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1 A New Health System for the 21st Century
Pages 23-38

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From page 23...
... National Roundtable on Health Care Quality documents three types of quality problems overuse, underuse, and misuse. The report describes the problem as follows: The burden of harm conveyed by the collective impact of all of our health care quality problems is staggering.
From page 24...
... For example, problems with breast cancer care include underuse of mammography for early cancer detection, lack of adherence to standards for diagnosis (such as biopsies and pathology studies) , inadequate patient counseling regarding treatment options, and underuse of radiation therapy and adjuvant chemotherapy following surgery.
From page 25...
... The nation' s current health care system often lacks the environment, the processes, and the capabilities needed to ensure that services are safe, effective, patient-centered, timely, efficient, and equitable. UNDERLYING REASONS FOR INADEQUATE QUALITY OF CARE Four key aspects of the current context for health care delivery help explain the quality problems outlined above: the growing complexity of science and technology, the increase in chronic conditions, a poorly organized delivery system, and constraints on exploiting the revolution in information technology.
From page 26...
... Increase in Chronic Conditions One of the consequences of advances in medical science and technology is that people are now living longer. Although health care is by no means the only factor that affects morbidity and mortality, innovations in medical science and technology have contributed greatly to increases in life expectancy.
From page 27...
... In 1990, the direct medical costs for persons with chronic conditions was $425 billion, nearly 70 percent of all personal health care expenditures (The Robert Wood Johnson Foundation, 1996~. The indirect costs lost productivity due to premature death or inability to work added another $234 billion to this figure.
From page 28...
... The prevailing model of health care delivery is complicated, comprising layers of processes and handoffs that patients and families find bewildering and clinicians view as wasteful. Patients in a 1996 Picker Survey reported that the health care system is a "nightmare to navigate" that it feels less like a system than a confusing, expensive, unreliable, and often impersonal disarray (Picker Institute and American Hospital Association, 1996~.
From page 29...
... These lessons include organized approaches to collecting data on errors and analyzing their causes, minimizing reliance on human memory, and standardizing routine aspects of care processes (Chassin, 1998; Institute of Medicine, 2000~. Patient safety emerges from systems that are skillfully designed to prevent harm (Cook, 1998~.
From page 30...
... To meet this challenge, there must be a commitment to organizing services around common patient needs and applying information technology and engineering concepts to the design of care processes. Constraints on Exploiting the Revolution in Information Technology The advent of the Internet and the World Wide Web has placed us on the threshold of a change that is reshaping virtually all aspects of society, including health care delivery.
From page 31...
... To better understand how information technology can contribute to improving quality, the Committee on the Quality of Health Care in America held a workshop in September 1999 at which participants identified five key areas in which information technology could contribute to an improved health care delivery system: · Access to the medical knowledge-base. Through use of the Web, it should be possible to help both providers and consumers gain better access to clinical evidence.
From page 32...
... The diverse and highly decentralized structure of the health care industry, as discussed above, makes the business models for new applications complex and difficult, resulting in slow adoption of even highly successful pioneering applications. Efforts to introduce new applications also encounter resistance from health care professionals for a variety of reasons, including uncertainties about how such applications will alter relationships among and between clinicians, patients, and health care organizations (National Research Council, 2000~.
From page 33...
... Substantial improvement in quality over the coming decade can be achieved only by engaging the support of patients, clinicians, governing boards and managers of health care organizations, private and public purchasers, state and federal policy makers, regulators, researchers, and others. Change is needed at all levels, including the clinician and patient relationship; the structure, management, and operation of health care organizations; the purchasing and financing of health care; the regulatory and liability environment; and others.
From page 34...
... With these precepts in mind, the committee proposes the following agenda designed to bridge the quality gap: · That all health care constituencies, including policymakers, purchasers, regulators, health professionals, health care trustees and management, and consumers, commit to a national statement of purpose for the heath care system as a whole and to a shared agenda of six aims for improvement that can raise the quality of care to unprecedented levels. · That clinicians and patients, and the health care organizations that support care delivery, adopt a new set of principles to guide the redesign of care processes.
From page 35...
... In sum, health care is plagued today by a serious quality gap. The current health care delivery system is not robust enough to apply medical knowledge and technology consistently in ways that are safe, effective, patient-centered, timely, efficient, and equitable.
From page 36...
... Ann Int Med 84:646-51, 1976.
From page 37...
... Ann Int Med 120: 135-42, 1994. Katon, Wayne, Michael Von Korff, Edward Lin, et al.
From page 38...
... The Robert Wood Johnson Foundation. Chronic Care in America: A 21St Century Challenge.


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