Carefully designed, evidence-based care processes, supported by automated clinical information and decision support systems, offer the greatest promise of achieving the best outcomes from care for chronic conditions. Some efforts are now under way to synthesize the clinical evidence pertaining to common chronic conditions and to make this information available to consumers and clinicians on the Web and by other means (Lindberg and Humphreys, 1999). In addition, evidence-based practice guidelines have been developed for many chronic conditions (Eisenberg, 2000). Yet studies of the quality of care document tremendous variability in practice for many such conditions. Given these variations and the prevalence of chronic conditions, these conditions represent an excellent starting point for efforts to better define optimum care or best practices, and to design care processes to meet patient needs. Moreover, such efforts to improve quality must be supported by payment methods that remove barriers to integrated care and provide strong incentives and rewards for improvement.
To facilitate this process, the Agency for Healthcare Research and Quality should identify a limited number of priority conditions that affect many people and account for a sizable portion of the national health burden and associated expenditures. In identifying these priority conditions, the agency should consider using the list of conditions identified through the Medical Expenditure Panel Survey (2000). According to the most recent survey data, the top 15 priority conditions are cancer, diabetes, emphysema, high cholesterol, HIV/AIDS, hypertension, ischemic heart disease, stroke, arthritis, asthma, gall bladder disease, stomach ulcers, back problems, Alzheimer’s disease and other dementias, and depression and anxiety disorders. Health care organizations, clinicians, purchasers, and other stakeholders should then work together to (1) organize evidence-based care processes consistent with best practices, (2) organize major prevention programs to target key health risk behaviors associated with the onset or progression of these conditions, (3) develop the information infrastructure needed to support the provision of care and the ongoing measurement of care processes and patient outcomes, and (4) align the incentives inherent in payment and accountability processes with the goal of quality improvement.
Recommendation 5: The Agency for Healthcare Research and Quality should identify not fewer than 15 priority conditions, taking into account frequency of occurrence, health burden, and resource use. In collaboration with the National Quality Forum, the agency should convene stakeholders, including purchasers, consumers, health care organizations, professional groups, and others, to develop strategies, goals, and action plans for achieving substantial improvements in quality in the next 5 years for each of the priority conditions.
Redirecting the health care industry toward the implementation of well-designed care processes for priority conditions will require significant resources.