March 9, 2001
IOM Proposes Reorganization and Reforms for Health Care Delivery System
Calling it "disjointed" and "inefficient," the Institute of Medicine (IOM) March 1 released a discouraging report on the state of the American health care delivery system. Coming out of the IOM's Committee on the Quality of Health Care in America, the report entitled "Crossing the Quality Chasm: A New Health System for the 21st Century," is the follow-up to the 1999 IOM report on medical errors.
The report identifies six areas that must be improved upon by all entities in the health care enterprise: safety, effectiveness, responsiveness to patients, timeliness, efficiency, and equity. To ensure improvement, the Department of Health and Human Services should monitor and track these areas and report annually to Congress and the president on progress being made. The IOM report recommends that this overhaul can only be made possible by a $1 billion "innovation fund" created by Congress for use over the next 3 to 5 years to support projects that seek to improve the health care system.
The report emphasizes that while the system is geared toward providing critical care, 70 percent of the health care administered is for chronic conditions, such as heart disease, diabetes, and asthma. The IOM committee looks to the Agency for Healthcare Research and Quality (AHRQ) to initiate reform in this area by directing it to identify 15 or more priority conditions, primarily chronic, that account for a sizable portion of the nation's health burden. Then, through a combined effort, health care organizations, clinicians and purchasers should research and implement evidence-based care for these conditions. AHRQ also is directed to convene a series of workshops to examine the various teams that deliver health care and to address a number of challenges, such as the most efficient way to coordinate care and improve outcomes within these teams.
The report also highlights the need to revamp the system to build a technology-based information infrastructure. This report says this will simplify the use of patient information, medication ordering, the prescribing and dosing of drugs, and payment for services. The report states that without a new technological framework, improvements to the quality of care in this country will occur extremely slowly.
Finally, the report addresses the importance of having an appropriately prepared health care workforce to provide care in an improved health care system. It calls for a multidisciplinary summit of leaders within the health professions to be convened to develop strategies for restructuring clinical education and assessing the implications of these changes on the credentialing programs, funding, and sponsorship of education programs for health professionals.
Information: Erica Froyd, AAMC Office of Governmental Relations, 202-828-0525.
