The IOM Next Steps Summit is intended to support communities of care providers in “Crossing the Chasm” to delivering high-quality care in one or more of the aforementioned five priority areas. This document lays the foundation for the condition-specific working groups. By investing in a modest amount of preparatory work, the participants should be able to maximize their time at the conference so that unique and valuable insights into how best to improve care within each community can be learned and deployed.

The first step towards optimizing the quality of care for the five conditions being targeted is to visualize the process of ideal care and to understand potential impediments to delivering that care. Figure 1 below represents the cycle of “ideal” care.

Using chronic heart failure as an example, the initial step is to recognize that the patient suffers from the syndrome of heart failure and to make a proper diagnosis. These diagnostic steps are outlined in the first column of the attached grids and include an assessment of left ventricular function, the use of laboratory tests to exclude other etiologies for these symptoms, and the exclusion of significant ischemic coronary disease. The next step of the care process is to educate patients about the nature of heart failure and what to expect regarding treatment (including lifestyle interventions) and prognosis. The third phase of care is to recommend initial treatment. Current standards of care for patients with left ventricular dysfunction include the use of angiotensin converting enzyme inhibitors, beta-blockers and anti-coagulation for those with atrial fibrillation. Ensuring that treatment recommendations are followed is the next step along the path of ideal care and includes teaching patients techniques of self-management such as monitoring weight and medication compliance. Finally, serial assessments of patients’ responses to treatment and monitoring the status of their heart failure are needed to continually optimize the other aspects of their heart failure care. This can be done through the serial assessment of patients’ symptoms, function and quality of life. Sub-optimal health status (symptoms, function and quality of life) should trigger a repeated pursuit, using the same steps outlined above, of opportunities to improve the patient’s condition. Naturally, it should be emphasized that this pursuit is one of shared management.

Figure F-1. Cycle of “Ideal” Care

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