Institute of Medicine (U.S.). Committee on Quality of Health Care in America's Books

Crossing the Quality Chasm

A New Health System for the 21st Century

By: Institute of Medicine,Committee on Quality of Health Care in America

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Crossing the Quality Chasm

A New Health System for the 21st Century

By: Institute of Medicine,Committee on Quality of Health Care in America

Second in a series of publications from the Institute of Medicine's Quality of Health Care in America project Today's health care providers have more research findings and more technology available to them than ever before. Yet recent reports have raised serious doubts about the quality of health care in America. Crossing the Quality Chasm makes an urgent call for fundamental change to close the quality gap. This book recommends a sweeping redesign of the American health care system and provides overarching principles for specific direction for policymakers, health care leaders, clinicians, regulators, purchasers, and others. In this comprehensive volume the committee offers: A set of performance expectations for the 21st century health care system. A set of 10 new rules to guide patient-clinician relationships. A suggested organizing framework to better align the incentives inherent in payment and accountability with improvements in quality. Key steps to promote evidence-based practice and strengthen clinical information systems. Analyzing health care organizations as complex systems, Crossing the Quality Chasm also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change.

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359

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National Academies Press

Published Date

ISBN 10

0309132967

ISBN 13

9780309132961

Leadership by Example

Coordinating Government Roles in Improving Health Care Quality

By: Institute of Medicine,Committee on Enhancing Federal Healthcare Quality Programs

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Leadership by Example

Coordinating Government Roles in Improving Health Care Quality

By: Institute of Medicine,Committee on Enhancing Federal Healthcare Quality Programs

The federal government operates six major health care programs that serve nearly 100 million Americans. Collectively, these programs significantly influence how health care is provided by the private sector. Leadership by Example explores how the federal government can leverage its unique position as regulator, purchaser, provider, and research sponsor to improve care - not only in these six programs but also throughout the nation's health care system. The book describes the federal programs and the populations they serve: Medicare (elderly), Medicaid (low income), SCHIP (children), VHA (veterans), TRICARE (individuals in the military and their dependents), and IHS (native Americans). It then examines the steps each program takes to assure and improve safety and quality of care. The Institute of Medicine proposes a national quality enhancement strategy focused on performance measurement of clinical quality and patient perceptions of care. The discussion on which this book focuses includes recommendations for developing and pilot-testing performance measures, creating an information infrastructure for comparing performance and disseminating results, and more. Leadership by Example also includes a proposed research agenda to support quality enhancement. The third in the series of books from the Quality of Health Care in America project, this well-targeted volume will be important to all readers of To Err Is Human and Crossing the Quality Chasm - as well as new readers interested in the federal government's role in health care.

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207

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National Academies Press

Published Date

ISBN 10

0309086183

ISBN 13

9780309086189

Envisioning the National Health Care Quality Report

By: Institute of Medicine,Board on Health Care Services,Committee on the National Quality Report on Health Care Delivery

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Envisioning the National Health Care Quality Report

By: Institute of Medicine,Board on Health Care Services,Committee on the National Quality Report on Health Care Delivery

How good is the quality of health care in the United States? Is quality improving? Or is it suffering? While the average person on the street can follow the state of the economy with economic indicators, we do not have a tool that allows us to track trends in health care quality. Beginning in 2003, the Agency for Healthcare Research and Quality (AHRQ) will produce an annual report on the national trends in the quality of health care delivery in the United States. AHRQ commissioned the Institute of Medicine (IOM) to help develop a vision for this report that will allow national and state policy makers, providers, consumers, and the public at large to track trends in health care quality. Envisioning the National Health Care Quality Report offers a framework for health care quality, specific examples of the types of measures that should be included in the report, suggestions on the criteria for selecting measures, as well as advice on reaching the intended audiences. Its recommendations could help the national health care quality report to become a mainstay of our nation's effort to improve health care.

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National Academies Press

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ISBN 10

0309171156

ISBN 13

9780309171151

Crossing the Quality Chasm

A New Health System for the 21st Century

By: Institute of Medicine (U.S.). Committee on Quality of Health Care in America

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Crossing the Quality Chasm

A New Health System for the 21st Century

By: Institute of Medicine (U.S.). Committee on Quality of Health Care in America

The National Academy Press, based in Washington, D.C., presents the full text of a book entitled "Crossing the Quality Chasm: A New Health System for the 21st Century," authored by the Institute of Medicine and originally published in 2001. The book highlights improvements to the health care system, rules concerning the redesign and improvement of care, organizational support for change, and the alignment of payment policies with quality improvement.

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335

Published Date

ISBN 10

0309073227

ISBN 13

9780309073226

Medicare

A Strategy for Quality Assurance, Volume I

By: Institute of Medicine,Committee to Design a Strategy for Quality Review and Assurance in Medicare

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Medicare

A Strategy for Quality Assurance, Volume I

By: Institute of Medicine,Committee to Design a Strategy for Quality Review and Assurance in Medicare

Health care for the elderly American is among our nation's more pressing social issues. Our society wishes to ensure quality health care for all older people, but there is growing concern about our ability to maintain and improve quality in the face of efforts to contain health care costs. Medicare: A Strategy for Quality Assurance answers the U.S. Congress' call for the Institute of Medicine to design a strategic plan for assessing and assuring the quality of medical care for the elderly. This book presents a proposed strategic plan for improving quality assurance in the Medicare program, along with steps and timetables for implementing the plan by the year 2000 and the 10 recommendations for action by Congress. The book explores quality of careâ€"how it is defined, measured, and improvedâ€"and reviews different types of quality problems. Major issues that affect approaches to assessing and assuring quality are examined. Medicare: A Strategy for Quality Assurance will be immediately useful to a wide audience, including policymakers, health administrators, individual providers, specialists in issues of the older American, researchers, educators, and students.

