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Pages 323-337

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From page 323... ... , 196 Advisory Commission on Consumer Protection and Quality in the Health Care Industry, 6, 24, 39, 231 Agency for Health Care Policy and Research. See Agency for Healthcare Research and Quality (AHRQ) Read the entire page →
From page 324... ... See Malcolm Baldrige National Quality Award Barriers to quality improvement in current payment methods, 191- 199 adverse risk selection, 195-197 annual contracting arrangements, 197 perverse payment mechanisms, 191-195 Read the entire page →
From page 325... ... , 81 Cataracts, inappropriate acute care of, 302 Center for Organization and Delivery Studies, 105 Centers for Disease Control and Prevention, 156 Centers of Excellence, 100, 106 Change building organizational supports for, 11-12 in the health care environment, responding to, 138 leadership for managing, 137- 140 providing assets and encouragement for positive, 13 providing the resources needed to initiate, 103-108 Changes in Health Care Financing and Organization Program, 105 CHESS database, 55 Chronic care asthma, 264-265 cancer, 274-279 cardiovascular disease, 279-291 diabetes mellitus, 265-268 hypertension, 269-270 mental/addictive disorder, 272-274 mental health, 270-272 peptic ulcer disease, 269 underuse of, 264-291 Chronic conditions, 3-4. See also Priority conditions health care for, 9 increase in, 26-27 Chronic heart failure, 97 Clinical care, potential benefits of information technology for, 167- 168 Clinical decision support system (CDSS) Read the entire page →
From page 326... ... , 152-155 Congress, recommendations to, 7, 11, 17, 166 Constraints on exploiting information technology access to medical knowledge-base, 31 computer-aided decision support systems, enhanced patient and clinician communication, 31-32 reduction in errors, 31 Consumers potential benefits of information technology for health of, 166-168 recommendations to, 5, 34 Context, in complex adaptive systems, 314 Continuous access, 68 Continuous flow, 125-126 redesigning care processes for, 124-126 Continuous healing relationships, care based on, 8, 61, 66-69 Control, patient as the source of, 8, 61, 70-72 Cooperation, among clinicians, 9, 62, 83 Coordinating care, across patient conditions, services, and settings over time, 12, 4950, 133-135 Coronary artery bypass graft (CABG) surgery, 241 CPG Infobase, 157 Criteria for identifying priority conditions, 103 for including studies, 234 Crossing the chasm, 5-20 bulldmg orgamzatlonal supports for change, 11-12 establishing a new environment for care, 13-20 establishing aims for the 21st-century health care system, 5-7 formulating new rules to redesign and improve care, 7-9 taking the first steps, 9-11 Current payment methods barriers to quality improvement in, 191-199 incentives of, 184-191 Read the entire page →
From page 327... ... , 196 Disease management programs, 99-100 "Doe Talk" form, 72 Domestic violence, 134 "Double-loop" learning, 136 Drugs, using computer-based clinical decision support systems for prescribing of, 153 327 EEducation issues, 50 for the future health care workforce, 220 Educational institutions, recommendations to, 5, 34 Effectiveness, 46-48 21st-century health care system, 6 Efficiency, 52-53 improvements in, 164 21st-century health care system, 6 80/20 principle, system design using, 120-122 Embeddedness, in complex adaptive systems, 314 Emergent behavior, in complex adaptive systems, 313 Emotional support, 50 Emphysema, 91, 103 Encouragement, providing for positive change, 13 Environment for care aligning payment policies with quality improvement, 17-19 applying evidence to health care delivery, 13-15 establishing new, 13-20 focus and align environment toward the six aims for improvement, 13 preparing the workforce, 19-20 provide assets and encouragement for positive change, 13 using information technology, 15-17 Equity, 53 21st-century health care system, 6 Errors designing procedures to make visible, 123 designing systems to prevent, 122-123 reduction in, 31 "Essential technology," 171 Evidence-Based Cardiovascular Medicine, 150 Evidence-based care, 28 Evidence-based decision making, 8, 62, 76-77, 145-163 background, 147-148 defining quality measures, 157-159 in health care delivery, 13-15, 145-163 making information available on the Internet, 155-157 synthesizing clinical evidence, 148-152 using computer-based clinical decision support systems, 152-155 Evidence-Based Medicine, 150 Read the entire page →
