Crossing the Quality Chasm: A New Health System for the 21st Century. Summary

Transcript

1 March 2001 O F E M E D I C I N E I N S T I T U T Shaping the Future for Health Q UALITY C HASM C ROSSING THE : NTURY A NEW HEALTH SYSTEM FOR THE 21ST CE he U.S. health care delivery system does not provide consistent, high- quality medical care to all people. Americans should be able to count T n­ on receiving care that meets their needs and is based on the best scie tific knowledge--yet there is strong evidence that this frequently is not the case. Health care harms patients too frequently and routinely fails to deliver its potential benefits. Indeed, between the health care that we now have and the health care that we could have lies not just a gap, but a chasm. A number of factors have combined to create this chasm. Medical sc i­ ence and technology have advanced at an unprecedented rate during the past In tandem has come growing complexity of health care, which half-century. today is characterized by more to know, more to do, more to manage, more to watch, and more people involved than ever before. Faced with such rapid changes, the nation’s health care delivery system has fallen far short in its ability to translate knowledge into practice and to apply new technology Faced with such And if the system cannot consistently deliver t o- safely and appropriately. rapid changes, the x­ day’s science and technology, it is even less prepared to respond to the e nation’s health care traordinary advances that surely will emerge during the coming decades. delivery system has The public’s health care needs have changed as well. Americans are fallen far short in its living longer, due at least in part to advances in medical science and l­ techno ability to translate ogy, and with this aging population comes an increase in the incidence and knowledge into prevalence of chronic conditions. Such conditions, including heart disease, p­ practice and to a diabetes, and asthma, are now the leading cause of illness, disability, and ply new technology death. But today’s health system remains overly devoted to dealing with safely and appro ­ acute, episodic care needs. There is a dearth of clinical programs with the priately. multidisciplinary infrastructure required to provide the full complement of services needed by people with common chronic conditions. The health care delivery system also is poorly organized to meet the r­ The delivery of care often is overly complex and uncoo challenges at hand. dinated, requiring steps and patient “handoffs” that slow down care and d e- e- crease rather than improve safety. These cumbersome processes waste r sources; leave unaccountable voids in coverage; lead to loss of information;

2 CARE SYSTEM and fail to build on the strengths of all health professionals involved to ensure that care is appropriate, Organizational timely, and safe. Outcomes: Supportive High perfor m­ Organizations rticularly apparent problems are pa Safe • patient- payment and ing that facilitate • Effective the work of regulatory e n­ centered teams regarding chronic conditions. The patient- • Efficient vironment fact that more than 40 percent of centered teams • Personalized people with chronic conditions have Timely • more than one such condition • Equitable argues strongly for more sophisticated mechanisms to Yet health care coordinate care. organizations, hospitals, and physician groups typically operate REDESIGN IMPERATIVES: SIX CHALLENGES as separate “silos,” acting wit hout • Reengineered care processes the benefit of complete information • Effective use of information technologies about the patient’s condition, • Knowledge and skills management medical history, services provided Development of effective teams • Coordination of care across patient- • in other settings, or medications conditions, services, sites of care over time provided by other cl inicians. Making change possible. tem Strategy for Reinventing the Sys Bringing state-of-the-art care to all Americans in every community will require a fundamental, sweeping redesign of the entire health system, according to a report by the Institute of Medicine (IOM), an arm of the National Academy of Sciences. Crossing the Quality Chasm: A New Health System for the 21st Century , prepared by the IOM’s Committee on the Quality of Health Care in America and released in March 2001, concludes that merely making incremental improvements in cu r- rent systems of care will not su ffice. The committee already has spoken to one urgent care problem--patient safety--in a 1999 report titled . To Err is Human: Building a Safer Health System Concluding that tens of thousands of Americans die each year as a result of pr e­ ventable mistakes in their care, the report lays out a comprehensive strategy by which government, health care providers, industry, and consumers can reduce medical errors. Crossing the Quality Chasm focuses more broadly on how the health sy s­ tem can be reinvented to foster innovation and improve the delivery of care. To- ward this goal, the committee presents a comprehensive strategy and action plan Advances must for the coming decade. begin with all ­ health care con Six Aims for Improvement stituencies... committing to a Advances must begin with all health care constituencies--health professionals, national statement federal and state policy makers, public and private purchasers of care, regulators, of pur pose... organization managers and governing boards, and consumers--committing to a 2

