advancement and diffusion of clinical knowledge. The discovery of new knowledge leads to the redefinition of what constitutes best practices in a specific clinical area. Overlooking or failing to adhere to best practices is an important source of errors of omission that lead to morbidity and mortality among patients. In the early 1980s, for example, new scientific evidence became available indicating that medications known as beta-blockers administered to patients at the time of a heart attack greatly reduce the likelihood of a subsequent heart attack (Beta-Blocker Heart Attack Trial, 1982). To be applied speedily and consistently in practice, such new evidence must be translated into a care guideline (e.g., absent contraindications, patients experiencing a heart attack should be prescribed beta-blockers). Hospitals, physicians, and other providers must modify their care processes to be consistent with the new best practice (e.g., the patient’s attending physician is responsible for prescribing a beta-blocker to the patient at the time of the heart attack). Information systems must be modified to capture information on the new practice (e.g., the pharmacy system must add this new drug to the formulary), and computerized decision support systems must be modified to issue an alert to the clinician and patient if the patient’s record does not include entries substantiating that beta-blockers were prescribed at the time of the heart attack, if appropriate.

Unfortunately, the current health care delivery system lacks well-defined processes for translating new knowledge into practice. Not surprisingly, then, a 1997 study showed that only 21 percent of eligible elderly patients suffering a heart attack had received beta-blockers, and there was a 75 percent higher mortality rate among those who did not receive the treatment than among those who did (Soumerai et al., 1997). Similar examples can be found in virtually every area of clinical practice (Institute of Medicine, 2001; McGlynn et al., 2003). Overall, the toll in terms of lost lives, pain and suffering, and wasted resources is staggering.

As a complement to the present study, DHHS asked the IOM to identify a limited number of clinical areas that might serve as a starting point for public- and private-sector efforts to improve care delivery. In fall 2002, the IOM released the report Priority Areas for National Action: Transforming Health Care Quality (Institute of Medicine, 2003b) identifying 20 areas—consisting primarily of leading chronic conditions—that account for a sizable proportion of health care services.

Through the efforts of the Agency for Healthcare Research and Quality (AHRQ) progress is being made on translating knowledge into practice in selected clinical areas, including the 20 priority areas identified by the IOM. As of October 2002, AHRQ had provided support to 13 evidence-based



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