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462

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National Academies Press

Published Date

ISBN 10

0309042305

ISBN 13

9780309042307

Improving the Quality of Health Care for Mental and Substance-Use Conditions

By: Institute of Medicine,Board on Health Care Services,Committee on Crossing the Quality Chasm: Adaptation to Mental Health and Addictive Disorders

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Improving the Quality of Health Care for Mental and Substance-Use Conditions

By: Institute of Medicine,Board on Health Care Services,Committee on Crossing the Quality Chasm: Adaptation to Mental Health and Addictive Disorders

Each year, more than 33 million Americans receive health care for mental or substance-use conditions, or both. Together, mental and substance-use illnesses are the leading cause of death and disability for women, the highest for men ages 15-44, and the second highest for all men. Effective treatments exist, but services are frequently fragmented and, as with general health care, there are barriers that prevent many from receiving these treatments as designed or at all. The consequences of this are seriousâ€"for these individuals and their families; their employers and the workforce; for the nation's economy; as well as the education, welfare, and justice systems. Improving the Quality of Health Care for Mental and Substance-Use Conditions examines the distinctive characteristics of health care for mental and substance-use conditions, including payment, benefit coverage, and regulatory issues, as well as health care organization and delivery issues. This new volume in the Quality Chasm series puts forth an agenda for improving the quality of this care based on this analysis. Patients and their families, primary health care providers, specialty mental health and substance-use treatment providers, health care organizations, health plans, purchasers of group health care, and all involved in health care for mental and substanceâ€"use conditions will benefit from this guide to achieving better care.

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528

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National Academies Press

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ISBN 10

0309133661

ISBN 13

9780309133661

Vital Signs

Core Metrics for Health and Health Care Progress

By: Institute of Medicine,Committee on Core Metrics for Better Health at Lower Cost

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Vital Signs

Core Metrics for Health and Health Care Progress

By: Institute of Medicine,Committee on Core Metrics for Better Health at Lower Cost

Thousands of measures are in use today to assess health and health care in the United States. Although many of these measures provide useful information, their usefulness in either gauging or guiding performance improvement in health and health care is seriously limited by their sheer number, as well as their lack of consistency, compatibility, reliability, focus, and organization. To achieve better health at lower cost, all stakeholders - including health professionals, payers, policy makers, and members of the public - must be alert to what matters most. What are the core measures that will yield the clearest understanding and focus on better health and well-being for Americans? Vital Signs explores the most important issues - healthier people, better quality care, affordable care, and engaged individuals and communities - and specifies a streamlined set of 15 core measures. These measures, if standardized and applied at national, state, local, and institutional levels across the country, will transform the effectiveness, efficiency, and burden of health measurement and help accelerate focus and progress on our highest health priorities. Vital Signs also describes the leadership and activities necessary to refine, apply, maintain, and revise the measures over time, as well as how they can improve the focus and utility of measures outside the core set. If health care is to become more effective and more efficient, sharper attention is required on the elements most important to health and health care. Vital Signs lays the groundwork for the adoption of core measures that, if systematically applied, will yield better health at a lower cost for all Americans.

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245

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National Academies Press

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ISBN 10

0309324963

ISBN 13

9780309324960

Priority Areas for National Action

Transforming Health Care Quality

By: Institute of Medicine,Board on Health Care Services,Committee on Identifying Priority Areas for Quality Improvement

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Priority Areas for National Action

Transforming Health Care Quality

By: Institute of Medicine,Board on Health Care Services,Committee on Identifying Priority Areas for Quality Improvement

A new release in the Quality Chasm Series, Priority Areas for National Action recommends a set of 20 priority areas that the U.S. Department of Health and Human Services and other groups in the public and private sectors should focus on to improve the quality of health care delivered to all Americans. The priority areas selected represent the entire spectrum of health care from preventive care to end of life care. They also touch on all age groups, health care settings and health care providers. Collective action in these areas could help transform the entire health care system. In addition, the report identifies criteria and delineates a process that DHHS may adopt to determine future priority areas.

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159

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National Academies Press

Published Date

ISBN 10

0309133173

ISBN 13

9780309133173

Measuring the Quality of Health Care

By: Institute of Medicine,The National Roundtable on Health Care Quality

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Measuring the Quality of Health Care

By: Institute of Medicine,The National Roundtable on Health Care Quality

The National Roundtable on Health Care Quality was established in 1995 by the Institute of Medicine. The Roundtable consists of experts formally appointed through procedures of the National Research Council (NRC) who represent both public and private-sector perspectives and appropriate areas of substantive expertise (not organizations). From the public sector, heads of appropriate Federal agencies serve. It offers a unique, nonadversarial environment to explore ongoing rapid changes in the medical marketplace and the implications of these changes for the quality of health and health care in this nation. The Roundtable has a liaison panel focused on quality of care in managed care organizations. The Roundtable convenes nationally prominent representatives of the private and public sector (regional, state and federal), academia, patients, and the health media to analyze unfolding issues concerning quality, to hold workshops and commission papers on significant topics, and when appropriate, to produce periodic statements for the nation on quality of care matters. By providing a structured opportunity for regular communication and interaction, the Roundtable fosters candid discussion among individuals who represent various sides of a given issue.

