Statement on Quality of Care

27 Pages·0.21 MB·English

by  Molla S.Donaldson, Editor

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k, not froographic Molla S.Donaldson, Editor
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m tret Institute of Medicine
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eakerte NOTICE: The project that is the subject of this statement was approved by the Governing Board of the
ge bry ins Nthaet iNonatailo nRaels Aeacracdhe Cmoyu onfc iEl,n wgihnoeseer imnge,m abnedr sth aer eIn dsrtiatwutne forfo Mm etdhiec icnoeu. nTchiles mofe mthbe eNrsa otifo nthael Acocmadmeimttyee o rfe sSpcoiennscibelse,
s. Paallent for the report were chosen for their special competencies and with regard for appropriate balance.
ed The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist
ting filesetbeen acci dhtoie sabtlietnh ga ounfi s athdheved ip semurb eltmioc b.t heIners t fheoidfs e, trthahele g aIonpvspterirotnupmtrei eaantcett sap nurdon fdietessrs iobowontnsh itinhnie t tiAhaetci vaeedx eiamnm yiid’nsea nt1it8oif6ny3 io ncfgo npisgosrluiecesyss ioomfn aamtlt eecrdhsia crpateel rrc traaeirnsepi, norgne ssteioba irltcihthye,
al typhave and education. Dr. Kenneth I.Shine is president of the Institute of Medicine.
ginay Support for this project was provided by The Agency for Health Care Research and Policy (DHHS), The
orim Commonwealth Fund, the National Research Council, the Department of Defense (Health Affairs), and Pfizer
he ors Inc. The views presented in this statement are those of the Members of the National Roundtable on Health Care
m terr Quality and are not necessarily those of the funding organizations.
k, not froographic For more information about the Institute of Medicine, visit the IOM home page at http://www.nas.edu
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ting filesetbeen acci MProarfke sRso.Cr hanasds iCnh, aMirDm,a Mn PP, MPH, Co-Chair* AChrnieofl,d ESpecstteioinn, MonD , HMeAalth Services and Policy
al typhave Department of Health Policy Research
ginay The Mount Sinai Medical Center Brigham and Women’s Hospital
orim New York, NY Professor and Chairman
he ors Robert W.Galvin, Co-Chair Department of Health Policy and Management
m terr Chairman of Executive Committee Harvard School of Public Health
ok, not fropographic MSKcaohtthaoulremoelnba u,O rIgn.A,c .nILgel BCAlodismfttooinnni ,s GMtraaAutso,r Sc.D. (until 04/01/97)†
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m tret The New England Journal of Medicine University of California
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L filwev Fairfax, VA New England Journal of Medicine
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the original work has beation of and other typesettinding styles, for attributioauthoritative version EAPDCKLrozheisonrsspaafgo raeA l-cCrseDtinssma.ogDr tRereeea w .lnaDvDetn si Merdod,e asf CweFn oOdA,on UiPbr,c msrnJaitrlieme. v,Crt er aMCierrcsnyhDsit ta Ceya*irn raodrfe MGyendeiccionleo gaynd Science ADWRPCYrhooseeasponnssiadskihsdurateitaenm rmKnnsge,tteta roNSnrsnpte Y U,aco tDrfnke iDCitonane,r yf Joe Donf fst heDee Ufennisteed f oSrt aHteesalth Affairs
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us ROSTER 4
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eakerte Kenneth W.Kizer, MD, MPH†
ge bry ins UDnepdaerrt mSeecnrte otafr yV feoterr Hane aAltfhfairs
s. Paallent Veterans Health Administration
ed Washington, DC
ting filesetbeen acci GFPfoeirrzmaelred rI DnCc.ELOaubach, PhD*
al typhave Essex Fells, NJ
ginay David McK. Lawrence, MD, MPH*
orim Chairman and Chief Executive Officer
he ors Kaiser Foundation Health Plan, Inc. and
m terr Kaiser Foundation Hospitals
ok, not fropographic OWDaeikallnliaanmd ,L C.RAoper, MD, MPH*
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m tret Bruce Vladeck, Ph.D.*†
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es creer, ca BIOaMlti mSotarfef, MD
L filwev Molla S.Donaldson, Project Director
Mo
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ed from matting, TEvraeclyy nM SciKmaeyo,n P, Arodjemcitn Aisstsriasttiavnet Assistant
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us PREFACE AND ACKNOWLEDGMENTS 5
