Oregon, Washington, and Idaho.

This study investigated medical waste practices used by hospitals in Oregon, Washington, and Idaho, which includes the majority of hospitals in the U.S. Environmental Protection Agency's (EPA) Region 10. During the fall of 1993, 225 hospitals were surveyed with a response rate of 72.5%. The results reported here focus on infectious waste segregation practices, medical waste treatment and disposal practices, and the operating status of hospital incinerators in these three states. Hospitals were provided a definition of medical waste in the survey, but were queried about how they define infectious waste. The results implied that there was no consensus about which agency or organization's definition of infectious waste should be used in their waste management programs. Confusion around the definition of infectious waste may also have contributed to the finding that almost half of the hospitals are not segregating infectious waste from other medical waste. The most frequently used practice of treating and disposing of medical waste was the use of private haulers that transport medical waste to treatment facilities (61.5%). The next most frequently reported techniques were pouring into municipal sewage (46.6%), depositing in landfills (41.6%), and autoclaving (32.3%). Other methods adopted by hospitals included Electro-Thermal-Deactivation (ETD), hydropulping, microwaving, and grinding before pouring into the municipal sewer. Hospitals were asked to identify all methods they used in the treatment and disposal of medical waste. Percentages, therefore, add up to greater than 100% because the majority chose more than one method. Hospitals in Oregon and Washington used microwaving and ETD methods to treat medical waste, while those in Idaho did not. No hospitals in any of the states reported using irradiation as a treatment technique. Most hospitals in Oregon and Washington no longer operate their incinerators due to more stringent regulations regarding air pollution emissions. Hospitals in Idaho, however, were still operating incinerators in the absence of state regulations specific to these types of facilities.

Idaho↗
PubMed1999

The long-term effect of an innovative family physician curricular pathway on the specialty and location of graduates of the University of Washington.

PURPOSE: To report the specialty and rural/urban distribution a mean of 19 years after graduation for a cohort of students from a family physician curricular pathway. METHOD: Specialty and location information for medical students who had entered the University of Washington between 1968 and 1973 was obtained from the 1994 Physician Masterfile of the American Medical Association. RESULTS: Of the 239 family physician pathway graduates, 173 (72%) had intended family practice at graduation, and 136 (57%) were family physicians two decades later. The proportions of all graduates in family practice and of graduates serving rural Washington as family physicians had increased over that of a cohort of students who had entered the University of Washington prior to the introduction of the pathway curriculum. These proportions surpassed the goals set at the time the new curriculum was introduced. CONCLUSION: With early identification and support of students interested in family practice, an increased number entered the specialty and were still family physicians in mid-career.

Career Choice↗
PubMed2004

Medical education research at the University of Washington School of Medicine: lessons from the past and potential for the future.

Faculty in the Department of Medical Education and Biomedical Informatics at the University of Washington School of Medicine received over $1.2 million in direct grant and contract support in 2003. In this case study, the authors provide some of the history and background of the evolution of the department's structure and its role in providing leadership in medical education research at the university, as well as regionally, nationally, and internationally. The authors offer their observations and reflections on what has helped and hindered the department's success, and end with some predictions on medical education research in the future. The University of Washington's five-state regional WWAMI educational program, establishing a single medical school for the states of Washington, Wyoming, Alaska, Montana, and Idaho, has been an important environmental influence on the direction of the department's educational and research activities. External support has helped the department to create the Northwest Consortium for Clinical Performance Assessment, the Center for Medical Education Research, the Teaching Scholars Program, and a Biomedical and Health Informatics graduate and fellowship training program, as well as a number of international programs.

Education, Medical↗
PubMed1992

Trends in the utilization of mammography in Washington state and British Columbia: relation to stage of diagnosis and mortality.