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ISBN 10

0309063876

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9780309063876

Primary Care

America's Health in a New Era

By: Committee on the Future of Primary Care,Institute of Medicine

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Primary Care

America's Health in a New Era

By: Committee on the Future of Primary Care,Institute of Medicine

Ask for a definition of primary care, and you are likely to hear as many answers as there are health care professionals in your survey. Primary Care fills this gap with a detailed definition already adopted by professional organizations and praised at recent conferences. This volume makes recommendations for improving primary care, building its organization, financing, infrastructure, and knowledge base--as well as developing a way of thinking and acting for primary care clinicians. Are there enough primary care doctors? Are they merely gatekeepers? Is the traditional relationship between patient and doctor outmoded? The committee draws conclusions about these and other controversies in a comprehensive and up-to-date discussion that covers The scope of primary care. Its philosophical underpinnings. Its value to the patient and the community. Its impact on cost, access, and quality. This volume discusses the needs of special populations, the role of the capitation method of payment, and more. Recommendations are offered for achieving a more multidisciplinary education for primary care clinicians. Research priorities are identified. Primary Care provides a forward-thinking view of primary care as it should be practiced in the new integrated health care delivery systems--important to health care clinicians and those who train and employ them, policymakers at all levels, health care managers, payers, and interested individuals.

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412

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National Academies Press

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ISBN 10

0309556686

ISBN 13

9780309556682

Future Directions for the National Healthcare Quality and Disparities Reports

By: Institute of Medicine,Board on Health Care Services,Committee on Future Directions for the National Healthcare Quality and Disparities Reports

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Future Directions for the National Healthcare Quality and Disparities Reports

By: Institute of Medicine,Board on Health Care Services,Committee on Future Directions for the National Healthcare Quality and Disparities Reports

As the United States devotes extensive resources to health care, evaluating how successfully the U.S. system delivers high-quality, high-value care in an equitable manner is essential. At the request of Congress, the Agency for Healthcare Research and Quality (AHRQ) annually produces the National Healthcare Quality Report (NHQR) and the National Healthcare Disparities Report (NHDR). The reports have revealed areas in which health care performance has improved over time, but they also have identified major shortcomings. After five years of producing the NHQR and NHDR, AHRQ asked the IOM for guidance on how to improve the next generation of reports. The IOM concludes that the NHQR and NHDR can be improved in ways that would make them more influential in promoting change in the health care system. In addition to being sources of data on past trends, the national healthcare reports can provide more detailed insights into current performance, establish the value of closing gaps in quality and equity, and project the time required to bridge those gaps at the current pace of improvement.

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247

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National Academies Press

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ISBN 10

0309159725

ISBN 13

9780309159722

Quality Through Collaboration

The Future of Rural Health

By: Institute of Medicine,Board on Health Care Services,Committee on the Future of Rural Health Care

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Quality Through Collaboration

The Future of Rural Health

By: Institute of Medicine,Board on Health Care Services,Committee on the Future of Rural Health Care

Building on the innovative Institute of Medicine reports To Err Is Human and Crossing the Quality Chasm, Quality Through Collaboration: The Future of Rural Health offers a strategy to address the quality challenges in rural communities. Rural America is a vital, diverse component of the American community, representing nearly 20% of the population of the United States. Rural communities are heterogeneous and differ in population density, remoteness from urban areas, and the cultural norms of the regions of which they are a part. As a result, rural communities range in their demographics and environmental, economic, and social characteristics. These differences influence the magnitude and types of health problems these communities face. Quality Through Collaboration: The Future of Rural Health assesses the quality of health care in rural areas and provides a framework for core set of services and essential infrastructure to deliver those services to rural communities. The book recommends: Adopting an integrated approach to addressing both personal and population health needs Establishing a stronger health care quality improvement support structure to assist rural health systems and professionals Enhancing the human resource capacity of health care professionals in rural communities and expanding the preparedness of rural residents to actively engage in improving their health and health care Assuring that rural health care systems are financially stable Investing in an information and communications technology infrastructure It is critical that existing and new resources be deployed strategically, recognizing the need to improve both the quality of individual-level care and the health of rural communities and populations.

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288

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National Academies Press

Published Date

ISBN 10

0309133475

ISBN 13

9780309133470

Keeping Patients Safe

Transforming the Work Environment of Nurses

By: Institute of Medicine,Board on Health Care Services,Committee on the Work Environment for Nurses and Patient Safety

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Keeping Patients Safe

Transforming the Work Environment of Nurses

By: Institute of Medicine,Board on Health Care Services,Committee on the Work Environment for Nurses and Patient Safety

Building on the revolutionary Institute of Medicine reports To Err is Human and Crossing the Quality Chasm, Keeping Patients Safe lays out guidelines for improving patient safety by changing nurses' working conditions and demands. Licensed nurses and unlicensed nursing assistants are critical participants in our national effort to protect patients from health care errors. The nature of the activities nurses typically perform â€" monitoring patients, educating home caretakers, performing treatments, and rescuing patients who are in crisis â€" provides an indispensable resource in detecting and remedying error-producing defects in the U.S. health care system. During the past two decades, substantial changes have been made in the organization and delivery of health care â€" and consequently in the job description and work environment of nurses. As patients are increasingly cared for as outpatients, nurses in hospitals and nursing homes deal with greater severity of illness. Problems in management practices, employee deployment, work and workspace design, and the basic safety culture of health care organizations place patients at further risk. This newest edition in the groundbreaking Institute of Medicine Quality Chasm series discusses the key aspects of the work environment for nurses and reviews the potential improvements in working conditions that are likely to have an impact on patient safety.

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485

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National Academies Press

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ISBN 10

0309090679

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9780309090674

Knowing What Works in Health Care

A Roadmap for the Nation

By: Institute of Medicine,Board on Health Care Services,Committee on Reviewing Evidence to Identify Highly Effective Clinical Services

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Knowing What Works in Health Care

A Roadmap for the Nation

By: Institute of Medicine,Board on Health Care Services,Committee on Reviewing Evidence to Identify Highly Effective Clinical Services

There is currently heightened interest in optimizing health care through the generation of new knowledge on the effectiveness of health care services. The United States must substantially strengthen its capacity for assessing evidence on what is known and not known about "what works" in health care. Even the most sophisticated clinicians and consumers struggle to learn which care is appropriate and under what circumstances. Knowing What Works in Health Care looks at the three fundamental health care issues in the United States-setting priorities for evidence assessment, assessing evidence (systematic review), and developing evidence-based clinical practice guidelines-and how each of these contributes to the end goal of effective, practical health care systems. This book provides an overall vision and roadmap for improving how the nation uses scientific evidence to identify the most effective clinical services. Knowing What Works in Health Care gives private and public sector firms, consumers, health care professionals, benefit administrators, and others the authoritative, independent information required for making essential informed health care decisions.

