1. How can the appropriateness, effectiveness, and adequacy of current and proposed quality assessment and improvement strategies for home care services and residential care services be optimized?

  2. What role should consumers and their informal caregivers play in defining and evaluating quality?

  3. Are national minimum standards or model standards needed to ensure the quality of home and residential care? If so, what should they address or emphasize and how can compliance with these standards be encouraged and enforced?

The committee laid out a study design to examine these key questions in a process that would be conducted over an 18-month period, guided by a study committee of 16 to 18 members. Studies at the IOM typically include the collection of existing data; analysis of that information; and the development of conclusions and recommendations that culminate in a published report. In addition to its final report, the planning committee concluded that the full study committee should prepare an interim report that defines the taxonomy of home and community-based services under study. Both reports would be reviewed by a separate and independent group of experts according to the procedures of the National Research Council and disseminated widely through a variety of means such as press conferences, briefings, and derivative publications.

The IOM is well qualified to lead such a project. The potentially contentious nature and broad scope of the study point to the utility of the IOM model, which employs a study committee composed of experts from a variety of disciplines who hold a range of different perspectives. Recommendations are formulated after a rigorous process of seeking input from many sources and developing consensus among the committee 's different stakeholders. The IOM's national reputation as an objective, scientific, and policy-relevant organization adds the considerable credibility necessary to influence policies at all levels of government. The product of this particular study is also intended to be of immediate, practical value to individual providers and consumers as well.

The IOM was asked to examine these important issues several years ago, at a time when the sweeping changes confronting the world of health care and LTC had just begun to gather force. The concerns that led Congress to seek guidance on how best to address those changes remain just as vital today. So, too, do the opportunities to create meaningful differences in the way care is provided to countless older and disabled individuals and their families.



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