3 national statement of purpose for the health care system as a whole. In making this commitment, the parties would accept as their explicit purpose “to continually reduce the burden of illness, injury, and disability, and to improve the health and The parties also would adopt a functioning of the people of the United States.” These aims are built around shared vision of six specific aims for improvement. the core need for health care to be: • Safe : avoiding injuries to patients from the care that is intended to help them. : providing services based on scientific knowledge to all who • Effective could benefit, and refraining from providing services to those not likely to benefit. Patient-centered : providing care that is respectful of and responsive to i n­ • dividual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions. • Timely : reducing waits and sometimes harmful delays for both those who A health care sys ­ receive and those who give care. tem that achieves Efficient : avoiding waste, including waste of equipment, supplies, ideas, • major gains in and energy. these six areas • : providing care that does not vary in quality because of personal Equitable would be far better characteristics such as gender, ethnicity, geographic location, and socioeconomic at meeting patient status. needs. A health care system that achieves major gains in these six areas would be Patients would experience care that is safer, far better at meeting patient needs. more reliable, more responsive to their needs, more integrated, and more available, and they could count on receiving the full array of preventive, acute, and chronic services that are likely to prove beneficial. Clinicians and other health workers also would benefit through their increased satisfaction at being better able to do their jobs and thereby bring improved health, greater longevity, less pain and suffering, and increased personal productivity to those who receive their care. Ten Rules for Redesign To help in achieving these improvement aims, the committee deemed that it would be neither useful nor possible to specify a blueprint for 21st-century health care delivery systems. Imagination abounds at all levels, and all promising routes for innovation should be encouraged. At the same time, the committee form u­ ...the health care lated a set of ten simple rules, or general principles, to inform efforts to redesign system must be These rules are: the health system. responsive at all . Patients should r e­ 1. Care is based on continuous healing relationships times, and access ceive care whenever they need it and in many forms, not just face-to-face visits. to care should be c­ This implies that the health care system must be responsive at all times, and a provided over the cess to care should be provided over the Internet, by telephone, and by other e­ Internet, by tel means in addition to in-person visits. phone, and by 2. Care is customized according to patient needs and values . The system other means in should be designed to meet the most common types of needs, but should have the addition to in- capability to respond to individual patient choices and preferences. person visits. . Patients should be given the ne c- The patient is the source of control 3. 3

4 essary information and opportunity to exercise the degree of control they choose m­ The system should be able to acco over health care decisions that affect them. modate differences in patient preferences and encourage shared decision making. Knowledge is shared and information flows freely . Patients should 4. l­ have unfettered access to their own medical information and to clinical know Reducing risk and edge. Clinicians and patients should communicate effectively and share inform a­ ensuring safety tion. t­ require greater a . Patients should receive care based 5. Decision making is evidence-based tention to systems on the best available scientific knowledge. Care should not vary illogically from that help prevent clinician to clinician or from place to place. and mitigate e r­ . Patients should be safe from injury caused 6. Safety is a system property rors. Reducing risk and ensuring safety require greater attention to by the care system. systems that help prevent and mitigate errors. . Transparency is necessary 7. ­ The system should make available to pa tients and their families information that enables them to make informed decisions when selecting a health plan, hospital, or clinical practice, or when choosing This should include information describing the among alternative treatments. system’s performance on safety, evidence-based practice, and patient satisfaction. The system should anticipate patient needs, . 8. Needs are anticipated rather than simply react to events. e- Waste is continuously decreased 9. . The system should not waste r sources or patient time. 10. Cooperation among clinicians is a priority . Clinicians and institutions should actively collaborate and communicate to ensure an appropriate exchange of information and coordination of care. Taking the First Steps To initiate the process of change, Congress should establish a Health Care Quality o­ Innovation Fund--roughly $1 billion for use over three to five years to help pr o­ To initiate the pr duce a public-domain portfolio of programs, tools, and technologies of wid e- cess of change, spread applicability, and to help communicate the need for rapid and significant Congress should change throughout the health system. Some of the projects funded should be ta r­ establish a Health geted at achieving the six aims of improvement. ­ Care Quality Inno The committee also calls for immediate attention on developing care proc ­ vation Fund esses for the common health conditions, most of them chronic, that afflict great numbers of people. The federal Agency for Healthcare Research and Quality (AHRQ) should identify 15 or more common priority conditions. (The agency has requested guidance from the IOM on selection of these conditions, and the Institute expects to issue its report in September 2002.) The AHRQ then should work with various stakeholders in the health community to develop strategies and action plans to improve care for each of these priority conditions over a five-year period. 4