From page 328... ... 328 Evidence-Based Mental Health, 150 Evidence-Based Nursing, 150 Evidence-Based Practice Centers, 14, 145, 150151 "Evidence formulary," 150 Evolutionary design, 314-315 Executive branch, recommendations to, 17, 166 Expressed needs, respect for patients', 49 F FACCTIONE, 158 Family, involvement of, 50 Fear, relieving, 50 Fee-for-service payment, adapting, 199 Financial requirements, for automated clinical information, 174-175 Financial transactions, potential benefits of information technology for, 167-168 First steps applications of priority conditions, 96- 103 criteria for identifying priority conditions, 103 providing the resources needed to initiate change, 103-108 value of organizing around priority conditions, 92-96 Follow-up, patients' needs for greater, 28 Food and Drug Administration, 26, 156 Foundation for Accountability, 158 Free flow of information, 8, 62, 72-75 Friends, involvement of, 50 Funding over several years, to ensure sustained and stable funding source, 104 G Gall bladder disease, 91, 103 Gastrointestinal disease, inappropriate acute care of, 302 General preventive care, 257 Genomics, 2 Good enough vision, 315-317 Group Health Cooperative of Puget Sound, 105 H Harm from errors, designing procedures that can mitigate, 123 Harris Poll results, 46, 166-167 INDEX Healing relationships, care based on continuous, 8, 61, 66-69 Health care conditions, patients with rare or complex, 122 Health care constituencies, recommendations to, 5, 34 Health care delivery, applying evidence to, 1315 Health care environment, obtaining resources and responding to changes in, 138 Health Care Financing Administration, 196 Centers of Excellence, 100, 106 Foundation for Accountability, 158 Medicare Participating Heart Bypass Center demonstration, 188 Office of Research and Development, 106 Peer Review Organizations, 158 recommendations to, 19, 182 Health care needs, of medium predictability, 121-122 Health care organizations as complex adaptive systems, 63-66 key challenges for the redesign of, 117-137 recommendations to, 6, 8-9, 34, 39-40 recommendations to leaders of, 17, 166 Health Care Quality Innovation Fund, 11 recommendations to, 91 - 92, 103 - 106, 166 Health care system, for the 21st-century, 6, 2360 Health care trustees and management, recommendations to, 5, 34 HEALTH database, 233 Health informatics associations and vendors, recommendations to, 17, 166 Health Insurance Portability and Accountability Act, 173 Health Plan Employer Data and Information Set (HEDIS) , 157, 159, 240, 242 Health Planning and Administration, HEALTH database, 233 Health professional education, changes required, 210 Health professionals new or enhanced skills required by, 209 recommendations to, 5, 34 Health professions, recommendations to, 5, 34 Health Resources Services Administration, Bureau of Primary Health Care, 91 Healthcare Informatics Standards Board, 172 HealthTopics, 157 Heart failure, 102 Read the entire page →
From page 329... ... , 13, 17, 23-24, 100, 103, 136-137, 165, 171, 191, 199 definition of accidental injury, 45 definition of quality, 232 National Roundtable on Health Care Quality, 23 Quality of Health Care in America Project, 225 Technical Advisory Panel on the State of Quality, 24, 226, 231-232, 234 Insurance coverage. See Equity Integrated Delivery System Research Network, 105 Integration of care, 49-50 Intensive care unit (ICU) Read the entire page →
From page 330... ... , 233 Medicare and Medicaid, 150, 174, 187 Medicare Participating Heart Bypass Center demonstration, 188 Medicare Peer Review Organizations, 227 Medicine, distinct cultures of, 78 Medium predictability, health care needs of, 121-122 MEDLINE, 156-157, 233 MEDLINEplus, 156-157, 233 Mental/addictive disorder, chronic care of, 272274 Mental health chronic care of, 270-272 misuse leading to, 306 Mergers, acquisitions, and affiliations, 3 Methodology criteria for including studies, 234 in the review of the literature, 233-236 types of studies not included, 234-236 Midcourse corrections, public funding for mix of projects to permit, 105 Misuse, 304-307 adverse events, 304-305 correcting problems of, 193 mental health, 306 preventable deaths, 304 tuberculosis, 307 U.S. examples of, 304-307 Molecular medicine, 155 Monitoring, using computer-based clinical decision support systems for, 152-153 Multidisciplinary summit, of leaders of health care organizations, 19, 208 Read the entire page →
