A History of the National Academy of Medicine 50 Years of Transformational Leadership (2022) / Chapter Skim
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5 U.S. Health Care and Policy
5 U.S. Health Care and Policy
Pages 101-138
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health care related to quality and safety, health care professional education and patient empowerment, health care reform and the availability of health insurance, and health care for complex illnesses and conditions. Underlying all of the work highlighted in this chapter is a foundational theme of quality -- from providing high-quality cancer and end-of-life care to enhancing the health care workforce and the health information technology (IT)
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Expansive in its thinking, the IOM Council envisioned the initiative cutting across all of the IOM's boards. To define the scope and structure of the initiative, the IOM established a steering committee -- chaired by external volunteer Walter J
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At the beginning of 1997, Board on Health Care Services Chair and NAM member Don Detmer7 suggested the IOM's efforts represented an "incomplete conceptual framework" with strategies that were too "imprecise to shape the future meaning of health care quality in our nation." Shine emphasized the need for consistency in the IOM's role in quality discussions and believed that the intersection between quality and value might be a good place for additional IOM work.8 The IOM proceeded by launching a Special Initiative on Health Care Quality that included a Quality Initiative Coordinating Committee, which was designed to oversee the IOM's health care quality activities and ensure the consistency Shine envisioned.9 By March 1998, the Board on Health Care Services had prepared a proposal for a Committee on Quality of Health Care in America, which stemmed from a perceived lack of information on the prevalence of health care quality problems and how changes to care delivery might improve quality. The Board felt that the existing roundtable efforts were important, but that it was necessary to undertake a consensus study, with its ability to draw conclusions and make formal recommendations.
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. To Err Is Human: Building a Safer Health System Released on November 29, 1999, the committee's first report, To Err Is Human, illuminated the scale of medical errors and patient safety gaps in the United States.
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Following the meeting with Richardson and IOM staff, Clinton ordered a series of executive actions. He required that the private health insurance plans that participated in the Federal Employee Health Benefits Program implement quality improvement and patient safety initiatives.
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While To Err Is Human concentrated specifically on medical errors and patient safety, the new report "focused more broadly on how the health care delivery system can be designed to innovate and improve care." According to the report, the health care system required fundamental change; incremental improvements would not be sufficient. Despite many technological advances, "a highly fragmented delivery system that largely lacks even rudimentary clinical information capabilities" resulted in "poorly designed care processes characterized by unnecessary duplication of services and long waiting time and delays" (IOM, 2001d, p.
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The redesigned health care system would need to ensure that health care delivery was evidence-based, leveraged available health information technologies, realigned payment structures with quality goals, and engaged and prepared health care professionals. To achieve this vision, the committee offered 10 guiding principles: 1.
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health care system overall. Citing widespread public and private patient safety efforts and initiatives that were sparked by To Err Is Human and Crossing the Quality Chasm, AHRQ released a report in 2014 that indicated that hospitals and health care providers nationwide made fewer mistakes in treating patients between 2010 and 2013, sparing at least 50,000 lives and saving $12 billion in health care spending (AHRQ, 2015)
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The desire to apply the ideas developed in the Quality Chasm series on a global scale led to the 2018 publication of Crossing the Global Quality Chasm: Improving Health Care Worldwide, which was developed under the auspices of the HMD. The report followed from the World Health Organization's sustainable development goals and argued that quality needed to become as "central an agenda as universal health coverage itself." The report noted that the problems identified in the Quality Chasm series, such as fragmentation, misaligned financing, and poor training, applied not only to the U.S.
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. The findings and recommendations from the IOM's Quality Chasm Series resulted in a variety of impacts, from the local to the national level, with the common goal of improving patient safety and health care quality in the United States.
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The roundtable's mission was to create a neutral venue in which stakeholders, such as health care providers, employers, payers, and researchers, could discuss ways to generate and apply better data to clinical decision making, thus improving quality and assuring value. The roundtable's mission complemented the six dimensions of quality, with particular emphasis on greater efficacy in health care services.
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From early discussions of health IT, the IOM supported the introduction, use, and integration of electronic medical records, data collection systems, and telemedicine as a mechanism to improve health care. For example, in 1991 the IOM released a report called The Computer-Based Patient Record: An Essential Technology for Health Care.
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In addition to the potential benefits, the summary and workshop participants also considered potential security risks, privacy concerns, and possible interoperability issues associated with the wide-scale implementation of health IT systems. In 2012, the IOM released Health IT and Patient Safety: Building Safer Systems for Better Care -- a consensus report that bridged the IOM's interests in quality and safety with the appropriate use of technology in a learning health care system.
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Schaeffer, University of Southern California • Joe Selby, Patient-Centered Outcomes Research Institute • Mark D Smith, California Health Care Foundation • Harrison C
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. HEALTH DISPARITIES AND HEALTH EQUITY As the IOM developed its Quality Chasm series, it also undertook a parallel effort to study one of the six dimensions of quality identified in Crossing the Quality Chasm -- equity.
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2) in the health care workforce and cross-cultural education for health care professionals.