5 Changing the Environment Redesigning the health care delivery system also will require changing the stru c­ tures and processes of the environment in which health professionals and organ i­ It is critical that zations function. Such changes need to occur in four main areas: leadership from • . Scientific knowledge about Applying evidence to health care delivery the private sector, both professional It now best care is not applied systematically or expeditiously to clinical practice. and other health takes an average of 17 years for new knowledge generated by randomized co n- care leaders and trolled trails to be incorporated into practice, and even then application is highly consumer repre ­ uneven. The committee therefore recommends that the Department of Health and Human Services establish a comprehensive program aimed at making scientific sentatives, be i n­ tients. volved in all a s­ evidence more useful and more accessible to clinicians and pa pects of this e f­ It is critical that leadership from the private sector, both professional and other health care leaders and consumer representatives, be involved in all aspects fort... of this effort to ensure its applicability and acceptability to clinicians and patients. The infrastructure developed through this public-private partnership should focus initially on priority conditions. Efforts should include analysis and synthesis of the medical evidence, delineation of specific practice guidelines, identification of best practices in the design of care processes, dissemination of the evidence and guidelines to the professional communities and the general public, development of support tools to help clinicians and patients in applying evidence and making t- decisions, establishment of goals for improvement in care processes and ou comes, and development of measures for assessing quality of care. Information technology, including the . Using information technology • Information tech ­ Internet, holds enormous potential for transforming the health care delivery sy s­ nology...holds tem, which today remains relatively untouched by the revolution that has swept ­ enormous poten nearly every other aspect of society. p­ Central to many information technology a tial for transform ­ ­ Such infor plications is the automation of patient-specific clinical information. ing the health care mation typically is dispersed in a collection of paper records, which often are delivery sys tem... poorly organized, illegible, and not easy to retrieve, making it nearly impossible to manage various illnesses, especially chronic conditions, that require frequent Many patients also could have their monitoring and ongoing patient support. needs met more quickly and at a lower cost if they could communicate with health professionals through e-mail. r­ In addition, the use of automated systems for o dering medications can reduce errors in prescribing and dosing drugs, and co m­ puterized reminders can help both patients and clinicians identify needed services. The challenges of applying information technology should not be unde r- estimated, however. Health care is undoubtedly one of the most, if not the most, Sizable capital investments and multiyear complex sectors of the economy. Widespread adoption of many commitments to building systems will be needed. information technology applications also will require behavioral adaptations on Thus, the the part of large numbers of clinicians, organizations, and patients. committee calls for a nationwide commitment of all stakeholders to building an information infrastructure to support health care delivery, consumer health, qua l­ ity measurement and improvement, public accountability, clinical and health services research, and clinical education. This commitment should lead to the elimination of most handwritten clinical data by the end of the decade. 5