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ge bry ins PREFACE AND ACKNOWLEDGMENTS
Paall
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original typmay have RounTdhtaeb Nlea ctioonnsails tRs oouf nedxtpaberlets ofno rHmeaallltyh aCpaproei nQteuda ltihtyro wugahs epsrtoacbelidsuhreeds ionf 1th9e9 5N bayti othnea lI nRsetsiteuatrec ho fC Mouendcicili n(eN. RTChe)
he ors who represent both public and private sector perspectives and appropriate areas of substantive expertise (not
m terr organizations). From the public sector, heads of appropriate Federal programs serve. It offers a unique,
k, not froographic ntphoreonsmaed invceehnrastna grreieapslr eefsonervn ittrhaoteni vmqeeusn aotl iftt oyt h eoex fpp lhroievraeal ttoehn aganondidn pghu rebaalplitcihd s cechcaatroenr g ie(nrs e tighnii osthn ean lam, tiseotdanti.ec aTal hnmed a fRrekodeuetpnraldalt)ca,e ba lacena ddc oetmhnevi eain,m eppsal tiniceaanttiitoos,nn asa lnoldyf
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ps By providing a structured opportunity for regular communication and interaction, the Roundtable fosters candid
original ed, and dmiescmubsesiro onf tahme oRnogu ninddtaivbilde uaarles inwchluod erdep arte tsheen te nvda roifo uthsi ss sidtaetse moef nat. given issue. Biographical sketches of each
he ain
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oe Additional Contributors to the Roundtable
ed frat bnnot In addition to appointed members of the Roundtable, several individuals from government programs
ea provided special assistance to the Roundtable. They are: from the Agency for Health Care Policy and Research,
es crer, c Lisa Simpson, M.B., B.ch., F.A.A.P., Deputy Administrator; Sandy Robinson, Acting Director, Center for
L filwev Quality Measurement and Improvement; and Irene Fraser, Director, Center for Organization and Delivery
Mo Studies; from the Health Care Financing Administration, Helen Smits, M.D., Deputy Administrator and Peter
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m g, Bouxsein, J.D., Acting Director, Office of Clinical Standards and Quality; from the Department of Defense
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us PREFACE AND ACKNOWLEDGMENTS 6
s are trd. Plea
eakerte 2. To identify important strengths and weaknesses in the current healthcare system that affect the
ge bry ins qseucatloitry. of health care and options for improvement that might be considered by the public or private
s. Paallent 3. To identify issues related to the quality of health care that should be recommended for formal
ed Institute of Medicine studies through the various Boards of the Institute.
ting filesetbeen acci 45.. sTTyoom ppirdooesvniiatd,i efiy nr veiipstsreeudse epsn retrasetelianottnea dtti oot noth, eoth rQ ec uoqamuliamtlyii tsyCs ioooonfr edhdin epaaalttpihne grc sC.aroem tmhaittt eseh oleualddi nbge toc lathriafti ecdo mbmy iwtteoer’kss hpoeeprs-,
al typhave reviewed assessment of the quality of health care and resulting in periodic reports, including specific
ginay recommendations for action.
orim 6. To identify other roles of the Roundtable consistent with Institute of Medicine and National
he ors Research Council policies that would lead to enhanced quality of health care in the United States.
m terr
ok, not fropographic ipnrvesiteeTndth apet rioeRsnoesun natatd ttimaobnelese t ifnmrogemst osefix xpt heteirm tsRe, osc uoinnndv tfeaonbrelmed a wtlw eporle ec:n oaJnorfy eI rvseeensycs eiBoson, usa fnbfdoe rtcdwo,em Memn. DiFs.se,i boDrnueeaadrn yp,, a W1p9ear9gs6n. eIarnn dGdi vrJaiaddnuuuaaaltser y wS, hc1oh9 o9mo8la. doIeft
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er bme t Public Service, New York University; Janet Corrigan, Ph.D., Executive Director, Advisory Commission on
apo Consumer Protection and Quality in the Health Care Industry; James E.Jensen, Director, Office of Congressional
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original ed, and aPKnraodhj enGc, toJ v.GDeer.n,o mr(gtheene ntW )A aMfsfhaaijinorsgr,it toyNn a sttUiaofnnfi,av lHe rAosiuctsyae d aeWnmday y Cso hfa anSirdc, iMeInOecMaens ;s C SSotumabnmcleoiymtt emBe. iJtotoenne e Cso hnDo Hiicreeeca tlaotnhrd;, LHMaewaanlrteahng ceIned s LuCreaawrneicn)e;, RMCeh.fBaor.rlAems.
