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In a new report, "Crossing the Quality Chasm: A New Health System for the 21st Century," the Institute of Medicine’s (IOM) Committee on the Quality of Health Care in America issued an urgent call for major overhaul of the health care delivery system in this country: "American health care is beset by serious problems, but they are not intractable."
Thirteen recommendations, including a proposal that Congress create a $1 billion "innovation fund" for health care’s revision process, make up the crux of the committee’s forward-looking report, which was unveiled with much fanfare, including a news conference and public webcast on www.nationalacademies.org.
"Today we cannot guarantee that patients will receive state-of-the-art care," says Donald Berwick, MD, MPP, president and CEO of the Institute for Healthcare Improvement and one of the study’s authors. "We need to develop a system where we can guarantee patients will receive the best care that exists."
The committee calls upon not only the legislative community but health care institutions, practitioners, purchasers, and regulators, "indeed, the entire health care enterprise to make significant improvement" in the health care system. Specifically, it says:
• Control should reside with the patient. Patients should be given the necessary information and the opportunity to exercise the degree of control they choose over health care decisions that affect them.
• Patients should have unfettered access to their own medical information and to clinical knowledge.
• The health system should anticipate patient needs rather than simply reacting to events.
• The Agency for Healthcare Research and Quality should identify a list of "Priority Conditions" to use as a starting point for improvement. That is to say, only 15 to 25 conditions, most of them chronic, account for a sizeable portion of the nation’s health burden and expenditures. The committee believes that the health care system must focus greater attention to care for those common conditions.
• Congress should establish a Health Care Quality Innovation Fund to support projects that contribute to the overall improvement of the system.
"Americans now annually invest $1.1 trillion in the health care sector," noted William Richardson, chair of the committee, in his opening remarks. "The committee believes a sizeable commitment, on the order of $1 billion over three to five years, is needed to strongly communicate the need for rapid and significant change in the health care system and to help initiate the transition," he added.
• The secretary of the Department of Health and Human Services should establish and maintain a process "aimed at making scientific evidence more useful and accessible to clinicians and patients." Currently, the authors explain, scientific knowledge about best care is not applied systematically or effectively to clinical practice.
• Information technology must play a central role in the redesign of the health care system, with the support of leaders in Congress, the White House, public and private health care purchasers, and health informatics associations and vendors. The hope is the cooperative effort will lead to the elimination of most handwritten clinical data by the end of the decade.
• Private and public purchasers should examine their current payment methods to remove barriers, which currently impede quality improvement, and build in stronger incentives for quality enhancement.
The IOM’s Committee on the Quality of Health Care in America was formed in June 1998 to advise the government on the quality of U.S. health care, with an eye for improvement, over the next 10 years. The quality report is available in a downloadable format at the National Academies’ web site: www.nationalacademies.org.