1 Crossing the Quality Chasm Second Report Committee on Quality of Health Care in America To order:

2 Studies Documenting the “Quality Gap” Literature reviews conducted by RAND Literature reviews conducted by RAND  Over 70 studies documenting quality shortcomings Large gaps between the care people should receive and the care they do receive Large gaps between the care people should receive and the care they do receive  true for preventive, acute and chronic  across all health care settings  all age groups and geographic areas (Schuster et.al., MMFQ,1998 ;updated 2000)

3 Medical Errors are a Serious Problem  Over 35 studies documenting patient safety concerns  Tens of thousands of Americans are seriously harmed  Most errors occur because of system failures

4 Major Forces Influencing Health Care Expanding Knowledge Base “Current practice depends upon the clinical decision-making capacity and reliability of autonomous individual practitioners, for classes of problems that routinely exceed the bounds of unaided human cognition.” Daniel R. Masys, M.D IOM Annual Meeting 2001 IOM Annual Meeting

5 Major Forces Influencing Health Care Chronic Care Needs 40% of population have one or more chronic conditions 40% of population have one or more chronic conditions Chronic conditions account for more than two- thirds of health care expenditures (RWJF, 1996) Chronic conditions account for more than two- thirds of health care expenditures (RWJF, 1996) 80/20 Rule: Limited number of conditions account for most of these health care expenditures 80/20 Rule: Limited number of conditions account for most of these health care expenditures

6 Delivery System Increasingly Inadequate Dearth of clinical programs with necessary infrastructure Dearth of clinical programs with necessary infrastructure Chronic Care Delivery Model (Wagner, 1996) Chronic Care Delivery Model (Wagner, 1996)  Systematic approach  Attention to information and self-management needs of patients  Multi-disciplinary teams  Coordination across settings and clinicians, and over time  Unfettered and timely access to clinical information

7 Committee’s Conclusion The American health care delivery system is in need of fundamental change. The current care systems cannot do the job. Trying harder will not work. Changing systems of care will.

8 Five Part Agenda for Change  Commit to six aims for improvement  Adopt “10 rules” to guide the redesign of care  Implement effective organizational supports  Focus efforts on “priority conditions”  Create environment that fosters improvement

9 Aims For Improvement Safe Safe Effective Effective Patient-centered Patient-centered Timely Efficient Equitable

10 10 Simple Rules Continuous Healing Relationships Continuous Healing Relationships Evidence-based Decisions Evidence-based Decisions Customized Care Customized Care Patient is the Source of Control Patient is the Source of Control Shared Knowledge Shared Knowledge Transparency Safety is a System Property Cooperation Among Clinicians Needs are Anticipated Waste is Continuously Decreased

11 Organizational Supports to… - redesign care processes -invest in information technology - management of knowledge and skills - develop effective multidisciplinary teams - coordinate care -measure and improve performance and outcomes

12 Focus on Priority Conditions AHRQ should identify 15 priority conditions AHRQ should identify 15 priority conditions Congress should establish $1B Innovation Fund Congress should establish $1B Innovation Fund There should be substantial improvements in quality for priority conditions over the next 5 years There should be substantial improvements in quality for priority conditions over the next 5 years

13 Align Environmental Forces Four Critical Forces: 1. Information Technology 2. Payment 3.Clinical Knowledge 4.Professional Workforce

14 Align Environmental Forces Information Technology Call for renewed national commitment to building an information infrastructure to support care delivery, consumer health, public accountability, public health, research, and clinical education. Call for renewed national commitment to building an information infrastructure to support care delivery, consumer health, public accountability, public health, research, and clinical education. Goal: elimination of most handwritten clinical data by 2010 Goal: elimination of most handwritten clinical data by 2010

15 Aligning Environmental Forces Payment  Current payment policies are complex and contradictory, and often work against efforts to improve quality.  Payment methods should provide an opportunity for providers to share in the benefits of quality improvement

16 Aligning Environmental Forces Clinical Knowledge Focusing on priority conditions, a public - private partnership should: - synthesize evidence - identify best practices in care delivery - communicate evidence to public and professionals - develop and apply decision support tools - establish goals for improvement in care processes - develop core sets of quality measures

17 Aligning Environmental Forces Professional Workforce A multidisciplinary summit of leaders within the health professions should be held to discuss and develop strategies for -restructuring clinical education at all levels -assessing the implications of change for credentialing programs

18 Crossing the Quality Chasm: Next Steps   Project Areas  Priority Conditions  Reports to Monitor and Track Quality  Health Professions Summit  Nursing Work Environment and Patient Safety  1 st Annual Chasm Summit  Related IT Initiative