6 • . Although pa y­ Aligning payment policies with quality improvement ment is not the only factor that influences provider and patient behavior, it is an important one. The committee calls for all purchasers, both public and private, to carefully reexamine their payment policies to remove barriers that impede quality improvement and build in stronger incentives for quality enhancement. Clinicians should be adequately compensated for taking good care of all types of patients, Clinicians should neither gaining nor losing financially for caring for sicker patients or those with be adequately Payment methods also should provide an opport more complicated conditions. u­ compensated for nity for providers to share in the benefits of quality improvement, provide an op­ taking good care portunity for consumers and purchasers to recognize quality differences in health a­ of all types of p m­ care and direct their decisions accordingly, align financial incentives with the i tients... plementation of care processes based on best practices and the achievement of better patient outcomes, and enable providers to coordinate care for patients across se ttings and over time. To assist purchasers in their redesign of payment policies, the federal go v­ ernment, with input from the private sector, should develop a program to identify, pilot test, and evaluate various options for better aligning payment methods with Examples of possible means of achieving this end quality improvement goals. include blended methods of payment designed to counter the disadvantages of one payment method with the advantages of another, multiyear contracts, payment modifications to encourage use of electronic interaction among clinicians and between clinicians and patients, and bundled payments for priority conditions. Preparing the workforce . • Health care is not just another service i n­ dustry. Its fundamental nature is characterized by people taking care of other people in times of need and stress. Stable, trusting relationships between a patient ...the importance and the people providing care can be critical to healing or managing an illness. - of adequately pre Therefore, the importance of adequately preparing the workforce to make a paring the n­ smooth transition into a thoroughly revamped health care system cannot be u workforce to make derestimated. ­ a smooth transi Three approaches can be taken to support the workforce in this transition. tion into a thor ­ One approach is to redesign the way health professionals are trained to emphasize oughly revamped the six aims for improvement, which will mean placing more stress on teaching ­ health care sys evidence-based practice and providing more opportunities for interdisciplinary tem cannot be u n­ u­ Second is to modify the ways in which health professionals are reg training. mated. deresti Third is to use lated and accredited to facilitate needed changes in care delivery. the liability system to support changes in care delivery while preserving its role in ensuring accountability among health professionals and organizations. All of these approaches likely will prove valuable, but key questions remain about each. p­ The federal government and professional associations need to study these a proaches to better ascertain how they can best contribute to ensuring the strong workforce that will be at the center of the health care system of the 21st century. Now is the right No Better Time time to begin work on reinventing the Now is the right time to begin work on reinventing the nation’s health care deliv­ nation’s health ery system. Technological advances are making it possible to accomplish things care delivery sys ­ today that were impossible only a few years ago. Health professionals and or - tem. 6

7 ganizations, policy makers, and patients are becoming all too painfully aware of the shortcomings of the nation’s current system and of the importance of finding radically new and better approaches to meeting the health care needs of all Although e­ Americans. Crossing the Quality Chasm does not offer a simple pr scription--there is none--it does provide a vision of what is possible and the path It will not be an easy road, but it will be most worthwhile. that can be taken. � � � � � � For More Inform ation... are Crossing the Quality Chasm: A New Health System for the 21st Century Copies of emy Press; call (800) 624-6242 or (202) 334- available for sale from the National Acad 3313 (in the Washington metropolitan area), or visit the NAP home page at www.nap.edu. The full text of this report is available at http://www.nap.edu/books/0309072808/html/ Support for this project was provided by: the Institute of Medicine; the National Research Council; The Robert Wood Johnson Foundation; the California Health Care Foundation; the Commonwealth Fund; and the Department of Health and Human Services’ Health Re- Care Finance Administration, Public Health Service, and Agency for Healthcare search and Quality. The views presented in this report are those of the Institute of Med i­ cine Committee on the Quality of Health Care in America and are not necessarily those of the funding age ncies. The Institute of Medicine is a private, nonprofit organization that provides health policy advice under a congressional charter granted to the National Academy of Sciences. For more information about the Institute of Medicine, visit the IOM home page at www.iom.edu. Copyright ©2000 by the National Academy of Sciences. All rights reserved. Permission is granted to reproduce this document in its entirety, with no additions or a l­ terations � � � � � � COMMITTEE ON QUALITY OF HEALTH CARE IN AMERICA WILLIAM C. RICHARDSON ( ), President and CEO, W.K. Kellogg Foundation, Chair Battle Creek, MI President and CEO, Institute for Healthcare Improvement, DONALD M. BERWICK, Boston, MA J. CRIS BISGARD, Director, Health Services, Delta Air Lines, Inc., Atlanta, GA LONNIE R. BRISTOW, Former President, American Medical Association, Walnut Creek, CA CHARLES R. BUCK, Program Leader, Health Care Quality and Strategy Initiatives, General Electric Company, Fairfield, CT CHRISTINE K. CASSEL, Professor and Chairman, Department of Geriatrics and Adult Development, The Mount Sinai School of Medicine, New York, NY 7

