Best Care at Lower Cost The Path to Continuously Learning Health Care in America (2013) / Chapter Skim
Currently Skimming:
1 Introduction and Overview
1 Introduction and Overview
Pages 47-62
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From page 47... ...
Yet, American health care is falling short on basic dimensions of quality, outcomes, costs, and equity. Available knowledge is too rarely applied to improve the care experience, and information generated by the care experience is too rarely gathered to improve the knowledge available.
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From page 48... ...
The point is not that health care can or should function in precisely the same way as all other sectors -- each is very different from the others, and every industry has room for improvement. Yet, if some of the transferable best practices from banking, construction, retailing, automobile manufacturing, flight safety, public utilities, and personal services were adopted as standard best practices in health care, the nation could see patient care in which: • records were immediately updated and available for use by patients; • care delivered were proven reliable at the core and tailored at the margins; • patient and family needs and preferences were a central part of the decision process; • all team members were fully informed in real time about each other's activities; • prices and total costs were fully transparent to all participants; • payment incentives were structured to reward outcomes and value, not volume; • errors were promptly identified and corrected; and • results were routinely captured and used for continuous improvement.
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From page 49... ...
Most physicians, nurses, and other health care professionals work diligently to care for their patients, but they often are contending with the challenges of a system that is poorly configured for the current complexity of treatments, technologies, and clinical science. These difficulties are exacerbated by administrative and organizational complexity that requires time that could be spent with patients.
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From page 50... ...
The threats toEvidence Science the health and economic security of Americans are clear, present, and compelling. What is needed -- and possible -- to transform care is a system that leverages the growing scientific evidence base, knowledge from other sectors on how to design reliable processes, and advances in information systems to enable continuous improvement in care, consistent implementation of best practices, and Leadership the ability to draw on knowledge generated every day through clinical care.
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Medical errors are far too common, different patient populations receive different intensities of services for the same conditions, and health care quality remains uneven. The lack of widespread progress on these now well-documented dimensions of care highlights the need for a substantially new approach.
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From page 52... ...
. The Robert Wood Johnson Foundation's Aligning Forces for Quality initiative is an effort to "improve health care quality in targeted communities,
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Learning Network, a member-driven network that provides participating organizations the tools necessary to implement accountable care successfully; the Quality Alliance Steering Committee, a collaborative effort aimed at implementing measures to improve the quality and efficiency of health care; and the Medicare Payment Reform Project, which is developing policy proposals to reward providers for improving the efficiency, quality, and coordination of care by moving toward greater accountability and support for overall quality and value (The Brookings Institution, 2012; Quality Alliance Steering Committee, 2012)
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This report cites the need for major changes in health professions education to keep pace with shifts in the nation's patient population and health care delivery environment and a rapidly expanding evidence base (IOM, 2003a)
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. Medicare's Quality Improvement Organization Program: Maximizing Potential considers the Quality Improvement Organization program and the need for technical assistance to aid providers undertaking improvement initiatives (IOM, 2006a)
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. • Digital Platform -- Digital Infrastructure for the Learning Health System: The Foundation for Continuous Improvement in Health and Health Care explores current efforts and opportunities to ac celerate progress in improving health and health care through in formation technology systems.
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The committee, whose work was supported by the Blue Shield of California Foundation, the Charina Endowment Fund, and the Robert Wood Johnson Foundation, was charged with (1) identifying how the effectiveness and efficiency of the current health care system can be transformed through tools and incentives for continuous assessment and improvement and (2)
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From page 58... ...
Based on this work, the Committee will prepare its Report with findings on major opportunities, deficiencies, and their consequences; identify the key pres sure points; and propose policy initiatives and priorities for government and other stakeholders to accelerate progress for continuous improvement in the value of health care delivered to Americans. organizing conceptual framework for addressing these challenges.
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From page 59... ...
Staff contacted 248 health care leaders from 215 organizations to solicit their thoughts on the current state of learning and improvement in the health care system and strategies for increasing learning among health care organizations and professionals. The committee received comments and suggestions from 137 individuals, who outlined the issues and challenges and highlighted successful strategies for moving forward.
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This report is divided into three parts. Part I builds the case for a continuously learning health care system, considering the challenges of managing complexity (Chapter 2)
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From page 61... ...
2011c. Learning what works: Infrastructure required for comparative effectiveness research: Workshop summary.
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