Crossing the Quality Chasm

1
Crossing the Quality Chasm

• Second Report
• Committee on
• Quality of Health Care
• in America
• To order www.nap.edu

2
Studies Documenting the Quality Gap

• Literature reviews conducted by RAND
• Over 70 studies documenting quality shortcomings
• Large gaps between the care people should receive
  and the care they do receive
• true for preventive, acute and chronic
• across all health care settings
• all age groups and geographic areas
• (Schuster et.al., MMFQ,1998 updated 2000)
  

3
Medical Errors are a Serious Problem

• Over 35 studies documenting patient safety
  concerns
• Tens of thousands of Americans are seriously
  harmed
• Most errors occur because of system failures

4
Major Forces Influencing Health Care

• Expanding Knowledge Base
• Current practice depends upon the clinical
  decision-making capacity and reliability of
  autonomous individual practitioners, for classes
  of problems that routinely exceed the bounds of
  unaided human cognition.
• Daniel R. Masys, M.D.
• 2001 IOM Annual Meeting

5
Major Forces Influencing Health Care

• Chronic Care Needs
• 40 of population have one or more chronic
  conditions
• Chronic conditions account for more than
  two-thirds of health care expenditures (RWJF,
  1996)
• 80/20 Rule Limited number of conditions account
  for most of these health care expenditures

6
Delivery System Increasingly Inadequate

• Dearth of clinical programs with necessary
  infrastructure
• Chronic Care Delivery Model (Wagner, 1996)
• Systematic approach
• Attention to information and self-management
  needs of patients
• Multi-disciplinary teams
• Coordination across settings and clinicians, and
  over time
• Unfettered and timely access to clinical
  information

7
Committees Conclusion

• The American health care delivery system is in
  need of fundamental change. The current care
  systems cannot do the job. Trying harder will
  not work. Changing systems of care will.

8
Five Part Agenda for Change

• Commit to six aims for improvement
• Adopt 10 rules to guide the redesign of care
• Implement effective organizational supports
• Focus efforts on priority conditions
• Create environment that fosters improvement

9
Aims For Improvement

• Safe
• Effective
• Patient-centered

• Timely
• Efficient
• Equitable

10
10 Simple Rules

• Continuous Healing Relationships
• Evidence-based Decisions
• Customized Care
• Patient is the Source of Control
• Shared Knowledge

• Transparency
• Safety is a System Property
• Cooperation Among Clinicians
• Needs are Anticipated
• Waste is Continuously Decreased

11
Organizational Supports to

• - redesign care processes
• - invest in information technology
• - management of knowledge and skills
• - develop effective multidisciplinary teams
• - coordinate care
• - measure and improve performance and outcomes

12
Focus on Priority Conditions

• AHRQ should identify 15 priority conditions
• Congress should establish 1B Innovation Fund
• There should be substantial improvements in
  quality for priority conditions over the next 5
  years

13
Align Environmental Forces

• Four Critical Forces
• 1. Information Technology
• 2. Payment
• 3. Clinical Knowledge
• 4. Professional Workforce

14
Align Environmental Forces

• Information Technology
• Call for renewed national commitment to building
  an information infrastructure to support care
  delivery, consumer health, public accountability,
  public health, research, and clinical education.
  
• Goal elimination of most handwritten clinical
  data by 2010

15
Aligning Environmental Forces

• Payment
• Current payment policies are complex and
  contradictory, and often work against efforts to
  improve quality.
• Payment methods should provide an opportunity for
  providers to share in the benefits of quality
  improvement

16
Aligning Environmental Forces

• Clinical Knowledge
• Focusing on priority conditions, a public -
  private partnership should
• - synthesize evidence
• - identify best practices in care delivery
• - communicate evidence to public and
  professionals
• - develop and apply decision support tools
• - establish goals for improvement in care
  processes
• - develop core sets of quality measures

17
Aligning Environmental Forces

• Professional Workforce
• A multidisciplinary summit of leaders within the
  health professions should be held to discuss and
  develop strategies for
• - restructuring clinical education at all levels
• - assessing the implications of change for
  credentialing programs

18
Crossing the Quality Chasm Next Steps

• 2001 - 2003
• Project Areas
• Priority Conditions
• Reports to Monitor and Track Quality
• Health Professions Summit
• Nursing Work Environment and Patient Safety
• 1st Annual Chasm Summit
• Related IT Initiative