From page 331... ... , 157 Nonclinical administrative management personnel, retraining, 212 Nonlinearity, in complex adaptive systems, 313 Novelty, in complex adaptive systems, 313 331 o Obtaining resources, in the health care environment, 138 Office of Research and Development, 106 On Lok Senior Health Services, 81 "Open-access" scheduling, 125 Organizational development, stages of, 112- 117 Organizational supports for change, 11-12, 111144 key challenges for the redesign of health care organizations, 117- 137 leadership for managing change, 137- 140 stages of organizational development, 112117 Organizing and coordinating care around patient needs Centers of Excellence, 100, 106 disease management programs, 99-100 Organizing around priority conditions ensures availability of specialized expertise to primary care practices, 95 includes strong focus on patient information and self-management, 95 redesigns practice to incorporate regular patient contact (regular follow-up) , 94 relies on having good information about patients, their care, and outcomes, 95 uses protocol providing explicit statement of what needs to be done for patient, 94 ORYX system for hospitals, 157 Osteoarthritis, 170 Otitis media acute care of, 259 inappropriate acute care of, 296 Outcome measurements, incorporating for improvement and accountability, 12, 135-137 Overuse problems correcting, 193 findings about, 226-227 p PacifiCare Health System, 200 Pain relief. Read the entire page →
From page 332... ... improvement methods, 315 Planned care, 28 Pneumococcal vaccine, findings about, 227 Pneumonia, 102 acute care of, 227, 258 Policymakers, recommendations to, 5, 34 Poor quality, level of harm caused by, 227-228 Poorly organized delivery system access to necessary clinical expertise, 29 evidence-based, planned care, 28 patients' need for information and behavioral change, 28 patients' needs for more time, resources, and follow-up, 28 supportive information systems, 29 Positive change, provide assets and encouragement for, 13 Potential benefits of information technology, 166-170 for administrative and financial transactions, 167-168 charted, 168 for clinical care, 167-168 for consumer health, 166-168 for professional education, 167, 169 for public health, 167, 169 for research, 167, 169 Practice guidelines delineate, 97-98 for synthesizing clinical evidence, 151-152 Practicing clinicians, retooling, 211-212 Predictable needs, patients with the most, 121 Preferences, respect for patients', 49 Pregnancy and delivery, 102 acute care of, 260-264 Read the entire page →
From page 333... ... INDEX Prescriptions, using computer-based clinical decision support systems for, 153 Preventable deaths, misuse leading to, 304 Preventive care cancer screening, 251-253 cardiac risk factors, 254-257 general, 257 immunizations, 250-251 telemedicine technologies in, 170 underuse of, 250-257 using computer-based clinical decision support systems for, 152-153 Primary care practices, availability of specialized expertise to, 95 Prioritizing, community health needs, 138 Priority conditions acute myocardial infarction, 102 Alzheimer's disease and other dementias, 91, 103 applications of, 96-103 arthritis, 91, 103 asthma, 91, 103 back problems, 91, 103 cancer, 91, 103 cardiac rehabilitation, 170 chronic heart failure, 97 criteria for identifying, 103 depression and anxiety disorders, 91, 97, 103 diabetes, 91, 97, 103, 170 domestic violence, 134 emphysema, 91, 103 gall bladder disease, 91, 103 heart failure, 102 high cholesterol, 91, 103 HIV/AIDS, 91, 97, 103, 134 hypertension, 91, 103 ischemic heart disease, 91, 97, 103 organizing and coordinating care around patient needs, 98-100 osteoarthritis, 170 pneumonia, 102 pregnancy and related conditions, 102 provide a common base for the development of information technology, 101 reduce suboptimization in payment, 101102 simplify quality measurement, evaluation of performance, and feedback, 102- 103 spinal cord injury, 97 333 stomach ulcers, 91, 103 stroke, 91, 97, 103 substance abuse, 97, 134 surgical procedures and complications, 102 synthesize the evidence base and delineate practice guidelines, 97-98 Privacy concerns, with automated clinical information, 171- 174 Private purchasers, recommendations to, 5, 8-9, 17-18, 39-40, 61-62, 166, 182, 184 Production planning, redesigning care processes for, 126-127 Professional education, potential benefits of information technology for, 167, 169 Professional groups, recommendations to, 6, 39-40 Profile of quality of care in U.S., from the review of the literature, 236-308 Program of All-Inclusive Care for the Elderly (PACE) , 81 Protocol, providing explicit statement of what needs to be done for patient, 94 Provider groups, up-front investments required by, 197-199 Providing the resources needed to initiate change, 103-108 funding over several years to ensure sustained and stable funding source, 104 public funding for mix of projects to permit midcourse corrections, 105 public support providing partial funding for up-front costs health care organizations face implementing changes, 104-105 Public funding for mix of projects, to permit midcourse corrections, 105 Public health, potential benefits of information technology for, 167, 169 Public purchasers, recommendations to, 5, 8-9, 17-18, 39-40, 61-62, 166, 182, 184 Public support providing partial funding, for up-front costs health care organizations face implementing changes, 104-105 Purchasers, recommendations to, 5-6, 8-9, 1718, 34, 39-40, 61-62, 166, 182, 184 Q Quality Center, 91 Quality Enhancement Research Initiative (QUERI) Read the entire page →
