Nancy Torres, MD, MPH


Physician, Sacramento County Public Health Department, Sacramento, CA

Dr. Torres most recently returned from Banda Aceh, Indonesia, where she participated in the Tsunami Relief efforts. She served as Deputy Director of the Division of Health Profession Diversity for the Bureau of Health Professions at the Health Resources and Services Administration (HRSA). Prior to that, she served as Chief of the Primary Care Medical Education Branch in the Division of Medicine and Dentistry, HRSA. Dr. Torres is a pediatrician with extensive experience in managed care, academic, and community health settings. She has worked with Kaiser Permanente in Northern California for over 18 years, holding various administrative and leadership roles in the organization. She was Director of the Intensive Care Nursery, Assistant Chief of the Pediatric Department and Co-Leader for Kaiser’s Diversity Initiative. She was also involved in the policy and program development for culturally/linguistically-competent health care of the organization, as well as in building Kaiser-community partnerships. Dr. Torres was appointed as Assistant Clinical Professor at the University of California, San Francisco in 1998, and has participated in the education and training of medical students and pediatric residents.

Dr. Torres received her medical degree from the University of California, San Francisco School of Medicine in 1982 and completed a residency in Pediatrics at the Children’s Hospital Medical Center of Northern California, Oakland, CA in 1985. She received an M.P.H. from the Harvard School of Public Health in 1998 as a CFHU Fellow.

Improving the Health of Uninsured Children: Quality of Care in the States’ Children’s Health Insurance Proposals (CHIP)


In the Federal Balanced Budget Act of 1997, Congress approved legislation “to provide funds to States to enable them to initiate and expand the provision of child health insurance to uninsured, low income children.”  This State Children’s Health Insurance Program (CHIP) legislation is the most significant expansion of government-sponsored health care since Medicaid and Medicare.  The purpose of this project was to assess how the federal mandate on health care quality for the CHIP program has been translated into state action.  Our specific aim was to assess how the State CHIP quality assessment programs will monitor and evaluate the health status of eligible uninsured children.  We performed a comprehensive review of 23 of 26 State proposals submitted to HCFA for approval as of May, 1998 to determine:

  • which aspects of health care are the focus of the states’ quality program;
  • whether there are any common “benchmark” quality measures that will be widely used to assess quality of care for children;
  • if the quality items assess the public health care problems of the population;
  • whether consumers are included in the quality assessment process; and
  • which important areas of health care delivery and outcomes should be targeted for inclusion in future revisions of the CHIP program.

Our analysis revealed considerable variability in the State CHIP quality assessment programs.  The majority of states primarily focus on assessing preventive and maintenance care with an emphasis on documenting service utilization.  There is less attention placed on assessing the quality of care related to significant public health problems relevant to this ethnically diverse population.  Stakeholders involved in child health issues should critically evaluate the quality of care aspects of these initial CHIP programs, and collaborate with state and federal health administrators to first refine the definition of quality of care for these children, and then develop appropriate quality measures that can be used to monitor health outcomes and document the efficacy of this government initiative.

Faculty Preceptors:

Judith Kurland, Regional Director
Sam Shekar, MD, MPH, Regional Health Administrator, DHHS, Region 1