The 1st Annual Crossing the Quality Chasm Summit: A Focus on Communities: Report of a Summit (2004)

The IOM summit committee developed the following criteria for communities likely to be most successful in furthering the vision of the Quality Chasm at the local level:

• Care coordination

  • Is care coordinated across patient conditions, services, and settings over time?

  • Have interdisciplinary teams been formed that communicate with and across diverse health care settings, institutions, and the public/personal health care systems?

• Evidence-based practice

  • Have care processes been redesigned in accordance with best practices?

  • Have guidelines been implemented? Is there a mechanism in place to provide feedback on patient outcomes—effective/ineffective interventions?

• Information and communications technology

  • Are information and communications technologies in place to improve access to clinical information and support clinical decision making?

  • Has a disease registry been compiled? Are prompts and reminders incorporated for needed services? What types of decision support are in place for clinicians?

• Reimbursement

  • Are there any programs in place that reward or pay for quality?

  • Does financing support approaches to care that further the six aims set fourth in the Quality Chasm report—for example, group visits and non–visit-based care—and thus may better meet patient needs?

  • Has a business model been articulated that would make it possible for existing revenue streams to support the program in other settings and/or could serve as a model for reforming payment streams?

• Measurement

  • Has the community incorporated performance and outcome measures for improvement and accountability?

  • Has measurement of some elements been demonstrated consistent with the six aims of the Quality Chasm.

• Consumer engagement

  • Have all the necessary stakeholders been identified?

  • Have multistakeholder coalitions been formed, and are they functioning?

  • Will stakeholders in the community think the changes made will significantly help them (perceived benefit of the change)?

• Leadership

  • Is there strong senior leadership that supports this initiative and considers it a priority?

The following additional screening criteria were applied:

• Willingness/ability to provide evidence for the efficacy of efforts to address key barriers

• Ability to demonstrate an evaluation component—commitment to measurement and accountability

• Stated willingness/commitment to take lessons back from the summit

• Identification of at least two primary stakeholders who would be represented at the summit and are actively engaged in the program

• Inclusion of an assessment/communication strategy in the work plan

  • Are the changes relatively simple?

  • Can they be successfully piloted?

  • How can others watch and learn?

• Geographic diversity among represented communities

Approximately 90 communities from across the country were identified as possible summit participants by committee members and a diverse set of organizations. From this initial pool, 45 communities were further screened, from which 15 were selected for the summit.

The IOM committee’s criteria specified that efforts must be focused on at least one of the five targeted priority areas and that stakeholders involved must include either a payer (e.g., health plan) or purchaser (public or private)—given their influence in shaping health care markets—and at least two of the following: hospital or health system, outpatient provider, consumer-based organization, and government. Coalitions that involved both the private and

public sectors were viewed favorably, given their ability to influence care across the community.

The committee further sought to invite communities to the summit that took an evidence-based approach to their quality improvement work and focused on system interventions (e.g., development of information and communications technology or reimbursement innovations). Communities were sought that evaluated their progress through measurement, were willing to be frank about their experiences, had the support of top leaders in their local markets, and exhibited signs of viability for the longer term. In addition, the committee desired a mix of communities in terms of clinical conditions addressed, geography, and the lead stakeholder driving the initiative.

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