Edward B. Perrin
The Institute of Medicine (IOM) committee report includes two recommendations that are aimed at increasing and broadening support for the research and training activities necessary for achieving the objectives of the quality assessment and assurance program outlined by the committee. One (Recommendation No. 8) suggests that Congress should direct the Secretary of the Department of Health and Human Services (DHHS) to support, expand, and improve research in the effectiveness and outcome of care and to support a systematic effort to develop clinical practice guidelines and standards of care. The other (Recommendation No. 9) recommends that Congress direct the Secretary of DHHS to establish and fund educational activities designed to enhance the nation's capacity to improve the quality of care. In the papers that follow, we consider more closely the nature of the research, training, and capacity building agendas needed to support the quality assurance program under Medicare.
Harold Luft, professor of economics at the University of California, San Francisco and its Institute for Health Policy Studies, first presents the IOM committee's views about the need for movement in these areas and the directions that such movement might take. Sheldon Greenfield, Senior Scientist, The New England Medical Center, and Edward W. Hook, Physician-in-Chief, University of Virginia Hospital, then offer their outside observations and responses to, respectively, the issues of research and capacity building.