persist between the care patients should and actually do receive (Leatherman and McCarthy, 2002):

  • Poor treatment of diabetes result in tens of thousands of cases of premature death, limb amputation, kidney disease and blindness (American Diabetes Association, 2002; Centers for Disease Control and Prevention, 2002).

  • Inadequate care after a heart attack results in 18,000 unnecessary deaths per year (Chassin, 1997).

  • The average Medicare beneficiary having one or more chronic conditions is seen by eight different physicians during a year (Anderson and Knickman, 2001). Results of a recent survey indicate that approximately 20 million Americans with chronic illnesses received contradictory information from different health care providers, and 17 million reported being told by their pharmacist that the drugs they were prescribed could have interactions (Harris Interactive, 2001).

  • Fewer than half of adults aged 50 and over were found to have received recommended screening tests for colorectal cancer, the second most common cause of cancer death in the United States (Centers for Disease Control and Prevention, 2001; Leatherman and McCarthy, 2002).

The 2001 IOM report Crossing the Quality Chasm: A New Health System for the 21st Century sets forth an ambitious agenda for taking the first steps in redesigning how health care is routinely delivered (Institute of Medicine, 2001a). The report recommends focusing greater attention on the development of care processes for common chronic conditions. The rationale for this emphasis is that targeting those conditions that account for the majority of health care burden and expenditures and making real changes in the care delivery processes for those conditions would benefit a sizable portion of the population. Moreover, a focus on enhancing quality for a few well-selected priority conditions would be likely to generate systems, skills, awareness, and a culture that would foster improvements in other areas as well. In addition, since many conditions are treated in more than one health care setting, a focus on priority conditions might be expected to encompass care provided in physicians’ offices, hospitals, and nursing homes, as well as home care settings. The Quality Chasm report therefore recommends that the Agency for Healthcare Research and Quality (AHRQ) within the Department of Health and Human Services (DHHS) identify no fewer than 15 priority conditions that might serve as the starting point for transforming the delivery of health care (Institute of Medicine, 2001a).

In response, DHHS contracted with the IOM to convene a committee of experts that would establish a process and develop a set of criteria for determining the priority conditions, identify candidate conditions, and recommend to DHHS a final list of priority conditions deserving of immediate attention. The IOM established a committee with broad-based representation from the following areas: public health, prevention, medicine, nursing, chronic disease management, behavioral medicine, epidemiology, quality of care, health care delivery/policy, health economics, consumer groups, geriatrics, mental health, and special populations (see Appendix A for biographies of the committee members). This report presents the results of the committee’s efforts.

The next step will be to work with various stakeholders in the health care community to develop and implement strategies for improving the quality of care for each priority condition within the next 5 years. To encourage action by other stakeholders, DHSS intends to review the committee’s recommendations; select priorities; and begin incorporating them into the National Health Care Quality Report, to be released for the first time in 2003 (Institute of Medicine, 2001b). That congressionally mandated report is intended to track the progress of the six national quality aims delineated in the Quality Chasm report: safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity (Institute of Medicine, 2001a).

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