8 MARK R. CHASSIN, Professor and Chairman, Department of Health Policy, The Mount Sinai School of Medicine, New York, NY MOLLY JOEL COYE, Senior Fellow, Institute for the Future, and President, Health Technology Center, San Francisco, CA Dennis Gillings Professor of Health Management, University of DON E. DETMER, Cambridge, UK JEROME H. GROSSMAN, Chairman and CEO, Lion Gate Management Corporation, Boston, MA BRENT JAMES, Executive Director, Intermountain Health Care Institute for Health Care Delivery Research, Salt Lake City, UT DAVID Chairman and CEO, Kaiser Foundation Health Plan, Inc., McK. LAWRENCE, Oakland, CA LUCIAN L. LEAPE, Adjunct Professor, Harvard School of Public Health, Bo ston, MA ARTHUR LEVIN, Director, Center for Medical Consumers, New York, NY RHONDA ROBINSON-BEALE, Executive Medical Director, Managed Care Manag e­ ment and Clinical Programs, Blue Cross Blue Shield of Michigan, Southfield Associate Dean for Primary Care, University of California, JOSEPH E. SCHERGER, Irvine College of Medicine ARTHUR SOUTHAM, President and CEO, Health Systems Design, Oakland, CA Director, Center for Health Policy, Research, and Ethics, MARY WAKEFIELD, George Mason University, Fairfax, VA GAIL L. WARDEN, President and CEO, Henry Ford Health System, Detroit, MI Study Staff JANET M. CORRIGAN, Director, Quality of Health Care in America Project Director, Board on Health Care Services, MOLLA S. DONALDSON, Project Codirector LINDA T. KOHN, Project Codirector SHARI K. MAGUIRE, Research Assistant KELLY C. PIKE, Senior Project Assistant Auxiliary Staff MIKE EDINGTON, Managing Editor JENNIFER CANGCO, Financial Advisor Consultant RONA BRIER, Brier Associates, Inc. � � � � � � 8

Related documents

The Health Consequences of Smoking   50 Years of Progress: A Report of the Surgeon General

The Health Consequences of Smoking 50 Years of Progress: A Report of the Surgeon General

The Health Consequences of Smoking—50 Years of Progress A Report of the Surgeon General U.S. Department of Health and Human Services

More info »
625137

625137

2018-19 Nebraska All-Sports Record Book - Nebraska Communications Office -

More info »
The 9/11 Commission Report

The 9/11 Commission Report

Final FM.1pp 7/17/04 5:25 PM Page i THE 9/11 COMMISSION REPORT

More info »
Computer Vision: Algorithms and Applications

Computer Vision: Algorithms and Applications

Computer Vision: Algorithms and Applications Richard Szeliski September 3, 2010 draft c © 2010 Springer This electronic draft is for non-commercial personal use only, and may not be posted or re-distr...

More info »
Managing the Risks of Extreme Events and Disasters to Advance Climate Change Adaptation

Managing the Risks of Extreme Events and Disasters to Advance Climate Change Adaptation

MANAGING THE RISKS OF EXTREME EVENTS AND DISASTERS TO ADVANCE CLIMATE CHANGE ADAPTATION SPECIAL REPORT OF THE INTERGOVERNMENTAL PANEL ON CLIMATE CHANGE

More info »
ECI Historical Listing    Volume III   March 2019

ECI Historical Listing Volume III March 2019

Employment Cost Index National Compensation Survey – Volume III Historical Listing April www.bls.gov/ect 2019 (December 2005=100) 2019 -March Current Dollar, March 2001 The estimates from 2001 to 2005...

