quality of health care in the United States, confirms that quality problems persist (Leatherman and McCarthy, 2002):
Fewer than half of adults aged 50 and over were found to have received recommended screening tests for colorectal cancer (Centers for Disease Control and Prevention, 2001; Leatherman and McCarthy, 2002).
Inadequate care after a heart attack results in 18,000 unnecessary deaths per year (Chassin, 1997).
In a recent survey, 17 million people reported being told by their pharmacist that the drugs they were prescribed could cause an interaction (Harris Interactive, 2001).
Problems such as those cited above have now been noted so frequently that we risk becoming desensitized even as we pursue change. Our technical lexicon of performance improvements and system interventions can obscure the stark reality that we invest billions in research to find appropriate treatments (National Institutes of Health, 2002), we spend more than $1 trillion on health care annually (Heffler et al., 2002), we have extraordinary knowledge and capacity to deliver the best care in the world, but we repeatedly fail to translate that knowledge and capacity into clinical practice.
The IOM’s Quality Chasm report sets forth a bold strategy for achieving substantial improvement in health care quality during the coming decade (Institute of Medicine, 2001a). As a crucial first step in making the nation’s health care system more responsive to the needs of patients and more capable of delivering science-based care, the Quality Chasm report recommends the systematic identification of priority areas for quality improvement. The idea behind this strategy was to have various groups at different levels focus on improving care in a limited set of priority areas, with the hope that their collective efforts would help move the nation forward toward achieving better-quality health care for all Americans. In response, the Department of Health and Human Services (DHHS) contracted with the IOM to form a committee whose charge was threefold: to select criteria for screening potential priority areas, to develop a process for applying those criteria, and to generate a list of approximately 15 to 20 candidate areas.
Behind each of the priority areas recommended in this report is a patient who may be receiving poor quality care. This is due not to a lack of effective treatments, but to inadequate health care delivery systems that fail to implement these treatments. For this reason, the committee considered quality to be a systems property, recognizing that although the health care workforce is trying hard to deliver the best care, those efforts are doomed to failure with today’s outmoded and poorly designed systems. The committee did not concentrate on ways of improving the efficacy of existing best-practice treatments through either biomedical research or technological innovation, but rather on ways to improve the delivery of those treatments. Indeed the goal of the study was to identify priority areas that presented the greatest opportunity to narrow the gap between what the health care system is routinely doing now and what we know to be best medical practice.
The Quality Chasm report proposes that chronic conditions serve as the focal point for the priority areas, given that a limited number of chronic conditions account for the majority of the nation’s health care burden and resource use (Hoffman et al., 1996; Institute of Medicine, 2001a; Partnership for Solutions, 2001; The Robert Wood Johnson Foundation, 2001). Chronic conditions do represent a substantial number of the priority areas on the final list presented in this report; however, this