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The Ist Annual Crossing the Quality Chasm Summit: A Focus on Communities Appendix J Condition-Specific Working Group Questions Asthma Working Group Questions Measurement: What can we do to enhance asthma performance measures and further the adoption of useful measures? Information and Communications Technology: What steps can be taken to promote the widespread use of clinical information systems for asthma care that support not only tracking and decision support, but also communication and patient involvement? Care Delivery: What strategies might be adopted to change care delivery at the clinician/ microsystem level to enable the right care at the right time? Patient Self-Management: What are the highest-priority steps for promoting the widespread development of self-management capabilities for patients with asthma (and their families)? Finance: What are the components of a model insurance benefits package for essential asthma services? What strategies could be used to foster widespread adoption of such a package? Community Activation: What strategies would create and foster a seamless web of asthma care for children and families, as well as adult patients, across the community—including the health, welfare, school, and work environments?
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The Ist Annual Crossing the Quality Chasm Summit: A Focus on Communities Depression Working Group Questions Measurement: How can we establish a common set of performance measures for depression, incorporating consumer satisfaction as well as outcomes? Information and Communications Technology: Given issues of stigma, confidentiality, and anonymity, how can we incorporate behavioral health information into patients’ electronic health records and registries? Care Coordination: What strategies can we implement to enhance communication between primary care physicians and specialists, including multiple behavioral health providers? Policy: What can be done to address gaps in policy to support the evidence-based treatment of major depression in both the private and public sectors (i.e. screening, care management, follow-up)? Finance: How can we align financial incentives to support an integrated approach among primary and specialty care, employers, and payers for the assessment and treatment of major depression? Community Activation: How can we foster community linkages to support patients (consumers) and families facing the challenges of major depression? Diabetes Working Group Questions Measurement: What strategies can be used to further adoption of diabetes measures and better performance among those already collecting and reporting such measures? Information and Communications Technology: What is the highest-leverage focus for information and communications technology to improve diabetes care (e.g., to support tracking, decision support, communications, measurement/ accountability), and what are the key strategies for furthering its implementation? Care Coordination: What are the highest-leverage strategies to support coordination of care between individual practitioners and organizations, with the goal of improving care for those with diabetes? Patient Self-Management: What are the key steps clinicians, health care organizations, and community organizations can take to create and foster patient self-management? Finance: What strategies can be used to make the business case to payers for supporting patient self-management and care management activities for those with diabetes? Community Activation: What are the most effective ways of activating the major stakeholders in a community to focus on diabetes care?
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The Ist Annual Crossing the Quality Chasm Summit: A Focus on Communities Heart Failure Working Group Questions Measurement: How can we best measure care processes (i.e., adherence to guidelines) and outcomes (e.g., health status, hospitalizations)? Information and Communications Technology: Why has the promise of information and communications technology not been realized in heart failure care? Care Coordination: Breakdowns in care coordination (both inpatient to outpatient care and across multiple providers) are rampant. What strategies can we implement to support care coordination? Clinical Engagement: Physicians need to have a sense of personal commitment to optimizing their patients’ care and outcomes. How do we encourage clinicians to use tools and systems to consistently deliver and monitor quality care? Finance: Several aspects of care are not reimbursed, including patient education, monitoring of health status, dietary management, community coordination, and end-of-life planning. How do we redesign the reimbursement system (Medicare and the major payers) to support quality in heart failure care? Clinical Leadership: Physician ownership of quality assurance/quality improvement efforts is critical to their success. How do we inspire clinician leadership in quality assessment and improvement? Pain Control in Advanced Cancer Working Group Questions Measurement: Who could undertake what specific actions to measure performance in the prevention and management of advanced cancer pain, both to motivate improvement and to monitor the effectiveness of progress overall and in key subpopulations? Abandoning Policy/Forging Will: What specific actions could be undertaken by various stakeholder groups (i.e., political leaders, public and private payers, cancer organizations, pharmaceutical companies, providers) that would eliminate the commonplace practice of tolerating serious cancer pain and instead forge the will to achieve reliable prevention and relief of cancer pain? Care Coordination: What improvements would create seamless and reliable care plans for the prevention and relief of cancer pain, from diagnosis to death, as patients change settings of care (i.e., hospital, home, nursing home) and provider organizations (i.e., cancer center, primary care physician, home care, hospice)? Regulatory: What changes in federal, state, and local regulations and enforcement would facilitate excellent prevention and management of the pain of advanced cancer? How could those changes be achieved? Assessment and Treatment: What strategies would ensure reliable assessment and prescribing practices so that clinicians will be effective in preventing and relieving pain for patients living with advanced cancer?
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