disease prevention, and health care for individuals and communities in every part of our nation.

During the next few years, as change continues, we cannot lose sight of the urgent need to monitor and improve the quality of health and the effectiveness of health care within our society. This White Paper reiterates the Institute of Medicine's belief that maintaining and indeed enhancing the quality of care is a central element in reform of our health care system—quality can and must be measured, monitored, and improved. Policymakers, whether in the public or the private sector at local, state, or federal levels, must insist that the tools for measuring and improving quality be applied. These approaches require constant modification and reassessment —that is, the continual development of new strategies and the refinement of old ones. Furthermore, credible, objective, and nonpolitical surveillance and reporting of quality in health and health care must be explicitly articulated and vigorously applied as change takes place.

The Institute of Medicine, with a membership that includes leaders in public health, nursing, medicine, dentistry, biomedical science, ethics, law, administration, economics, health services research, and numerous other fields, stands ready to participate in this process. As the Institute embarks on its Special Initiative—America's Health in Transition: Protecting and Improving the Quality of Health and Health Care—this White Paper represents the first of many calls for high standards of quality that it will make in the service of good health and health care for all the American people.

Kenneth I. Shine, M.D.

President, Institute of Medicine

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