Statement on Quality of Care (1998) / Chapter Skim
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The Urgent Need to Improve Health Care Quality
The Urgent Need to Improve Health Care Quality
Pages 10-21
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From page 10... ...
the National Roundtable on Health Care Quality3,4, 5, 6 ABSTRACT Objective To identify issues related to the quality of health care in the United States, including its measurement, assessment, and improvement, requiring action by health care professionals or other constituencies in the public or private sectors. Participants The National Roundtable on Health Care Quality, convened by the Institute of Medicine, a component of the National Academy of Sciences, comprised 20 representatives of the private and public sectors, practicing medicine and nursing, representing academia, business, consumer advocacy, and the health media, and including the heads of federal health programs.
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From page 11... ...
a component of the National Academy of Sciences, Washington DC, convened the National Roundtable on Health Care Quality to bring together a wide variety of individuals to engage in a series of discussions about health care quality, a process that took place over a 2-year period. The roundtable solicited presentations from experts, convened conferences, and initiated a parallel set of detailed discussions about managed care and quality.
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From page 12... ...
Increasingly, health care professionals practice within groups and systems of care. The functioning of those systems in preventing and minimizing errors and the harm such errors may cause, coordinating care among settings and various practitioners, and ensuring that relevant and accurate health care information is available when needed are critical factors in ensuring high-quality care.
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From page 13... ...
A recent review of quality research published from 1993 to 1997 reached the same conclusions 7 as did the report of the President's Advisory Commission on Consumer Protection and Quality in the Health Care Tndustry.8 Underuse of proven effective interventions leads to major foregone opportunities to improve health and function. Undetected and untreated hypertension or depression, failure to immunize children, and prenatal care begun too late in pregnancy are examples of important underuse problems.
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From page 14... ...
Recent research indicates that patient injuries resulting from the administration of medications occur at the rate of about 2,000 per year in each large teaching hospital; about 28% are preventable given current knowledge.24 Each of these preventable injuries adds nearly $5,000 to the cost of the hospital stay during which it occurs.25 The Harvard Medical Practice Study estimate that more than 27,000 patient injuries due to negligent care occurred among patients hospitalized in New York State in ~ 984.26 The RAND study of prospective payment for hospitals showed that Medicare patients who received poor-quality care for congestive heart failure, as judged by adherence to objectively defined criteria, experienced a 74% greater mortality rate within 30 days of hospital admission compared with patients who received good-quality care.27 This tripartite classification of quality problems illuminates the relationship between quality and cost. It also helps answer the question of whether improving quality leads to increased or decreased costs.
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From page 15... ...
OTHER QUALITY-OF-CARE ISSUES In discussing quality problems in terms of overuse, underuse, and misuse, this statement does not attempt to address all the issues that might relate to quality. Such issues include geographic variations in the rates of use of health care services, generalist and specialist physician training, the makeup of the nonphysician health care workforce, and the effect of organization of medical services as a determinant of quality, for which there is an emerging literature.30~32 These and other relevant issues may be causal or explanatory factors leading to a better understanding of quality problems; that is, they will be related to specific overuse, underuse, or misuse problems.
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From page 16... ...
New York State's program of collecting standardized clinical data for coronary artery bypass surgery (CABS) patients, producing and publishing risk-adjusted mortality rates for hospitals and surgeons, and using these data to facilitate quality improvement efforts has resulted in lower statewide mortality following this procedure.34 5 This ongoing program now also produces risk-adjusted mortality data on percutaneous transluminal coronary angioplasty.
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From page 17... ...
The answer is everyone: health care professionals, patients and their families, consumer advocates, health care administrators (whether serving in health care plans, hospitals, medical groups, nursing homes, or other facilities) , private and public purchasers of health care services, and policymakers at the national, state, and local levels.
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From page 18... ...
It requires the urgent attention of all the stakeholders: the health care professions, health care policymakers, consumer advocates and purchasers of care. The challenge is to bring the full potential benefit of effective health care to all Americans while avoiding unneeded and harmful interventions and eliminating preventable complication of care.
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From page 19... ...
and the Northern New England Cardiovascular Disease Study Group. A regional intervention to improve the hospital mortality associated with coronary artery bypass graft surgery.
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From page 20... ...
Steiner JF, Sande MA. Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians.
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From page 21... ...
Assessing the Impact of Continuous Quality: What it Wii! Take to Accelerate Progress.
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