he ain Chief Executive Officer, The Lewin Group; and Harold S.Luft, Ph.D., Caldwell B.Esselstyn Professor of Health
om te ret Policy and Economics Director, Institute for Health Policy Studies, University of California, San Francisco.
ed freat bannot CONTEXT OF THIS STATEMENT
es crer, c Based on its deliberations over a two-year period, two major conferences, guest presentations, and
L filwev commissioned papers, the Roundtable members determined that a statement outlining its conclusions was
Mo
Xh warranted. The statement presented here has been reviewed by individuals chosen for their diverse perspectives
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ed fromattin panudrp toesceh noifc tahli se xinpdeertpiseen,d ienn ta crecvoiredwan icse t ow pitrho vpirdoec ecdaunrdeisd aapnpdr ocvrietidc ably c othme mNeRnCts’ tsh Rate wpoilrlt aRsesivsite twh eC aoumthmoristt eaen.d T thhee
en recomposg-specific forn. IsaOtnadMn dd Wariarndef ts mw mfoiaaskrnh iou ntbsgocj erttichhptaeitnv rkipet myut,bh aleeii vnsfhi ocdeloeldonn wfcrieedi,pne aognnr ttiid na aldr seitvo ssip pdooruunoanstledisvc eftao ntsrhe septsh oi entsiotsre i tbgphlraeeirt tysiat cnuoidpdf aythtt oiceo h ndea enrilgnsieub t.reh erTe ah ttrhieeva vecti oeptnwhrtoee c onerftse otsph.foi srtht reem preeoevrttis:e wPina csuotli mtGumtriioennneatrsl,
the original work has beation of and other typesettinding styles, for attributioauthoritative version MMAf.efDdaii.r,c si,nV eHi,c aeAr vsPasrrodec siPiaditleigonrnti m oa fnH dAe amDlteihrr eiCccaatonrer ,;M ACerednnioctleadrl MCfooirlls lteteghieens , ;AM Jso.sDhen.s,s MmLue.Pdnd.tH ean.,n, MdM aM.nDaa.g,n ianSggeenmioern Vt iocfe CPrheasnidgeen ti nf oAr cMadedemicaicl
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us PREFACE AND ACKNOWLEDGMENTS 7
s are trd. Plea
eakerte Director, William M.Mercer, Inc.; David Nash, M.D., M.B.A., Associate Dean and Director, Health Policy,
ge bry ins TSyhsotmemas. AJelftfheorusognh tUhne ivinedrsiivtiyd;u aalnsd liGstaeidl aWboavrdee nh,a vPer epsriodvenidt ed& mCahniye f coEnxsetcruuctitvive e Ocfofmicmere, nHtse narnyd Fsuogrdg eHsteioanltsh,
s. Paallent responsibility for the final content of this statement rests solely with the authoring committee and the IOM
ed The contributions of many other individuals to the work and conclusions of the Roundtable are gratefully
ting filesetbeen acci acknowledged. In addition to those mentioned above the roles of these people are described below.
al typhave ACTIVITIES OF THE ROUNDTABLE
ginay
orim Conferences
he ors
m terr Two conferences sponsored by the Roundtable contributed significantly to the conclusions expressed in this
k, not froographic sMtaetaesm“uSeritnnattg.e T tohhfee s teQh ecu oaAnlirfttey r oeofnf c QeHuse awallietthyre CMaeraes—urSemtateen to,”f tSheep tAemrt.b eSru, m19m9a6r.y Tohfi sa cCoonnfefreernencec ew, aMs Ss uDmomnaalrdizseodn iann dIO KMN.
