The Institute of Medicine’s (IOM) 2001 report Crossing the Quality Chasm: A New Health System for the 21st Century rose out of a series of studies conducted by the IOM and others documenting serious and widespread quality problems in the nation’s health care system (Chassin and Galvin, 1998; IOM, 2000; President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry, 1998; Schuster et al., 1998). Disturbing examples of overuse of procedures that cannot help, underuse of procedures known to be beneficial, and misuse or errors of execution of care are pervasive (Bates et al., 1995; Berwick, 2004; Leatherman and McCarthy, 2002; Wang et al., 2000; Wennberg et al., 2004). And despite more than a decade of alarming statistics, the quality of care the average American receives is still unacceptable. This observation is supported by a recent study published in the New England Journal of Medicine revealing that on average, Americans have just over a 50 percent chance of receiving recommended care for a host of acute and chronic conditions, as well as preventive services (McGlynn et al., 2003).
Given the magnitude and urgency of this problem, the Quality Chasm report called not for incremental tentative steps, but a major overhaul of the current health care delivery system. Though reforming a system as vast and complex as American health care is a daunting task, the Quality Chasm report distilled the principles of change into six guiding aims: health care should be safe, effective, patient-centered, timely, efficient, and equitable (IOM, 2001:5).
As a starting point for translating the above six aims into clinical reality, the Quality Chasm report recommended focusing on a set of common chronic conditions that account for the majority of the nation’s health care burden and resource consumption (Druss et al., 2002, 2001; Hoffman et al., 1996; Partnership for Prevention, 2002). In response, an IOM committee was convened to select at least 15 priority conditions for which reform strategies should be implemented. After carefully analyzing such criteria as impact on the population, potential for improvement, and inclusiveness for a broad range of individuals, health care settings, and providers, the committee identified 20 priority clinical areas for national action. These 20 areas represent the full spectrum of health care, including preventive care, acute and chronic disease management, and palliative care (IOM, 2003).
The 1st Annual Crossing the Quality Chasm Summit was charged with catalyzing the transformation of the health care delivery system as delineated in the Quality Chasm report. A diverse committee representing a wide range of perspectives from many health care sectors was assembled to organize and lead this activity. While the committee is responsible for the overall quality and accuracy of this report as a record of what transpired at the summit, the views contained herein are not necessarily those of the committee.
In an effort to manage this enormous undertaking, the committee decided to narrow its focus to 5 of the original 20 priority areas—asthma, depression, diabetes, heart failure, and pain control in advanced cancer—with the goal that lessons learned from this initial summit would then be disseminated and further applied to the remaining 15 priority areas and beyond. The committee then identified 6 critical crosscutting topics applicable to all of these priority areas: measurement, information and communications technology, care coordination, patient self-management support, finance, and community coalition building.