in continuing to raise the awareness of the American public about the quality-of-care challenges facing the health care system. Public awareness of shortcomings in quality is critical to securing public support for the steps that must be taken to address these concerns.

Recommendation 3: Congress should continue to authorize and appropriate funds for, and the Department of Health and Human Services should move forward expeditiously with the establishment of, monitoring and tracking processes for use in evaluating the progress of the health system in pursuit of the above-cited aims of safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity. The Secretary of the Department of Health and Human Services should report annually to Congress and the President on the quality of care provided to the American people.

The committee applauds Congress and the Administration for their current efforts to establish a National Quality Report for tracking the quality of care. Ongoing input from the many public- and private-sector associations, professional groups, and others involved in quality measurement and improvement will contribute to the success of these efforts. The establishment of specific goals for each of the six aims could further enhance the usefulness of this monitoring and tracking system as a stimulus for performance improvement. Continued funding for this activity should be ensured, as well as regular reports that communicate progress to all concerned. It should be noted that although this report focuses only on health care for individuals, the above overarching statement of purpose and six aims for improvement are sufficiently robust that they can be applied equally to decisions and evaluations at the population-health level.

Formulating New Rules to Redesign and Improve Care

As discussed earlier, improved performance will depend on new system designs. The committee believes it would be neither useful nor possible for us to specify in detail the design of 21st-century health care delivery systems. Imagination and valuable pluralism abound at the local level in the nation’s health care enterprise. At the same time, we believe local efforts to implement innovation and achieve improvement can benefit from a set of simple rules to guide the redesign of the health care system.

In formulating these rules, the committee has been guided by the belief that care must be delivered by systems that are carefully and consciously designed to provide care that is safe, effective, patient-centered, timely, efficient, and equitable. Such systems must be designed to serve the needs of patients, and to ensure that they are fully informed, retain control and participate in care delivery whenever possible, and receive care that is respectful of their values and preferences. Such systems must facilitate the application of scientific knowledge to



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