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oy Nolan, eds. April, 1997. (available online at http://www2.nas.edu/quality/212a.html) and Donaldson, M.S. and
er bme t Nolan, K. Conference. Measuring the Quality of Health Care: State of the Art. Journal on Quality Improvement
p
paso 23:283–292, 1997; and
original ed, and confe“rIenntceeg riantcinlugd eSdt rpatreegseienst atfioorn sH oefa lctho mCmairses ioQnueadl itpya pIemrsp, rpoavneemlse notf, ”r eAspirolnied eHntosu, sae ,r aVppao, rtOeuctro, baenrd, a1 9s9y7n.t hTeshies
he ain session. The papers and commentaries on the conference topic will be published in a forthcoming issue of The
m tret Milbank Quarterly.
ed froeat be annot ReseaA“rAcuh thR Poeropslo iwcrtyh Coa nawrddr oD oteenv peCalpooepnrtmsin efunootr,u pMsr eQasseusnaatlcaithtyiuo sInem tatpts r toGhviesen mceoreannlft e.H”re oDnscpaeivt aiwdl e aBrneld:u mCehnatrhleasl , MM.K.Dil.o, ,M M.P.D.P..,, MC.hPi.eHf .o, fI nHsteitaultthe
es crer, c for Healthcare Improvement.
L filwev “Accelerating the Impact of Continuous Quality Improvement on Clinical Practice: Assessing the Evidence
Mo and Recommendations for ‘Improvement.’” Stephen M.Shortell, Ph.D., Professor of Health Services
Xh
m g, Management, Professor of Organization Behavior, Northwestern University, Charles L.Bennett, M.D., Ph.D.,
ed fromattin ALasksoesciidaete DPirvoifseisosno ra nodf MGaeydliec iRne.B, yNcokr,t hMw.ePs.tHer.n, RUensievaerrcshit yA sMsoecdiiactael ICnestnitteurt,e VfoAr HCheaicltahg oS eHrveiacleths CRaersee aSrcyhs teamnd-
een recomposng-specific foron. PHProaolrifocel“ysdTs SohStre.u,L dIDumiefetspp,, a aPNcrhtto m.oDrtfeh .n Fw(tiI neOosafMt neMcr)in,ea CdlU iIacnnliidcnveween,re tsIliilnvt yseBts.i. tEousntse eQ flsoutray lnHit yeP arolotfhf eH sPesoaollrit choy fC SHatrueead.l”ite hRs ,P. AUodlniacivmye sar snDidtuy Ed olcefo yCn, oaMmli.fiDocrs.n,, iMDa,i. rBSea.cAnto .,rF ,Ar Iansnsscitisisttucaonte,t
the original work has bation of and other typesettiding styles, for attributiauthoritative version fHoer alHthe aPlothli cPyo Slitcuyd iSestu, dUiensiv, eUrsnitiyv eorfs iCtya loiffo rCnaiali, fSoarnni aF,r aSnacnis cFor.ancisco and Robert H.Miller, Ph.D., Institute for
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us PREFACE AND ACKNOWLEDGMENTS 8
s are trd. Plea
eakerte “Increased Competition and the Quality of Health Care.” Jane Sisk, Ph.D., Professor, Columbia University,
ge bry ins Schoo“Tl ohfe PRuobllei co Hf Reaelgthu.lation in Quality Improvement.” Troy Brennan, M.D., J.D., Executive Director, Brigham
s. Paallent and Women’s Hospital
ed Many other invited participants at the two conferences sponsored by the Roundtable provided information
ting filesetbeen acci aiPnbeconluuntds yethl:v eaiIrnr miwaa oH rkAo sarpissi tpwaele,, l lP Pahhsi .lDvada.,le ulpaPbhrlioeaj ,e icnPtsAoigr; hCtOsa fatfhibceoeruirn,t eq AuBaHoliCrtbyPa Ros,f; PcJahor.ehD,n .h, oERwx.B eicat ulclt,ai vnMe b D.eD im.r,e ecaJtso.Dur r.eH, de Paarlnetdhsi diCmeanprter o avEnedddu .c TCathEioeOyn
al typhave and Research Foundation, Alan Bredt, M.D., Assistant to Associate Medical Director, Southern California
ginay Permanente Medical Group; Peter Budetti, M.D., J.D., Professor of Health Services, Management, Preventive
orim Medicine and Law and Director, Institute for Health Services Research and Policy Studies Northwestern