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278

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National Academies Press

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ISBN 10

0309134196

ISBN 13

9780309134194

Redesigning Continuing Education in the Health Professions

By: Institute of Medicine,Board on Health Care Services,Committee on Planning a Continuing Health Care Professional Education Institute

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Redesigning Continuing Education in the Health Professions

By: Institute of Medicine,Board on Health Care Services,Committee on Planning a Continuing Health Care Professional Education Institute

Today in the United States, the professional health workforce is not consistently prepared to provide high quality health care and assure patient safety, even as the nation spends more per capita on health care than any other country. The absence of a comprehensive and well-integrated system of continuing education (CE) in the health professions is an important contributing factor to knowledge and performance deficiencies at the individual and system levels. To be most effective, health professionals at every stage of their careers must continue learning about advances in research and treatment in their fields (and related fields) in order to obtain and maintain up-to-date knowledge and skills in caring for their patients. Many health professionals regularly undertake a variety of efforts to stay up to date, but on a larger scale, the nation's approach to CE for health professionals fails to support the professions in their efforts to achieve and maintain proficiency. Redesigning Continuing Education in the Health Professions illustrates a vision for a better system through a comprehensive approach of continuing professional development, and posits a framework upon which to develop a new, more effective system. The book also offers principles to guide the creation of a national continuing education institute.

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296

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National Academies Press

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ISBN 10

0309140781

ISBN 13

9780309140782

Variation in Health Care Spending

Target Decision Making, Not Geography

By: Institute of Medicine,Board on Health Care Services,Committee on Geographic Variation in Health Care Spending and Promotion of High-Value Care

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Variation in Health Care Spending

Target Decision Making, Not Geography

By: Institute of Medicine,Board on Health Care Services,Committee on Geographic Variation in Health Care Spending and Promotion of High-Value Care

Health care in the United States is more expensive than in other developed countries, costing $2.7 trillion in 2011, or 17.9 percent of the national gross domestic product. Increasing costs strain budgets at all levels of government and threaten the solvency of Medicare, the nation's largest health insurer. At the same time, despite advances in biomedical science, medicine, and public health, health care quality remains inconsistent. In fact, underuse, misuse, and overuse of various services often put patients in danger. Many efforts to improve this situation are focused on Medicare, which mainly pays practitioners on a fee-for-service basis and hospitals on a diagnoses-related group basis, which is a fee for a group of services related to a particular diagnosis. Research has long shown that Medicare spending varies greatly in different regions of the country even when expenditures are adjusted for variation in the costs of doing business, meaning that certain regions have much higher volume and/or intensity of services than others. Further, regions that deliver more services do not appear to achieve better health outcomes than those that deliver less. Variation in Health Care Spending investigates geographic variation in health care spending and quality for Medicare beneficiaries as well as other populations, and analyzes Medicare payment policies that could encourage high-value care. This report concludes that regional differences in Medicare and commercial health care spending and use are real and persist over time. Furthermore, there is much variation within geographic areas, no matter how broadly or narrowly these areas are defined. The report recommends against adoption of a geographically based value index for Medicare payments, because the majority of health care decisions are made at the provider or health care organization level, not by geographic units. Rather, to promote high value services from all providers, Medicare and Medicaid Services should continue to test payment reforms that offer incentives to providers to share clinical data, coordinate patient care, and assume some financial risk for the care of their patients. Medicare covers more than 47 million Americans, including 39 million people age 65 and older and 8 million people with disabilities. Medicare payment reform has the potential to improve health, promote efficiency in the U.S. health care system, and reorient competition in the health care market around the value of services rather than the volume of services provided. The recommendations of Variation in Health Care Spending are designed to help Medicare and Medicaid Services encourage providers to efficiently manage the full range of care for their patients, thereby increasing the value of health care in the United States.

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207

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National Academies Press

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ISBN 10

030928872X

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9780309288729

Clinical Practice Guidelines

Directions for a New Program

By: Institute of Medicine,Committee to Advise the Public Health Service on Clinical Practice Guidelines

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Clinical Practice Guidelines

Directions for a New Program

By: Institute of Medicine,Committee to Advise the Public Health Service on Clinical Practice Guidelines

The Alberta clinical practice guidelines program is supporting appropriate, effective and quality medical care in Alberta through promotion, development and implementation of evidence-based clinical practice guidelines.

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169

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National Academies Press

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ISBN 10

0309043468

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9780309043465

In the Nation's Compelling Interest

Ensuring Diversity in the Health-Care Workforce

By: Institute of Medicine,Board on Health Sciences Policy,Committee on Institutional and Policy-Level Strategies for Increasing the Diversity of the U.S. Health Care Workforce

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In the Nation's Compelling Interest

Ensuring Diversity in the Health-Care Workforce

By: Institute of Medicine,Board on Health Sciences Policy,Committee on Institutional and Policy-Level Strategies for Increasing the Diversity of the U.S. Health Care Workforce

The United States is rapidly transforming into one of the most racially and ethnically diverse nations in the world. Groups commonly referred to as minorities-including Asian Americans, Pacific Islanders, African Americans, Hispanics, American Indians, and Alaska Natives-are the fastest growing segments of the population and emerging as the nation's majority. Despite the rapid growth of racial and ethnic minority groups, their representation among the nation's health professionals has grown only modestly in the past 25 years. This alarming disparity has prompted the recent creation of initiatives to increase diversity in health professions. In the Nation's Compelling Interest considers the benefits of greater racial and ethnic diversity, and identifies institutional and policy-level mechanisms to garner broad support among health professions leaders, community members, and other key stakeholders to implement these strategies. Assessing the potential benefits of greater racial and ethnic diversity among health professionals will improve the access to and quality of healthcare for all Americans.