From page 334... ... , redesigning practice to incorporate, 94 Regulation of the professions ensuring continuing competency, 217 licensure systems, 215-216 scope-of-practice acts, 215-217 Regulators, recommendations to, 5, 34 Regulatory issues, for the future health care workforce, 221 Read the entire page →
From page 335... ... arrangements, adapting, 201 Simple rules, 315-317 in complex adaptive systems, 313 Simplifying quality measurement, evaluation of performance, and feedback, 102- 103 "Single-loop" learning, 136 Specialized expertise, availability to primary care practices, 95 Spinal cord injury, 97 Stages of organizational development, 112- 117 charted, 114-115 Stage 1 highly fragmented delivery system, 112-114 Read the entire page →
From page 336... ... 336 Stage 2 well-defined referral networks, 113-114 Stage 3 some movement toward patientcentered system, 113, 115- 116 Stage 4 21st-century health care system envisioned, 115- 117 Standards, need for, with automated clinical information, 171- 174 State of Quality Panel, 226 Stomach ulcers, 91, 103 Stroke, 91, 97, 103 Structural measures, not included in quality report, 235 Studies not included, 234-236 access to care studies, 235 comparisons of outcomes across multiple institutions, 234-235 physicians reports, 235 satisfaction ratings, 235 structural measures, 235 Suboptimization in payment, reducing, 101-102 Substance abuse, 97, 134 Support, emotional, 50 Surgical procedures and complications, 102 Sustained and stable funding source, funding over several years to ensure, 104 Synthesizing clinical evidence, 97-98, 148-152 practice guidelines, 151- 152 systematic reviews, 148-151 System design using the 80/20 principle Level 1 most predictable needs, 121 Level 2 health care needs of medium predictability, 121-122 Level 3 patients with rare or complex health care conditions, 122 redesigning care processes for, 120-122 System properties, safety as, 8, 62, 78-79 Systematic reviews, for synthesizing clinical evidence, 148-151 Systems thinking, 309-311 T Teams developing effective, 12, 130-133 optimizing performance of, 138- 139 Technical Advisory Panel on the State of Quality, 24, 226, 231-232, 234 Technology, growing complexity of, 25-26 Telemedicine technologies, 170 in preventive care, 170 INDEX Ten Commandments, 64 Time, patients' needs for more, 28 Timeliness, 51-52 improvements in, 164 21st-century health care system, 6 To Err Is Human: Building a Safer Health System, 2, 24, 44, 119, 122 Traditional clinical education, reasons for little change in, 213-214 Training issues, for the future health care workforce, 220 Translating Research into Practice, 155 Transparency, need for, 8, 62, 79-80 Tuberculosis, misuse leading to, 307 21st-century health care system, 6, 23-60, 3960, 66-83 agenda for the future, 33-35 anticipation of needs, 8, 62, 80-81 care based on continuous healing relationships, 8, 61, 66-69 complexity thinking applied to design of, 314-317 contrasted with current approach, 67 cooperation among clinicians, 9, 62, 83 customization based on patient needs and values, 8, 61, 69-70 effective, 6 efficient, 6 equitable, 6 establishing aims for, 5-7 evidence-based decision making, 8, 62, 76-77 need for transparency, 8, 62, 79-80 patient as the source of control, 8, 61, 70-72 patient-centered, 6 quality gap, 23-25 safe, 5 safety as a system property, 8, 62, 78-79 shared knowledge and free flow of information, 8, 62, 72-75 six aims for improvement, 6, 40-54 timely, 6 underlying reasons for inadequate quality of care, 25-33 vision of, 54-56, 115-117 waste continuously decreased, 9, 62, 81-83 U UCLA/RAND appropriateness method, 239 Underlying reasons for inadequate quality of care, 25-33 Read the entire page →
From page 337... ... , 97-98, 158. See also Department of Veterans Affairs Quality Enhancement Research Initiative, 97, 106 Virginia Mason Medical Center, 72 Visa International, 65, 316 Vision, good enough, 315-317 W Waste, continuously decreasing, 9, 62, 81-83 Wide space for innovation, 315- 317 Workforce preparation, 19-20, 207-223 clinical education and training, 208-214 investing in, 139 legal liability issues, 218-219 regulation of the professions, 214-218 research agenda for the future health care workforce, 219-221 Workforce supply issues, for the future of health care, 221 World Wide Web, 30, 154 health information found on, 31 technologies based on, 211 y Year 2000 Health Plan Employer Data and Information Set, 157, 159 Read the entire page →

From page 323...

... , 196 Advisory Commission on Consumer Protection and Quality in the Health Care Industry, 6, 24, 39, 231 Agency for Health Care Policy and Research. See Agency for Healthcare Research and Quality (AHRQ)

Index Pages 323-337

Index
Pages 323-337