Today’s health care system is not well designed to meet the needs of patients with common chronic conditions. Some patients receive good-quality care that is well coordinated, with good communication among the various clinicians involved. For too many others, however, care for even a single condition is fragmented across many clinicians and settings with little coordination or communication, and some needs remain undetected and/or unmet.

Given the magnitude of the change that is required, the committee believes that leadership at the national level is required to initiate the process of change by taking two important steps. First, a short list of priority conditions should be promulgated by the Department of Health and Human Services, and all health care stakeholders should then focus attention on making substantial progress toward the establishment of state-of-the-art processes for these conditions in the next 5 years. Second, resources should be provided to seed innovative projects at the delivery system level, especially those projects that have a high likelihood of producing knowledge and tools that can be applied on a widespread basis throughout the health care sector.

The committee believes such a focus on specific common clinical conditions is the best way to achieve the substantial improvement in quality that is required. Such conditions represent the needs around which patients have the greatest interaction with the system and make the most choices about cost and quality (and other issues). This is also the level at which care processes can be designed and refined. Thus, priority conditions offer the best opportunity for undertaking the development of the evidence base for practice; the reorganization of care; the development of supportive information technologies; and the design and refinement of quality measures and reporting processes, as well as payment incentives and rewards.

Recommendation 5: The Agency for Healthcare Research and Quality should identify not fewer than 15 priority conditions, taking into account frequency of occurrence, health burden, and resource use. In collaboration with the National Quality Forum, the agency should convene stakeholders, including purchasers, consumers, health care organizations, professional groups, and others, to develop strategies, goals, and action plans for achieving substantial improvements in quality in the next 5 years for each of the priority conditions.

Identifying priority conditions represents a starting point to support the organization of care, bring the evidence base into practice, develop information technology and infrastructure to support care, and develop mechanisms to measure and pay for quality care. Instead of defining care by where it is delivered or who delivers it, the system should be designed to optimize care for patients’ needs across the entire continuum of care in the most effective and efficient way possible.

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