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429

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National Academies Press

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ISBN 10

0309166616

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9780309166614

Relieving Pain in America

A Blueprint for Transforming Prevention, Care, Education, and Research

By: Institute of Medicine,Board on Health Sciences Policy,Committee on Advancing Pain Research, Care, and Education

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Relieving Pain in America

A Blueprint for Transforming Prevention, Care, Education, and Research

By: Institute of Medicine,Board on Health Sciences Policy,Committee on Advancing Pain Research, Care, and Education

Chronic pain costs the nation up to $635 billion each year in medical treatment and lost productivity. The 2010 Patient Protection and Affordable Care Act required the Department of Health and Human Services (HHS) to enlist the Institute of Medicine (IOM) in examining pain as a public health problem. In this report, the IOM offers a blueprint for action in transforming prevention, care, education, and research, with the goal of providing relief for people with pain in America. To reach the vast multitude of people with various types of pain, the nation must adopt a population-level prevention and management strategy. The IOM recommends that HHS develop a comprehensive plan with specific goals, actions, and timeframes. Better data are needed to help shape efforts, especially on the groups of people currently underdiagnosed and undertreated, and the IOM encourages federal and state agencies and private organizations to accelerate the collection of data on pain incidence, prevalence, and treatments. Because pain varies from patient to patient, healthcare providers should increasingly aim at tailoring pain care to each person's experience, and self-management of pain should be promoted. In addition, because there are major gaps in knowledge about pain across health care and society alike, the IOM recommends that federal agencies and other stakeholders redesign education programs to bridge these gaps. Pain is a major driver for visits to physicians, a major reason for taking medications, a major cause of disability, and a key factor in quality of life and productivity. Given the burden of pain in human lives, dollars, and social consequences, relieving pain should be a national priority.

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383

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National Academies Press

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ISBN 10

030921484X

ISBN 13

9780309214841

Core Measurement Needs for Better Care, Better Health, and Lower Costs

Counting What Counts: Workshop Summary

By: Institute of Medicine,Roundtable on Value and Science-Driven Health Care

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Core Measurement Needs for Better Care, Better Health, and Lower Costs

Counting What Counts: Workshop Summary

By: Institute of Medicine,Roundtable on Value and Science-Driven Health Care

Health care quality and its affordability have become very pressing issues in the United States. All sectors of the country are attempting to push forward initiatives that will improve the health care system as well as the health of the American population in general. Despite the economical dedication to health care, about 1/5, the system remains uneven and fragmented, patient harm is quite common, care is often uncoordinated, and many more mishaps occur. There exists many obstacles to improve the nation's health care system; these include the capacity to reliably and consistently measure progress. In 2006 the Institute of Medicine (IOM) established the Roundtable on Value & Science-Driven Health Care which has since accelerated the development of a learning health system- one in which science, informatics, incentives, and culture are aligned to create a continuous learning loop. This learning loop would thus help make the health care system better. In response, the IOM organized a 2-day workshop to explore in depth the core measurement needs for population health, health care quality, and health care costs. The workshop hoped to gain a full understanding of how to improve the nation's measurement capacity to track progress in the health care system. Having this knowledge would help the nation get one step closer to the creation of an efficient learning loop. The workshop was divided into a series of sessions that focused on different aspects of measurement. Core Measurement Needs for Better Care, Better Health, and Lower Costs: Counting What Counts: Workshop Summary includes explanations and key details for these sessions: Vision, Current Measurement Capabilities, Specifying the Shape of a Core Metric Set, and Implementation. The report also features common themes within these areas, the workshop agenda, and information about those involved.

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149

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National Academies Press

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ISBN 10

0309285224

ISBN 13

9780309285223

The 1st Annual Crossing the Quality Chasm Summit

A Focus on Communities: Report of a Summit

By: Institute of Medicine,Board on Health Care Services,Committee on the Crossing the Quality Chasm: Next Steps Toward a New Health Care System

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The 1st Annual Crossing the Quality Chasm Summit

A Focus on Communities: Report of a Summit

By: Institute of Medicine,Board on Health Care Services,Committee on the Crossing the Quality Chasm: Next Steps Toward a New Health Care System

In January 2004, the Institute of Medicine (IOM) hosted the 1st Annual Crossing the Quality Chasm Summit, convening a group of national and community health care leaders to pool their knowledge and resources with regard to strategies for improving patient care for five common chronic illnesses. This summit was a direct outgrowth and continuation of the recommendations put forth in the 2001 IOM report Crossing the Quality Chasm: A New Health System for the 21st Century. The summit's purpose was to offer specific guidance at both the community and national levels for overcoming the challenges to the provision of high-quality care articulated in the Quality Chasm report and for moving closer to achievement of the patient-centerd health care system envisioned therein.

