Priority Areas for National Action Transforming Health Care Quality (2003) / Chapter Skim
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Executive Summary
Executive Summary
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focus national attention on patient safety concerns surrounding the high incidence of medical errors and sizable gaps in health care quality, respectively. In addition to the TOM, many others have assumed leadership roles in the movement to address and improve health care safety and quality.
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Indeed the goal of the study was to identify priority areas that presented the greatest opportunity to narrow the gap between what the health care system is routinely doing now and what we know to be best medical practice. Scope and Framework The Quality Chasm report proposes that chronic conditions serve as the focal point for the priority areas, given that a limited number of chronic conditions account for the majority of the nation's health care burden and resource use (Hoffman et al., 1996; Institute of Medicine, 2001a; Partnership for Solutions, 2001; The Robert Wood Johnson Foundation, 20011.
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population's health care needs across the lifespan, in multiple health care settings involving many types of health care professionals. Extend across the full spectrum of health care, from keeping people well and maximizing overall health; to providing treatment to cure people of disease and health problems as often as possible; to assisting people who become chronically ill to live longer, more productive and comfortable lives; to providing dignified care at the end of life that is respectful of the values and preferences of individuals and their families.
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For this purpose, the committee supplemented quantitative data with qualitative data and case studies of successful examples of system change. These sources were used to study whether, for a condition posing a high health burden, there was evidence that quality improvement could substantially improve care.
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Asthma appropriate treatment for persons with mild/moderate persistent asthma Cancer screening that is evidencebased focus on colorectal and cervical cancer - Children with special health care needs 3 Diabetes focus on appropriate management of early disease End of life with advanced organ system failure focus on congestive heart failure and chronic obstructive pulmonary disease Frailty associated with old agcpreventing falls and pressure ulcers, maximizing function, and developing advanced care plans Hypertension focus on appropriate management of early disease Immunization children and adults Ischemic heart disease prevention, reduction of recurring events, and optimization of functional capacity Major depression screening and treatment Medication management preventing medication errors and overuse of antibiotics Nosocomial infections prevention and surveillance Pain control in advanced cancer Pregnancy and childbirth— appropriate prenatal and intrapartum care Severe and persistent mental illness focus on treatment in the public sector Stroke- early intervention and rehabilitation Tobacco dependence treatment in adults Obesity (emerging area) 2 An emerging area is one of high burden (impact)
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Ischemic heart disease I 6
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Self-managemenVhealth literacy (cross-cutting) End of life with advanced organ system failure Ischemic heart disease Medication management Medication errors Overuse of antibiotics Nosocomial infections Pain control in advancecl cancer Pregnancy and childbirth Severe and persistent mental illness Stroke 7
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For example, using the committee's initial framework, diabetes was placed under chronic care, tobacco dependency treatment under preventive care, pain control under palliative care, antibiotic overuse under acute care, and care coordination under cross-cutting systems interventions.
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Next Steps With the priority areas having been identified, the final step in the process is to implement strategies for improving care in the priority areas, measure the impact of implementation, and periodically review/update the list of areas. Impact should be measured using methods that are standardized and can permit comparison across these diverse areas of quality improvement.
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The costs of investing strategically in research aimed at developing new scientific evidence on interventions that improve the quality of care and at creating additional accurate, valid, and reliable standardized measures of quality. Such research is especially critical in areas of high importance in which either the scientific evidence for effective interventions is lacking, or current measures of quality are inadequate.
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Faster health spending growth and a slowing economy drive the health spending projection for 2001 up sharply. Health Aff (Millwood)
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Princeton, NJ: Robert Wood Johnson Foundation. United States Department of Health and Human Services.
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