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IOM Calls for Overhaul of Health Care Industry
March 1, 2001 -- The nation's health care industry has foundered
in its ability to provide safe, high-quality care consistently to
all Americans, says a new report from the Institute of Medicine
(IOM) of the National Academies. 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.
Health care organizations are only beginning to apply technological
advances. Many patients also could have their needs met more quickly
and at a lower cost if they had the option of communicating with
health care professionals through e-mail. The use of automated medication
order entry systems can reduce errors in prescribing and dosing
drugs, and computerized reminders can help both patients and clinicians
identify needed services. However, the report recognizes that many
policy, payment, and legal issues would have to be resolved before
much headway could be made.
A nationwide effort is needed to build a technology-based information
infrastructure that would lead to the elimination of most handwritten
clinical data within the next 10 years, the committee said. Congress,
the executive branch, leaders of health care organizations, and
public and private purchasers should work together toward this goal.
Without a national pledge to create and fund such a technological
framework, progress to enhance quality of care will be painfully
slow.
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.
"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," said
William C. Richardson, chair of the committee that wrote the report
and president of the W.K. Kellogg Foundation, Battle Creek, Mich.
"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."
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. These ailments typically
require care involving a variety of clinicians and health care settings,
over extended periods of time. But physician groups, hospitals,
and health care organizations work so independently from 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 pointed out.
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 findings in that report amounted to only the tip of the
iceberg in the larger story about quality care. America's health
system is 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 new report states. It calls for
immediate action to improve care -- in all aspects and for everyone
-- over the next decade, and offers a comprehensive strategy to
do so. The committee examined the health care delivery system as
a whole; it did not address the issue of the uninsured, who are
the subject of a separate Institute of Medicine project.
A Broad View of Quality
To initiate across-the-board reform, the federal Agency for Healthcare
Research and Quality should identify 15 or more common health conditions,
most of them chronic, the report says. Then, health care professionals,
hospitals, health plans, and purchasers should develop strategies
and action plans to improve care for each of these priority conditions
over a five-year period.
To stay aware of the big picture, the U.S. Department of Health
and Human Services (HHS) should monitor and track quality improvements
in six key areas: safety, effectiveness, responsiveness to patients,
timeliness, efficiency, and equity. And the secretary of HHS should
report annually to Congress and the president on progress made in
those areas, the report says.
In addition, public and private purchasers should develop payment
policies that reward quality. Current methods provide little financial
reward for improvements in the quality of health care delivery,
and may even inadvertently pose barriers to innovation. With input
from relevant private and public interests, the federal government
should identify, test, and evaluate various payment options that
more closely align compensation methods with quality-improvement
goals.
The committee also offers 10 new rules intended to make the health
system more responsive to patients' needs and preferences and to
encourage their participation in decision-making. These rules also
are intended to promote the development of systems that are consciously
and carefully designed to be safe, anticipate patient needs, promote
cooperation among clinicians, use resources wisely, and make available
information on quality and safety performance (see attached list).
The study was sponsored by the Institute of Medicine, National Research
Council, Robert Wood Johnson Foundation, California Health Care
Foundation, the Commonwealth Fund, and U.S. Department of Health
and Human Services. The Institute of Medicine is a private, nonprofit
institution that provides health policy advice under a congressional
charter granted to the National Academy of Sciences. A committee
roster follows.
Pre-publication copies of Crossing the Quality Chasm: A New Health
System for the 21st Century are available from the National
Academy Press at the mailing address in the letterhead; tel. (202)
334-3313 or 1-800-624-6242. The cost is $50.00 (prepaid) plus shipping
charges of $4.50 for the first copy and $.95 for each additional
copy. Reporters may obtain a copy from the Office of News and Public
Information at the letterhead address (contacts listed above).
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