Crossing the Quality Chasm
Second Report
Committee on
Quality of Health Care
in America
To order: www.nap.edu
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Studies Documenting the “Quality Gap”


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
 true for preventive, acute and chronic
 across all health care settings
 all age groups and geographic areas
(Schuster et.al., MMFQ,1998 ;updated 2000)
2
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

3
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.
2001 IOM Annual Meeting
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Major Forces Influencing Health Care
Chronic Care Needs

40% of population have one or more chronic
conditions

Chronic conditions account for more than twothirds of health care expenditures (RWJF, 1996)

80/20 Rule: Limited number of conditions
account for most of these health care expenditures
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Delivery System Increasingly Inadequate

Dearth of clinical programs with necessary infrastructure

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
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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.
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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
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Aims For Improvement
 Safe
 Timely
 Effective
 Efficient
 Patient-centered
 Equitable
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10 Simple Rules





Continuous Healing
Relationships
Evidence-based
Decisions
Customized Care
Patient is the Source
of Control
Shared Knowledge





Transparency
Safety is a System
Property
Cooperation Among
Clinicians
Needs are Anticipated
Waste is Continuously
Decreased
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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
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Focus on Priority Conditions

AHRQ should identify 15 priority conditions

Congress should establish $1B Innovation
Fund

There should be substantial improvements in
quality for priority conditions over the next 5
years
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Align Environmental Forces
Four Critical Forces:
1.
2.
3.
4.
Information Technology
Payment
Clinical Knowledge
Professional Workforce
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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.

Goal: elimination of most handwritten clinical
data by 2010
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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
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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
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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
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Crossing the Quality Chasm: Next Steps
 2001 - 2003
 Project Areas
 Priority Conditions
 Reports to Monitor and Track Quality
 Health Professions Summit
 Nursing Work Environment and Patient Safety
 1st Annual Chasm Summit
 Related IT Initiative
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