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176

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National Academies Press

Published Date

ISBN 10

0309133440

ISBN 13

9780309133449

Managing Managed Care

Quality Improvement in Behavioral Health

By: Committee on Quality Assurance and Accreditation Guidelines for Managed Behavioral Health Care,Institute of Medicine

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Managing Managed Care

Quality Improvement in Behavioral Health

By: Committee on Quality Assurance and Accreditation Guidelines for Managed Behavioral Health Care,Institute of Medicine

Managed care has produced dramatic changes in the treatment of mental health and substance abuse problems, known as behavioral health. Managing Managed Care offers an urgently needed assessment of managed care for behavioral health and a framework for purchasing, delivering, and ensuring the quality of behavioral health care. It presents the first objective analysis of the powerful multimillion-dollar accreditation industry and the key accrediting organizations. Managing Managed Care draws evidence-based conclusions about the effectiveness of behavioral health treatments and makes recommendations that address consumer protections, quality improvements, structure and financing, roles of public and private participants, inclusion of special populations, and ethical issues. The volume discusses trends in managed behavioral health care, highlighting the emerging role of the purchaser. The committee explores problems of overlap and fragmentation in the delivery of behavioral health care and discusses the issue of access, a special concern when private systems are restricted and public systems overburdened. Highly applicable to the larger health care system, this volume will be of particular interest to all stakeholders in behavioral health--federal and state policymakers, public and private purchasers, health care providers and administrators, consumers and consumer advocates, accrediting organizations, and health services researchers.

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395

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National Academies Press

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ISBN 10

0309523680

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9780309523684

Unequal Treatment

Confronting Racial and Ethnic Disparities in Health Care (with CD)

By: Institute of Medicine,Board on Health Sciences Policy,Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care

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Unequal Treatment

Confronting Racial and Ethnic Disparities in Health Care (with CD)

By: Institute of Medicine,Board on Health Sciences Policy,Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care

Racial and ethnic disparities in health care are known to reflect access to care and other issues that arise from differing socioeconomic conditions. There is, however, increasing evidence that even after such differences are accounted for, race and ethnicity remain significant predictors of the quality of health care received. In Unequal Treatment, a panel of experts documents this evidence and explores how persons of color experience the health care environment. The book examines how disparities in treatment may arise in health care systems and looks at aspects of the clinical encounter that may contribute to such disparities. Patients' and providers' attitudes, expectations, and behavior are analyzed. How to intervene? Unequal Treatment offers recommendations for improvements in medical care financing, allocation of care, availability of language translation, community-based care, and other arenas. The committee highlights the potential of cross-cultural education to improve provider-patient communication and offers a detailed look at how to integrate cross-cultural learning within the health professions. The book concludes with recommendations for data collection and research initiatives. Unequal Treatment will be vitally important to health care policymakers, administrators, providers, educators, and students as well as advocates for people of color.

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781

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National Academies Press

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ISBN 10

030921582X

ISBN 13

9780309215824

Medicare

A Strategy for Quality Assurance, Volume I

By: Institute of Medicine,Committee to Design a Strategy for Quality Review and Assurance in Medicare

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Medicare

A Strategy for Quality Assurance, Volume I

By: Institute of Medicine,Committee to Design a Strategy for Quality Review and Assurance in Medicare

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468

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National Academies Press

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ISBN 10

0309042305

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9780309042307

State of the USA Health Indicators

Letter Report

By: Institute of Medicine,Board on Population Health and Public Health Practice,Committee on the State of the USA Health Indicators

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State of the USA Health Indicators

Letter Report

By: Institute of Medicine,Board on Population Health and Public Health Practice,Committee on the State of the USA Health Indicators

Researchers, policymakers, sociologists and doctors have long asked how to best measure the health of a nation, yet the challenge persists. The nonprofit State of the USA, Inc. (SUSA) is taking on this challenge, demonstrating how to measure the health of the United States. The organization is developing a new website intended to provide reliable and objective facts about the U.S. in a number of key areas, including health, and to provide an interactive tool with which individuals can track the progress made in each of these areas. In 2008, SUSA asked the Institute of Medicine's Committee on the State of the USA Health Indicators to provide guidance on 20 key indicators to be used on the organization's website that would be valuable in assessing health. Each indicator was required to demonstrate: a clear importance to health or health care, the availability of reliable, high quality data to measure change in the indicators over time, the potential to be measured with federally collected data, and the capability to be broken down by geography, populations subgroups including race and ethnicity, and socioeconomic status. Taken together, the selected indicators reflect the overall health of the nation and the efficiency and efficacy of U.S. health systems. The complete list of 20 can be found in the report brief and book.

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ISBN 10

0309185440

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9780309185448

A Summary of the October 2009 Forum on the Future of Nursing

Acute Care

By: Institute of Medicine,Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine

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A Summary of the October 2009 Forum on the Future of Nursing

Acute Care

By: Institute of Medicine,Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine

The Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the IOM, seeks to transform nursing as part of larger efforts to reform the health care system. The first of the Initiative's three forums was held on October 19, 2009, and focused on safety, technology, and interdisciplinary collaboration in acute care.

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National Academies Press

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ISBN 10

0309150213

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9780309150217

How Can Health Care Organizations Become More Health Literate?

Workshop Summary

By: Institute of Medicine,Board on Population Health and Public Health Practice,Roundtable on Health Literacy

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How Can Health Care Organizations Become More Health Literate?

Workshop Summary

By: Institute of Medicine,Board on Population Health and Public Health Practice,Roundtable on Health Literacy

Approximately 80 million adults in the United States have low health literacy - an individual's ability to obtain, process, and understand basic health information. Low health literacy creates difficulties in communicating with clinicians, poses barriers in managing chronic illness, lessens the likelihood of receiving preventive care, heightens the possibility of experiencing serious medication errors, increased risk of hospitalization, and results in poorer quality of life. It is important for health care organizations to develop strategies that can improve their health literacy, yet organizations often find it difficult to determine exactly what it means to be health literate. How Can Health Care Organizations Become More Health Literate?: Workshop defines a health literate health care organization as "an organization that makes it easier for people to navigate, understand, and use information and services to take care of their health." In November 2011, the IOM Roundtable on Health Literacy held a workshop to discuss the growing recognition that health literacy depends not only on individual skills and abilities but also on the demands and complexities of the health care system. How Can Health Care Organizations Become More Health Literate?: Workshop summarizes the workshop.

