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2 Improving the 21st-Century Health Care System
Pages 39-60

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From page 39...
... Recommendation 1: All health care organizations, professional groups, and private and public purchasers should adopt as their explicit purpose to continually reduce the burden of illness, injury, and disability, and to improve the health and functioning of the people of the United States. It is helpful to translate this general statement into a more specific agenda for improvement a list of performance characteristics that, if addressed and improved, would lead to better achievement of that overarching purpose.
From page 40...
... The Secretary of the Department of Health and Human Services should report annually to Congress and the President on the quality of care provided to the American people. Without ongoing tracking of quality to assess the country's progress in meeting the aims set forth in this chapter, interested parties including patients, health care practitioners, policy makers, educators, and purchasers cannot identify
From page 41...
... Once she had joined CityCare, she was asked to choose a primary care physician. After receiving some recommendations from a neighbor and several coworkers, she called several of the offices to sign up.
From page 42...
... After numerous calls, she was finally able to track down her old mammograms. It turned out that a possible abnormal finding had been circled the previous year, but neither she nor her primary care physician had ever been notified.
From page 43...
... These aims are not new; they are familiar and have been valued, arguably for decades, among health care professionals, patients, policy makers, and communities. Yet American health care fails far too often with respect to these aims, despite its enormous cost and the dedication and good efforts of millions of American health care workers.
From page 44...
... The IOM has defined quality as "the degree to which health care services for individuals and populations increase the likelihood of desired outcomes and are consistent with current professional knowledge" (Institute of Medicine, 1990~. The committee believes the health care system should define safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity using measures determined by the outcomes patients desire, although clinicians should not be asked to compromise their ethical values.
From page 45...
... use of a wrong plan to achieve an aim. In health care these errors include, for example, administering the wrong drug or dosage to a patient, diagnosing pneumonia when the patient has congestive heart failure, and failing to operate when the obvious (as opposed to ambiguous)
From page 46...
... Kaiser Family Foundation, 2000) , the committee is concerned about Americans' remarkably low level of confidence in the health care system overall.
From page 47...
... Such evidence-based practice has been defined by Sackett and colleagues and is adapted here (Sackett et al., 1996~: evidence-based practice is the integration of best research evidence with clinical expertise and patient values. Best research evidence refers to clinically relevant research, often from the basic sciences of medicine, but especially from patient-centered clinical research into the accuracy and precision of diagnostic tests (including the clinical examination)
From page 48...
... includes intense interest in health information (Brown, 1998; Cyber Dialogue, 2000~. In an October 1998 survey of Internet users, 27 percent of female and 15 percent of male Internet users said that they accessed medical information weekly or daily (Eysenbach et al., 1999; Georgia Tech Research Corporation, 19981.
From page 49...
... The right of patients to be informed decision makers is well accepted, but not always well implemented. An analysis of audiotaped encounters between patients and their primary care physicians or general and orthopedic surgeons revealed that overall, only 9 percent met the authors' definition of completely informed decision making (Braddock et al., 1999~.
From page 50...
... Suffering is more than just physical pain and other distressing symptoms; it also encompasses significant emotional and spiritual dimensions (Byock, 1998; Cassell, 1991~. Patientcentered care attends to the anxiety that accompanies all injury and illness, whether due to uncertainty, fear of pain, disability or disfigurement, loneliness, financial impact, or the effect of illness on one's family.
From page 51...
... In the earlier scenario, Ms. Martinez' surgery was nearly cancelled because important information that should have been in her record was missing, and staff spent valuable time finding it and rearranging schedules to avoid having to cancel the operation.
From page 52...
... and in other industries (Heskett et al., 1997~. Promising work in health care has begun to result in reduced delays by decreasing cycle time and by applying lessons from other industries on continuous rather than batch production (Nolan et al., 1996~.
From page 53...
... Lack of health insurance has a profound effect on access to appropriate services, and is directly associated with poor functioning, increased morbidity, and increased mortality (American College of PhysiciansAmerican Society of Internal Medicine, 2000; Baker et al., 2000; Franks et al., 1993; Haas and Goldman, 1994; Hafner-Eaton, 1993; Kasper et al., 2000~. Institutions and health professionals that deliver uncompensated care to uninsured or underserved patients are at risk financially (Institute of Medicine, 2000a)
From page 54...
... Because unnecessary services can do harm and offer no benefit, ethical principles dictate that a physician not recommend or prescribe requested treatment that is of no known benefit whether, for example, the request is for antibiotics, diagnostic tests, or a wide variety of invasive procedures. A VISION OF FUTURE CARE The six aims for improvement described in this chapter define the tasks ahead for the health care system, for organizations, and for clinical practices that wish to contribute to the overarching social purpose set forth at the beginning of this chapter.
From page 55...
... Since the information for the appointment had already been completed, she went directly to a breast care center, where the exam and mammogram were completed without delay. Before leaving, she learned that a lump discovered during the breast exam had been confirmed by mammogram and sonography, and that she should have a biopsy to determine the nature of the finding.
From page 56...
... REFERENCES Advisory Commission on Consumer Protection and Quality in the Health Care Industry.
From page 57...
... A Radical Prescription for Hospitals. Harvard Business Review 67(3)
From page 58...
... Now Are You Satisfied? The 1998 American Customer Satisfaction Index.
From page 59...
... Poll by National Public Radio, the Henry J Kaiser Family Foundation, and Harvard University's Kennedy School of Government." Online.
From page 60...
... Harvard Business Review 75:87-95, 1997. Veatch, Robert M


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