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The second report from the Institute of Medicine (IOM) of the National Academies paints a grim picture, saying the nation’s health care industry has foundered in its ability to provide safe, high-quality care consistently to all Ameri-cans. "Reorganization and reform are urgently needed to fix what is now a disjointed and inefficient system," the report states.
To spur an overhaul, Congress should create an innovation fund of $1 billion for use during the next three to five years to help subsidize promising projects and communicate the need for rapid and significant change throughout the health system, the report adds. Just as a solid commitment of public funds and other resources supported the ultimately successful mapping of the human genome, a similar commitment is needed to redesign the health care delivery system so all Americans can benefit, says William Richardson, chair of the committee that wrote the report and president of the W.K. Kellogg Foundation in Battle Creek, MI.
"Americans should be able to count on receiving care that uses the best scientific knowledge to meet their needs, but there is strong evidence that this frequently is not the case," Richardson says. "The system is failing because it is poorly designed. For even the most common conditions, such as breast cancer and diabetes, there are very few programs that use multidisciplinary teams to provide comprehensive services to patients. For too many patients, the health care system is a maze, and many do not receive the services from which they would likely benefit."
The report says clinicians, health care organizations, and purchasers — companies or groups that compensate health care providers for delivering services to patients — should focus on improving care for common, chronic conditions such as heart disease, diabetes, and asthma that are now the leading causes of illness in the United States and consume a substantial portion of health care resources. Those ailments typically require care involving a variety of clinicians and health care settings over extended periods of time. But Richardson says physician groups, hospitals, and health care organizations work so independently of one another that they frequently provide care without the benefit of complete information about patients’ conditions, medical histories, or treatment received in other settings.
The committee’s previous report, To Err Is Human: Building a Safer Health System, found that more people die from medical mistakes each year than from highway accidents, breast cancer, or AIDS. But Richardson says findings in that report amounted to only the tip of the iceberg in the larger story about quality care. The IOM calls America’s health care system "a tangled, highly fragmented web that often wastes resources by providing unnecessary services and duplicating efforts, leaving unaccountable gaps in care and failing to build on the strengths of all health professionals."
The report calls for immediate action to improve care over the next decade and offers a comprehensive strategy to do so. The report envisions a revamped system that not only is centered on the needs, preferences, and values of patients, but also encourages teamwork among health care workers and makes much greater use of information technology. The IOM committee suggests more emphasis on electronic records, communicating with patients via e-mail, and automated medication order entry systems that can reduce errors in prescribing and dosing drugs. However, the report recognizes that many policy, payment, and legal issues would have to be resolved before much headway could be made.
To initiate across-the-board reform, the IOM says the federal Agency for Healthcare Research and Quality should identify 15 or more common health conditions, most of them chronic. Then health care professionals, hospitals, health plans, and purchasers should develop strategies and action plans to improve care for each of those priority conditions over a five-year period. The report also calls on the U.S. Department of Health and Human Services (HHS) to monitor and track quality improvements in six key areas: safety, effective-ness, responsiveness to patients, timeliness, efficiency, and equity. The HHS secretary should report annually to Congress and the president on progress made in those areas, the report says.
The study was sponsored by the IOM, the National Research Council, the Robert Wood Johnson Foundation, the California Health Care Foundation, the Commonwealth Fund, and HHS. The National Patient Safety Foundation (NPSF) welcomed the second report, saying it emphasizes how important it is to make care safer for patients.
"Harming patients is a critical indicator that quality improvements are needed. You can’t have a quality system that is not safe," says Joanne Turnbull, PhD, executive director of the NPSF. "To create safe systems, we need multidisciplinary teams that work together to identify and implement solutions. We need a commitment to continuous learning and continuous training, and we need to more quickly move from theories and concepts to applications and system improvements."
Turnbull says the NPSF has involved patients and family members who have experienced medical errors in their efforts to improve health care safety. "We’ve learned a tremendous amount about what they expect and need as they deal with so many unfortunate consequences," she says. "We must value patients’ perspectives, and adopt better principles of patient-centered care if we’re going to make care safer."
Earlier this year, the NPSF developed its own "Statement of Principle" to encourage better communication with patients. The statement was mailed to nearly every hospital CEO and board trustee across the country. It urges health care professionals to be open and honest in their communication with patients and families, and to share information about errors in a timely and proactive manner.