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122

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National Academies Press

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ISBN 10

0309256844

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9780309256841

Living Well with Chronic Illness

A Call for Public Health Action

By: Institute of Medicine,Board on Population Health and Public Health Practice,Committee on Living Well with Chronic Disease: Public Health Action to Reduce Disability and Improve Functioning and Quality of Life

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Living Well with Chronic Illness

A Call for Public Health Action

In the United States, chronic diseases currently account for 70 percent of all deaths, and close to 48 million Americans report a disability related to a chronic condition. Today, about one in four Americans have multiple diseases and the prevalence and burden of chronic disease in the elderly and racial/ethnic minorities are notably disproportionate. Chronic disease has now emerged as a major public health problem and it threatens not only population health, but our social and economic welfare. Living Well with Chronic Disease identifies the population-based public health actions that can help reduce disability and improve functioning and quality of life among individuals who are at risk of developing a chronic disease and those with one or more diseases. The book recommends that all major federally funded programmatic and research initiatives in health include an evaluation on health-related quality of life and functional status. Also, the book recommends increasing support for implementation research on how to disseminate effective longterm lifestyle interventions in community-based settings that improve living well with chronic disease. Living Well with Chronic Disease uses three frameworks and considers diseases such as heart disease and stroke, diabetes, depression, and respiratory problems. The book's recommendations will inform policy makers concerned with health reform in public- and private-sectors and also managers of communitybased and public-health intervention programs, private and public research funders, and patients living with one or more chronic conditions.

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350

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National Academies Press

Published Date

ISBN 10

0309221277

ISBN 13

9780309221276

The U.S. Commitment to Global Health

Recommendations for the Public and Private Sectors

By: Institute of Medicine,Board on Global Health,Committee on the U.S. Commitment to Global Health

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The U.S. Commitment to Global Health

Recommendations for the Public and Private Sectors

By: Institute of Medicine,Board on Global Health,Committee on the U.S. Commitment to Global Health

Health is a highly valued, visible, and concrete investment that has the power to both save lives and enhance the credibility of the United States in the eyes of the world. While the United States has made a major commitment to global health, there remains a wide gap between existing knowledge and tools that could improve health if applied universally, and the utilization of these known tools across the globe. The U.S. Commitment to Global Health concludes that the U.S. government and U.S.-based foundations, universities, nongovernmental organizations, and commercial entities have an opportunity to improve global health. The book includes recommendations that these U.S. institutions: increase the utilization of existing interventions to achieve significant health gains; generate and share knowledge to address prevalent health problems in disadvantaged countries; invest in people, institutions, and capacity building with global partners; increase the quantity and quality of U.S. financial commitments to global health; and engage in respectful partnerships to improve global health. In doing so, the U.S. can play a major role in saving lives and improving the quality of life for millions around the world.

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297

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National Academies Press

Published Date

ISBN 10

0309145422

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9780309145428

Child and Adolescent Health and Health Care Quality

Measuring What Matters

By: National Research Council,Institute of Medicine,Board on Health Care Services,Board on Children, Youth, and Families,Committee on Pediatric Health and Health Care Quality Measures

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Child and Adolescent Health and Health Care Quality

Measuring What Matters

By: National Research Council,Institute of Medicine,Board on Health Care Services,Board on Children, Youth, and Families,Committee on Pediatric Health and Health Care Quality Measures

Increasing public investments in health care services for low-income and special needs children and adolescents in the United States have raised questions about whether these efforts improve their health outcomes. Yet it is difficult to assess the general health status and health care quality for younger populations, especially those at risk of poor health outcomes, because the United States has no national information system that can provide timely, comprehensive, and reliable indicators in these areas for children and adolescents. Without such a system in place, it is difficult to know whether and how selected health care initiatives and programs contribute to children's health status. Child and Adolescent Health and Health Care Quality identifies key advances in the development of pediatric health and health care quality measures, examines the capacity of existing federal data sets to support these measures, and considers related research activities focused on the development of new measures to address current gaps. This book posits the need for a comprehensive strategy to make better use of existing data, to integrate different data sources, and to develop new data sources and collection methods for unique populations. Child and Adolescent Health and Health Care Quality looks closely at three areas: the nature, scope, and quality of existing data sources; gaps in measurement areas; and methodological areas that deserve attention. Child and Adolescent Health and Health Care Quality makes recommendations for improving and strengthening the timeliness, quality, public transparency, and accessibility of information on child health and health care quality. This book will be a vital resource for health officials at the local, state, and national levels, as well as private and public health care organizations and researchers.

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281

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National Academies Press

Published Date

ISBN 10

0309225116

ISBN 13

9780309225113

The Nation's Physician Workforce

Options for Balancing Supply and Requirements

By: Committee on the U.S. Physician Supply,Institute of Medicine

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The Nation's Physician Workforce

Options for Balancing Supply and Requirements

By: Committee on the U.S. Physician Supply,Institute of Medicine

Enormous changes are occurring in the organization and financing of the U.S. health care system--rapid changes that are being driven by market forces rather than by government initiatives. Although it is difficult to predict what they system will look like once it begins to stabilize, the changes will affect all components of the health care workforce, and the numbers and types of health care professionals that will be needed in the future--as well as the roles they will fill--will surely be much different than they were in the past. Despite numerous studies in the past 15 years showing that we might have more doctors than we need, the number of physicians in residency training continues to grow. At the same time, there is evidence that the demand for physician services will decrease as a result of growth of managed care. All of this is evidence that the demand for physician services will decrease as a result of growth of managed care. All of this is taking place at a time when, coincident with the result of failure of comprehensive health care reform, there is no coordinated and widely accepted physician workforce policy in the United States. The present study examines the following three questions: (1) Is there a physician policy in the United States? (2) If there a surplus, what is its likely impact on the cost, quality, and access to health care and on the efficient use of human resources? (3) What realistic steps can be taken to deal with a physician surplus? December