More info »
SR288.PS

SR288.PS

113th Congress S. Report ! " SENATE 2d Session 113–288 REPORT of the SENATE SELECT COMMITTEE ON INTELLIGENCE COMMITTEE STUDY of the CENTRAL INTELLIGENCE AGENCY’S DETENTION AND INTERROGATION PROGRAM to...

More info »
PLAW 107publ56

PLAW 107publ56

PUBLIC LAW 107–56—OCT. 26, 2001 UNITING AND STRENGTHENING AMERICA BY PROVIDING APPROPRIATE TOOLS REQUIRED TO INTERCEPT AND OBSTRUCT TERRORISM (USA PATRIOT ACT) ACT OF 2001 VerDate 11-MAY-2000 19:15 No...

More info »
Administrative Work in the Information Technology Group, GS 2200

Administrative Work in the Information Technology Group, GS 2200

Administrative Work in the Information Issued: May 2001 Revised: 8/03, 9/08, 5/11, October 2018 Technology Group, 2200 Job Family Standard for Administrative Work in the Information Technology Group, ...

More info »
OCS Operations Field Directory

OCS Operations Field Directory

Gulf of Mexico OCS Region OCS Operations Field Directory (Includes all active and expired fields and leases) Quarterly Repor t, as of March 31 , 201 9 U.S. Department of the Interior Bureau of Ocean E...

More info »
UNSCEAR 2008 Report Vol.I

UNSCEAR 2008 Report Vol.I

This publication contains: VOLUME I: SOURCES SOURCES AND EFFECTS Report of the United Nations Scientific Committee on the Effects of Atomic Radiation to the General Assembly OF IONIZING RADIATION Scie...

More info »
Second National Report on Biochemical Indicators of Diet and Nutrition in the U.S. Population

Second National Report on Biochemical Indicators of Diet and Nutrition in the U.S. Population

Second National Report on Biochemical Indicators of Diet and Nutrition in the U.S. Population Second National Report on Biochemical Indicators of Diet and Nutrition in the U.S. Population 2012 Nationa...

More info »
Qualys Web Application Scanning API User Guide

Qualys Web Application Scanning API User Guide

Web Application Scanning API User Guide Version 2.38 April 09, 2019

More info »
9780199554232_000i-00ii_Sodhi_Biology_color_Htitle 1..2

9780199554232_000i-00ii_Sodhi_Biology_color_Htitle 1..2

1 Conservation Biology for All EDITED BY : Navjot S. Sodhi AND * Department of Department of Biological Sciences, National University of Singapore Organismic and Evolutionary Biology, Harvard Universi...

More info »
CDIR 2018 07 27

CDIR 2018 07 27

S. Pub. 115-7 2017-2018 Official Congressional Directory 115th Congress Convened January 3, 2017 JOINT COMMITTEE ON PRINTING UNITED STATES CONGRESS UNITED STATES GOVERNMENT PUBLISHING OFFICE WASHINGTO...

More info »
Vaginal Birth After Cesarean: New Insights. Evidence Report/Technology Assessment, No. 191

Vaginal Birth After Cesarean: New Insights. Evidence Report/Technology Assessment, No. 191

Evidence Report/Technology Assessment Number 191 Vaginal Birth After Cesarean: New Insights Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 540 Ga...

More info »
00 SV COVER.qxd

00 SV COVER.qxd

Definition and Selection of Key Competencies Contributions to the Second DeSeCo Symposium Geneva, Switzerland, 11-13 February, 2002 Neuchâtel 2003

More info »
13128

13128

This PDF is available from The National Academies Press at http://www.nap.edu/catalog.php?record_id=13128 The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better...

More info »