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. Continuing to explore options for eliminating disparities and ensuring health equity, the HMD released a five-part series in 2016 and early 2017 that examined social risk factors that could influence health outcomes for Medicare beneficiaries (see Box 5-3)
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The report initiated the IOM's ongoing examination of health literacy -- one of the many factors that can contribute to health disparities and impede the realization of health equity. For example, studies indicate that individuals with lower levels of health literacy have less knowledge about managing chronic illnesses and health-promoting behaviors, decreased ability to actively participate in health decision making, lower compliance with prescribed therapies, and poorer overall health status (IOM, 2004b)
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For example, in 2016, the roundtable collaborated with the Roundtable on the Promotion of Health Equity to host a workshop that resulted in a publication called People Living with Disabilities: Health Equity, Health Disparities, and Health Literacy: Proceedings of a Workshop, which considered the "intersections of health equity, health disparities, health literacy, and people living with disabilities" (NASEM, 2018c, p.
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In the spring of 2008, the IOM released Retooling for an Aging America: Building the Health Care Workforce, a report that evaluated the current health care workforce in light of the health care needs of an aging population. The committee, which was chaired by NAM member John W
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models and the linkages across IPE, safety, quality, cost, and patient outcomes and satisfaction grew. In response to a request from the sponsors of the IOM's Global Forum on Innovation in Health Professional Education, the IOM convened a committee to analyze "the available data and information to determine the best methods for measuring the impact of interprofessional education on specific aspects of health care delivery and the functioning of health care systems." In 2015, the IOM released Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes, which called on relevant stakeholders to "commit resources to a coordinated series of well-designed studies" that assessed the association between "interprofessional education and collaborative behavior" (IOM, 2015c, p.
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. In addition to education and training for the health care workforce, the IOM also considered the environment in which health care professionals and students worked and the impact that those environments had on the delivery of high-quality care and patient safety.
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. More than two decades later, the organization launched an initiative designed to maximize the value and contributions of nurses to the health care workforce and system.
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. The Role of Informal Caregivers In conjunction with physicians, nurses, physical and occupational therapists, social workers, and other health care professionals, informal caregivers, such as family, friends, and neighbors, are 63 Impact of IOM Reports (Database)
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For example, the roundtable hosted workshops related to quality measures for serious illnesses, pain management and opioids, health equity, palliative care, and better integration of patients and caregivers into care for serious illnesses. Cancer Coordinating and advancing cancer research (described in Chapter 4)
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and 25 other co-sponsors. The bill sought to implement the recommendations of the IOM report and included provisions for providing Medicare coverage of comprehensive cancer care planning, establishing a Medicare hospice care demonstration program, and providing grants for programs related to palliative care and symptom management for patients with cancer, clinician education, and other related research areas.73 In its 2008 report Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs 70 Peter Howley was the George Fabyan Professor and the Chair of the Department of Pathology at the Harvard Medical School during this time.
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introduced the Improving Cancer Treatment Education Act of 2013, which was developed to provide comprehensive treatment education for patients with cancer under Medicare, citing two IOM reports: Cancer Care for the Whole Patient (IOM, 2008c) and Ensuring Quality Cancer Care (IOM, 1999c)
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. The framework cited the IOM's Delivering High-Quality Cancer Care report and focused heavily on efficacy, safety, efficiency, patient centeredness, timeliness, and equity -- elements identified by the IOM as essential to high-quality care.77 Cognitive Aging and Dementia Understanding cognitive aging and preventing cognitive decline and dementia are among the most complex challenges the health care system and health scientists have ever faced.
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. A little more than a decade later, the IOM released its first major work on end-of-life care -- Approaching Death: Improving Care at the End of Life.
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Levine,84 offered 10 recommendations that were designed to develop and implement more effective palliative care options within cancer care, integrate palliative care as part of high-quality cancer care, improve communication with patients and their families about palliative care options, and enhance data collection and quality measures for end-of-life care for cancer patients (IOM and NRC, 2001)
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The committee found that progress had been made since the 1997 report, noting that hospice had become a mainstay in end-of-life care and that palliative care was now a regular part of care in larger hospitals. However, training for health care professionals was lacking, and systematic changes were needed to improve the delivery of care.
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. In 2000, the IOM released a report called Extending Medicare Reimbursement in Clinical Trials,89 which led to an executive order signed by President Clinton that required Medicare to cover routine medical costs for beneficiaries participating in clinical trials in an effort to encourage expanded clinical trials participation among older adults (IOM, 2000d; White House, 2000)
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: The second report evaluated research on the "effects of having or lacking health insurance on a variety of personal health-related outcomes" and offered criteria for reviewing the quality of available data related to insurance status and health outcomes. • Health Insurance Is a Family Matter (IOM, 2002f)
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. The committee, which was chaired by external volunteer Lawrence S
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, or the minimum set of benefits that health insurance plans had to cover through the state-based "purchasing exchanges." In response to the HHS request, the IOM released Essential Health Benefits: Balancing Coverage and Costs in 2012. The committee, which was chaired by John R
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CONCLUSION In a multitude of ways, the IOM, and subsequently the NAM and the HMD, have played a sustained and essential role in advising the nation, the government, and the health care industry on 99 Impact of IOM Reports (Database) , IOM/NAM Records.
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Throughout its history, the IOM expanded its reach to cover a wide range of topics related to the delivery of health care and improvement of the health care system. Even though modifications to the U.S.
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