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122

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National Academies Press

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ISBN 10

0309588901

ISBN 13

9780309588904

Conflict of Interest in Medical Research, Education, and Practice

By: Institute of Medicine,Board on Health Sciences Policy,Committee on Conflict of Interest in Medical Research, Education, and Practice

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Conflict of Interest in Medical Research, Education, and Practice

By: Institute of Medicine,Board on Health Sciences Policy,Committee on Conflict of Interest in Medical Research, Education, and Practice

Collaborations of physicians and researchers with industry can provide valuable benefits to society, particularly in the translation of basic scientific discoveries to new therapies and products. Recent reports and news stories have, however, documented disturbing examples of relationships and practices that put at risk the integrity of medical research, the objectivity of professional education, the quality of patient care, the soundness of clinical practice guidelines, and the public's trust in medicine. Conflict of Interest in Medical Research, Education, and Practice provides a comprehensive look at conflict of interest in medicine. It offers principles to inform the design of policies to identify, limit, and manage conflicts of interest without damaging constructive collaboration with industry. It calls for both short-term actions and long-term commitments by institutions and individuals, including leaders of academic medical centers, professional societies, patient advocacy groups, government agencies, and drug, device, and pharmaceutical companies. Failure of the medical community to take convincing action on conflicts of interest invites additional legislative or regulatory measures that may be overly broad or unduly burdensome. Conflict of Interest in Medical Research, Education, and Practice makes several recommendations for strengthening conflict of interest policies and curbing relationships that create risks with little benefit. The book will serve as an invaluable resource for individuals and organizations committed to high ethical standards in all realms of medicine.

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436

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National Academies Press

Published Date

ISBN 10

0309145449

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9780309145442

Monitoring HIV Care in the United States

A Strategy for Generating National Estimates of HIV Care and Coverage

By: Institute of Medicine,Board on Population Health and Public Health Practice,Committee to Review Data Systems for Monitoring HIV Care

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Monitoring HIV Care in the United States

A Strategy for Generating National Estimates of HIV Care and Coverage

By: Institute of Medicine,Board on Population Health and Public Health Practice,Committee to Review Data Systems for Monitoring HIV Care

In September 2010, the White House Office of National AIDS Policy commissioned an Institute of Medicine (IOM) committee to respond to a two-part statement of task concerning how to monitor care for people with HIV. The IOM convened a committee of 17 members with expertise in HIV clinical care and supportive services, epidemiology, biostatistics, health policy, and other areas to respond to this task. The committee's first report, Monitoring HIV Care in the United States: Indicators and Data Systems, was released in March 2012. The report identified 14 core indicators of clinical HIV care and mental health, substance abuse, and supportive services for use by the Department of Health and Human Services (HHS) to monitor the impact of the National HIV/AIDS Strategy (NHAS) and the Patient Protection and Affordable Care Act (ACA) on improvements in HIV care and identified sources of data to estimate the indicators. The report also addressed a series of questions related to the collection, analysis, and dissemination of data necessary to estimate the indicators. In this second report, Monitoring HIV Care in the United States: A Strategy for Generating National Estimates of HIV Care and Coverage, the committee addresses how to obtain national estimates that characterize the health care of people with HIV within the context of the ACA, both before 2014 and after 2014, when key provisions of the ACA will be implemented. This report focuses on how to monitor the anticipated changes in health care coverage, service utilization, and quality of care for people with HIV within the context of the ACA.

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144

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National Academies Press

Published Date

ISBN 10

0309257158

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9780309257152

Health IT and Patient Safety

Building Safer Systems for Better Care

By: Institute of Medicine,Board on Health Care Services,Committee on Patient Safety and Health Information Technology

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Health IT and Patient Safety

Building Safer Systems for Better Care

By: Institute of Medicine,Board on Health Care Services,Committee on Patient Safety and Health Information Technology

IOM's 1999 landmark study To Err is Human estimated that between 44,000 and 98,000 lives are lost every year due to medical errors. This call to action has led to a number of efforts to reduce errors and provide safe and effective health care. Information technology (IT) has been identified as a way to enhance the safety and effectiveness of care. In an effort to catalyze its implementation, the U.S. government has invested billions of dollars toward the development and meaningful use of effective health IT. Designed and properly applied, health IT can be a positive transformative force for delivering safe health care, particularly with computerized prescribing and medication safety. However, if it is designed and applied inappropriately, health IT can add an additional layer of complexity to the already complex delivery of health care. Poorly designed IT can introduce risks that may lead to unsafe conditions, serious injury, or even death. Poor human-computer interactions could result in wrong dosing decisions and wrong diagnoses. Safe implementation of health IT is a complex, dynamic process that requires a shared responsibility between vendors and health care organizations. Health IT and Patient Safety makes recommendations for developing a framework for patient safety and health IT. This book focuses on finding ways to mitigate the risks of health IT-assisted care and identifies areas of concern so that the nation is in a better position to realize the potential benefits of health IT. Health IT and Patient Safety is both comprehensive and specific in terms of recommended options and opportunities for public and private interventions that may improve the safety of care that incorporates the use of health IT. This book will be of interest to the health IT industry, the federal government, healthcare providers and other users of health IT, and patient advocacy groups.

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234

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National Academies Press

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ISBN 10

0309221153

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9780309221153

Book's by Institute of Medicine (U.S.). Committee on Quality of Health Care in America

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