To compare the utilization of an imaging technology in the United States and Canada and its effect on clinical outcomes, trends in the utilization of mammography among women aged 50 to 75 years from 1984 through 1988 in Washington State and British Columbia were examined. Also compared were trends in the stage at time of diagnosis of invasive breast cancer and mortality due to breast cancer in the two regions. Annual mammography use increased in both regions, but the proportion of women examined was consistently two to three times higher in Washington than in British Columbia (43% vs 16% in 1988). Although there was no difference in mortality trends, the proportion of women diagnosed with localized disease in Washington increased each year (from 52% to 64%, P less than .001), while in British Columbia it remained unchanged at approximately 56%. Results of this study suggest that differences in utilization were influenced by clinical policies, the degree to which these policies were promoted, reimbursement, and the organization of radiology services.

Aged↗
PubMed1999

Evaluation of the Washington State Workers' Compensation Managed Care Pilot Project I: medical outcomes and patient satisfaction.

OBJECTIVES: This study examined the effect of managed care on medical outcomes and patient satisfaction as part of an evaluation of the Washington State Workers' Compensation Managed Care Pilot. METHODS: One hundred twenty firms (7,041 employees) agreed to have their injured workers treated in managed-care plans. Managed care introduced two changes from the fee-for-service (FFS) delivery system currently used by injured workers in Washington State: (1) experience-rated capitation, and (2) a primary occupational-medicine delivery model. The FFS control group included injured workers employed at 392 firms (12,000 employees). A total of 1,313 workers who experienced occupationally related injuries or illnesses between April 1995 and June 1996 were interviewed by telephone at 6 weeks after injury regarding their medical outcomes and satisfaction with care. Workers whose injuries resulted in four or more lost workdays (n = 372) were also interviewed at 6 months after injury on the same topics. The areas surveyed included functional outcomes and satisfaction with care, providers, and access to providers. RESULTS: The measures of functional outcome reflected no consistent differences between the managed care and the FFS conditions. The workers who attended the managed-care system reported lower levels of satisfaction with care, particularly with access to providers. For example, 58% of managed-care patients reported satisfaction with their attending physician as compared with 69% of FFS patients (P<0.01). CONCLUSIONS: Workers treated through managed-care arrangements were less satisfied with their care, but their medical outcomes were similar to those of workers who received traditional FFS care. The current workers' compensation system in Washington State affords injured workers great latitude in choosing providers. If provider choice is substantially restricted by managed care, worker satisfaction is likely to diminish.

Adult↗
PubMedDate not supplied

Evaluation of the Washington State National Pharmaceutical Stockpile dispensing exercise, part II--dispensary site worker findings.

On January 24, 2002, the Washington State Department of Health, in collaboration with local and federal agencies, conducted an exercise of the Centers for Disease Control and Prevention's National Pharmaceutical Stockpile dispensing portion of the Washington State plan. This exercise included predrill planning, training, and the orchestration of services of more than 40 dispensary site workers. These workers provided education and post-exposure prophylaxis for over 230 patient volunteers in the aftermath of a simulated exposure to B. anthracis. This article discusses findings of a postdrill questionnaire completed by 90% of these dispensary site workers who provided triage, education, dispensary, security and other services during this exercise. In general, this dispensing drill promoted confidence in the worker participants and provided an opportunity for these participants to coordinate their activities. This mock bioterrorist preparedness exercise allowed worker participants and observers to review and evaluate the Washington State plan for dispensing the National Pharmaceutical Stockpile. This article is apparently the first published account of dispensary site workers' subjective impressions and quantitative analysis of their postdrill opinions following a simulated bioterrorist post-exposure chemoprophylaxis dispensing exercise.

Anti-Bacterial Agents↗
PubMedDate not supplied

Application of quality measurement and performance standards to public health systems: Washington State's approach.

To date, there have been few points of intersection between the quality work done in the general health system and performance review in the public health system. This article describes Washington State's set of performance standards for public health, the accreditation-type evaluation process, and some of the results of the recent performance evaluation against the Washington State Standards. Taking action on the evaluation results could enhance the capacity of public health to join general health systems in Washington State to address several of the priority areas described in Transforming Health Care Quality, the 2003 Institute of Medicine Report.

Accreditation↗