Reforms suggested in IOM's second report

The Institute of Medicine of the Washington-based National Academy of Sciences has released "Crossing the Quality Chasm: A New System for the 21st Century," a follow-up to its earlier report, "To Err is Human." While "To Err is Human" concentrated on the issue of patient safety, the new report offers suggestions for wider healthcare reform.

The report states that the first "aim for improvement" in the system should be safety. "Patients should not be harmed by the care that is intended to help them," the report reads. "Achieving a higher level of safety is an essential first step in improving the quality of care overall."

"Americans should be able to count on receiving care that uses the best scientific knowledge to meet their needs, but there is strong evidence that this frequently is not the case," said William C. Richardson, chair of the committee that wrote the report and president of the Battle Creek, MI-based W.K. Kellogg Foundation. "The system is failing because it is poorly designed. For even the most common conditions, such as breast cancer and diabetes, there are very few programs that use multidisciplinary teams to provide comprehensive services to patients. For too many patients, the healthcare system is a maze, and many do not receive the services from which they would likely benefit."

Suggestions for reform

According to the report, the Federal Agency for Healthcare Research and Quality should identify 15 or more common health conditions, most of them chronic, to initiate across-the-board healthcare reform. Then healthcare professionals, hospitals, health plans and purchasers should develop strategies and action plans to improve care for each of these priority conditions over a five-year period.

The report also proposes that in order to stay aware of the big picture, the U.S. Department of Health and Human Services should monitor and track quality improvements in six key areas: safety, effectiveness, responsiveness to patients, timeliness, efficiency and equity. The secretary of HHS should report annually to Congress and the president on progress made in those areas.

In addition, the report suggests that public and private purchasers should develop payment policies that reward quality. Current methods provide little financial reward for improvements in the quality of healthcare delivery, and may even inadvertently pose barriers to innovation. With input from relevant private and public interests, the federal government should identify, test and evaluate various payment options that more closely align compensation methods with quality-improvement goals. PR