he ors University; Charles R.Buck, Sc.D.Leader, Health Care Quality and Strategy Initiatives, General Electric Co.;
m terr David Classen, M.D., Latter Day Saints Hospital, Intermountain Health System, Molly Joel Coye, M.D., M.P.H.,
ok, not fropographic DJP.rDierse.,ic dtMeonr.,tP ,W .AUe.ns, itv MCeroasanitsaytg Oeorff f oiVcfe i,rM gTianhnieaa ;Lg eeMdw airCny a GrLer,.o uDGpu;T rCEh hamaSre,l revPsi hcD.eDasr .b,C yVo, riCpceoo -rPaPtrrioeojsnei;dc te DnOto fnfai ncEde r.D,D AeitrHmecCetroP,r R,M , CT.Dehn.ot, merSa esfno Jir.o DrH aeVvaiielctshe,
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er bme t Research, Kaiser Permanente; Susan Edgman-Levitan, P.A., Executive Director, Picker Institute, Lynn
apo Etheredge, Ph.D., Consultant, Paul B. Ginsburg, Ph.D., President, Center for Health System Change, Sheldon
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original ed, and SHIn..GdGurrseotersnisafmli eaElndn,, g MMin..eDDer..,,i nDCgih,r aeUicrntmoivra,en rP sariintmyd a oCrfy E WCOai,s rceHo eOnasulittnhc; o QmJauecaskl i RtHye;as deDalearycvh,i d PI nhHs.D.tGit.u,u tsDet,ai rfNesocetwno, rE,P nhIng.Dslat.in,t udPt erMo ffeoedsri scHoarle, aCDltehen ptPaeorrt;lm iJceeyrn otam nodef
he ain Research, Georgetown University; Clark C.Havighurst, J.D., Wm. Neal Reynolds Professor of Law, Duke
om te ret University School of Law; Lisa I.Iezzoni, M.D., M.Sc., Associate Professor of Medicine, Division of General
ed frat bnnot IVnatelurnea Hl eMaletdhi cSicniee,n Bceest,h IInscr.a;e Ll uHcoiasnp iLtael,a pJaec, qMue.Dli.n, eP Kroofseescsoorf fo, fP Hh.eDa.l,t hP rPeosliidceyn,t Haanrdv aCrod- CSchhieofo lE oxfe cPuutbivliec OHfefiaclethr,,
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es crer, c AEvrtahluura tLioenv inan, dM C.Ph.Hie.f, DScirieecnttoifri,c COenftfeicre fro, r JMoinedt icCaol mCmonisssuimone rso;n JaArocdcr eMdi.Ltaotieobn, Pohf .DH.,e aDltihreccatroe r,O Rrgesaenaizrcahti oannsd;
L filwev Kathleen N.Lohr, Ph.D., Director, Health Services Policy and Research, Research Triangle Institute; Patrick
Mo
Xh Mattingly, M.D., Senior Vice President Planning and Development, Harvard Pilgrim Health Care, Catherine
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us PREFACE AND ACKNOWLEDGMENTS 9
s are trd. Plea
eakerte Sponsors
ge bry ins The Roundtable wishes to acknowledge the generous funding provided for this project by the Agency for
Paall Health Care Policy and Research (U.S. Department of Health and Human Services), The Commonwealth Fund,
s. ent and the National Research Council. Additional funding was provided by the Department of Defense (Health
ed
ting filesetbeen acci AinfcflauidSrsee) v Maenraadrl gPmafriezemet rbK Ienercys. eos,f Pthroej esctat fOfsf foifc etrh, eCsee notregr afnoizr aQtiounalsi tgy raMcieoaussulrye mpreonvt idaendd hImelppr otov etmhee nRt,o AunHdCtaPbRle;. BTrhieayn
al typhave BFuilneds,; aMnd.D a.,t SPefinzieorr IVnci cFe rePdreersiicdke nTt eallnindg D, Pavhi.dD .S, aVnidcme aPnr,e sMid.ePn.tH, .C, oPrrpoogrraatme SAtrsastoegciiact eP loafn ntihneg Canodm mPoolnicwye aalnthd
ginay Alison Keith, Ph.D., Director, Economic Policy Analysis.
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oy Officer; Molla S.Donaldson, Project Director; Kay Harris, Financial Analyst; Kathleen Nolan, Research
er bme t Assistant; Evelyn Simeon, Administrative Assistant; and Tracy McKay, Project Assistant.
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