IOM quality study targets 20 priority areas
The revolutionary report is the latest from the
Institute of Medicine aimed at improving patient care.
By
Andis Robeznieks, AMNews
staff.
Feb. 17, 2003. Additional information
Narrowing the gap between what is common practice
and
what is recognized as the best medical practice is the goal behind
an
Institute of Medicine study identifying 20 key areas where quality
improvement could "transform" health care delivery.
To establish the 20 target areas, a study committee judged the
disabling, mortality and economic impact particular medical
conditions
have on patients, families and communities.
The committee also evaluated a condition's
"improvability"
(likelihood the gap between current and best practices could be
closed), and its inclusiveness in regard to age, gender,
socioeconomic
status and ethnicity.
"The key thing is that it's a terrific set of starting
points to
improve quality of care in this country," said committee
Chair George
J. Isham, MD, medical director of Bloomington, Minn.-based
HealthPartners Inc.
"It's not about finding new solutions for heart
disease," he said.
"It's about taking what we already know about heart disease
and
delivering it to the people with heart disease."
Unlike other medical reports that create a stir and then gather
dust on bookshelves, Dr. Isham said that "Priority Areas for
National
Action: Transforming Health Care Quality" has the potential
for
"revolutionizing health care delivery."
Auspicious origins
He described how "Transforming Health Care Quality"
follows in the
footsteps of the IOM reports "To Err is Human: Building a
Safer Health
System" and "Crossing the Quality Chasm: A New Health
System for the
21st Century" and how the priority areas originated from a
list of
recommendations contained in that second landmark report.
"The plan that was laid out in the previous report was
quite bold,"
he said. "And this report fits into that -- in both scope and
ambition."
Feedback regarding the report has been overwhelmingly positive,
Dr.
Isham said, but there has been some complaints that AIDS treatment
was
not listed as a targeted area.
"We considered hundreds and hundreds of conditions, each
of which
is important to the people who have them," he explained.
"We did
specifically look at AIDS, but -- by going through this process --
these were the 20 that emerged."
By targeting better coordination of care and self-management of
care, Dr. Isham added, the results could be better treatment for
AIDS
and thousands of other conditions not specifically listed.
The report also highlighted the broad-spectrum impact major
depression has on the nation's health and noted how improving
delivery
of treatment for depression could have many ripple effects.
"I think there is increased attention to the important
role
depression plays in mortality and morbidity, and the tremendous
prevalence of this condition," Dr. Isham said.
He noted how the World Health Organization recently stated that
depression "contributes to more medical disability than any
other
single medical condition" in the United States.
Good starting points
Gordon Schiff, MD, director of clinical quality research at
Chicago's John H. Stroger Jr. Hospital of Cook County, gave the
latest
IOM report lukewarm support.
Dr. Schiff, whose critique of "Crossing the Quality
Chasm" appeared
in Public Health Reports, said "Transforming Health
Care
Quality" hasn't had much of an impact.
Nevertheless, he added that its writers chose reasonable and
broad
targets, and he agreed that they were good starting points for
getting
the issue of quality improvement moving forward. "What I have
seen is
somewhat lacking in specificity of exactly who should do what,
when,
where and how to fund [it]."
Dr. Schiff added that it's "not always as easy to
implement the
changes in reality as on paper," and noted how even
apparently obvious
quality improvements -- such as The Leapfrog Group's call for
computer
prescription order entry -- can be difficult to complete.
Dr. Isham said some of these concerns are being addressed, and
that
funding for a "summit meeting" to follow up on the
report's
recommendations already has been secured by the IOM. The meeting,
most
likely convened this fall, would discuss strategies for hitting
the
targets mentioned in the report.
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ADDITIONAL INFORMATION:
Transforming the U.S. health care system
Medical responses to these 20 target areas, chosen for their
"impact, improvablity, and inclusiveness" are viewed
as starting
points to improve quality for all patients.
Asthma: Use anti-inflammatories; treat persistent mild
cases better.
Care coordination: Collaborate on care for 60 million
Americans with multiple chronic conditions.
Children with special health care needs: Recognize that
those
with chronic physical, developmental, behavioral or emotional
conditions need more care.
Diabetes: Prevent progression.
End of life with advanced organ system failure: Minimize
symptoms; reduce exacerbation rates.
Evidence-based cancer screening: Reduce death rates for
several forms of cancer.
Frailty associated with old age: Prevent falls and
pressure
ulcers; maximize function.
Hypertension: Educate the nearly one-third of the people
who
have it and don't know it.
Immunization: Target nursing home residents, low-rate
populations.
Ischemic heart disease: Prevent disease; reduce
recurrence of
attacks.
Major depression: Reach the more than 50% who are
misdiagnosed.
Medication management: Use technology to prevent errors.
Nosocomial infections: Use CDC guidelines to save 40,000
lives a year.
Obesity: Focus on treating the nation's most preventable
cause of premature death and disability.
Pain control for advanced cancer: Cooperate across care
settings; educate public about opioids.
Pregnancy and childbirth: Raise the number of those
getting
first-trimester care.
Self-management/health literacy: Boost health-managing
skills.
Severe and persistent mental illness: Raise public-sector
care quality.
Stroke: Integrate care across disciplines; begin
rehabilitation as soon as possible.
Tobacco-dependence treatment in adults: Use layered
interventions.
Source: Institute of Medicine
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Weblink
IOM report,
"To Err is Human: Building a Safer Health System"
(http://www.nap.edu/catalog/9728.html)
IOM report,
"Crossing the Quality Chasm: A New Health System for the
21st
Century" (http://www.nap.edu/books/0309072808/html/)
IOM report,
"Priority Areas for National Action: Transforming Health
Care
Quality" (http://www.nap.edu/books/0309085438/html/)
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Copyright 2003 American Medical
Association.
All rights reserved.
