Demonstrations of illness self-management programs Demonstrations of programs for illness self-management for individuals with M/SU illnesses are needed (see Chapter 3).

Gaps in Knowledge About How to Improve Quality

As discussed in Chapter 4, many published reports on successful quality improvement initiatives clearly show that it is possible for organizations to improve the quality of their health care (Shojania and Grimshaw, 2005). Yet little evidence exists about the most effective ways to ensure the consistent application of research findings in routine clinical practice (Shojania et al., 2004). Still less evidence exists about how to do so across the diverse clinicians, organizations, and systems delivering M/SU health care.

Shortcomings in Public Policy

Gaps in knowledge about treatment, the effectiveness of care delivery, and mechanisms and processes for improving quality all lead to shortcomings in public policy for the management of M/SU care. These shortcomings are reflected throughout this report and need to be redressed. Thus research to fill the knowledge gaps described above must result in an agenda that supports and informs policy.

Improved treatment models that support patient-centered care by involving patients in treatment choices (see Chapter 3) will necessitate changes in the structure and delivery of M/SU care. Purchasing decisions that are based on established and common outcomes, guided by market incentives, and driven by quality measures (see Chapters 4 and 8) will also serve as leverage for the needed changes. The structure of public policy will be impacted as well by efforts to address the M/SU workforce issues discussed in Chapter 7.

Thus while the committee recommends a coordinated research agenda and a diversity of research approaches (see below), a central theme must also be the impact on public policy. In addition, research must continually address the shortcomings in public policy noted above and inform the purchasing, management, and delivery of systems of care. This need is applicable at all levels, including patients and families, microsystems of care, health care organizations, and the larger health care environment (Berwick, 2002).


The committee concludes that a coordinated and broadened program of research is needed to fill the gaps in knowledge and inform public policy

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