Definition of Serious and Complex Medical Conditions

Carole A. Chrvala, Ph.D., and Steven Sharfstein, M.D., Editors

Committee on Serious and Complex Medical Conditions

Division of Health Care Services

Institute of Medicine

NATIONAL ACADEMY PRESS
Washington, DC



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement



Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.

OCR for page R1
--> Definition of Serious and Complex Medical Conditions Carole A. Chrvala, Ph.D., and Steven Sharfstein, M.D., Editors Committee on Serious and Complex Medical Conditions Division of Health Care Services Institute of Medicine NATIONAL ACADEMY PRESS Washington, DC

OCR for page R1
--> NATIONAL ACADEMY PRESS 2101 Constitution Avenue, N.W. Washington, D.C. 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts both under the Academy’s 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. Support for this study was provided by the Department of Health and Human Services, Health Care Financing Administration, Contract No. 500-99-0002. The views presented are those of the Institute of Medicine Committee on Serious and Complex Medical Conditions and are not necessarily those of the funding organization. International Standard Book No. 0-309-06640-9 Additional copies of this report are available for sale from: National Academy Press 2101 Constitution Avenue, N.W. Box 285 Washington, DC 20055 Call (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area), or visit the NAP’s on-line bookstore at www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at www.iom.edu. Copyright 1999 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The image adopted as a logotype by the Institute of Medicine is based on a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

OCR for page R1
--> COMMITTEE ON SERIOUS AND COMPLEX MEDICAL CONDITIONS STEVEN SHARFSTEIN, M.D. (Chair,) Sheppard Pratt Health Systems, Baltimore, Maryland WILLIAM GOLDEN, M.D., University of Arkansas for Medical Sciences, Little Rock SAM HO, M.D., PacifiCare Health Systems, Santa Ana, California SHARON LEVINE, M.D., The Permanente Medical Group, Oakland, California KATHLEEN McGINLEY, Ph.D., The Arc of the United States, Governmental Affairs Office, Washington, D.C. GARTH SPLINTER, M.D., M.B.A., University of Oklahoma College of Medicine, Chief Medical Officer, University Hospitals Trust, and Former CEO of the Oklahoma Health Care Authority, Oklahoma City NANCY WHITELAW, Ph.D., Henry Ford Health System, Detroit, Michigan Staff CAROLE A. CHRVALA, Study Director JANET CORRIGAN, Director, Division of Health Care Services DONNA DUNCAN, Administrative Assistant, Division of Health Promotion and Disease Prevention KELLY PIKE, Project Assistant KELLY NORSINGLE, Project Assistant

OCR for page R1
This page in the original is blank.

OCR for page R1
--> Acknowledgments Preparation of this report would not have been possible without the guidance and expertise of numerous individuals. Although it is not possible to mention by name all of those who contributed to its work, the committee wants to express its gratitude to a number of groups and individuals for their special contributions. Special thanks are extended to Judith Bragdon, Center for Health Plans and Providers, Health Care Financing Administration; Patricia Kurtz, Center for Medicaid and State Operations, Health Care Financing Administration; and Gavin Kennedy, Office of the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services, for the guidance they provided to clarify the charge to the committee and facilitate identification of the major issues to be considered as the committee undertook its charge. The committee is especially appreciative of the efforts of Tony Hausner, Ph.D., of the Health Care Financing Administration, for serving as the project officer and providing information relevant to the committee's deliberations. Sincere thanks go to all of the participants at the workshop convened on June 14, 1999. The speakers (Appendix B) gave generously of their time and expertise to help inform and guide the committee's work. We are particularly appreciative of the efforts of David Nerenz, Ph.D., director, Center for Health Services Research, Henry Ford Health System. His commissioned paper on "Definitions of Serious and Complex Medical Conditions: Alternatives and Implications" was seriously considered in the deliberations of the committee and his advice throughout the committee's work has been greatly appreciated. We also recognize the careful and thoughtful efforts of Florence Poillen to edit the text of this report.

OCR for page R1
--> The committee extends special thanks to the dedicated and hardworking staff at the Institute of Medicine. The expertise and leadership of Janet Corrigan, director of the Division of Health Care Services, Institute of Medicine, helped to ensure that this report met the highest standards of quality. Study Director Carole A. Chrvala's expertise in study management and organization, as well as her commitment to the topic of defining serious or complex medical conditions, successfully advanced the progress of the committee's report through several drafts and a rapid report review process. Kelly Norsingle served as project assistant and worked closely with the study director on many aspects of this study. She coordinated the logistics for all committee meetings and conference calls as well as completing all of the arrangements for the workshop. Kelly Pike and Donna Duncan contributed their skills and knowledge in preparing this report for its publication. Other Institute of Medicine staff provided valuable guidance in the areas of both substance and process including the Administrative Office, Office of Contracts and Grants, Office of Finance, and the Report Review Committee. Kathleen Stratton, Lyla Hernandez, and Catharyn Liverman provided invaluable technical and moral support to the study director that helped her to carry this project to successful completion. Individuals chosen for their diverse perspectives and expertise in health services research, health care insurance and economic policies, clinical issues, and delivery of services by health care plans reviewed this report in draft form. This review was conducted in accordance with procedures approved by the National Research Council's Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the IOM in making the published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their participation in the review of this report: Christine K. Cassel, M.D., Mount Sinai Hospital School of Medicine; Kristine M. Gebbie, R.N., Dr.P.H., Columbia University; Lynn Gerber, M.D., National Institutes of Health, Clinical Center; Stanley Jones, Consultant, Sheperdstown, WV; Judith Krauss, M.S.N., F.A.A.N.; Lee N. Newcomer, M.D., United Health Group; Peter Rabins, M.D., Johns Hopkins University Hospital; Deborah Spitalnik, Ph.D., Robert Wood Johnson Medical School; Barbara Vickrey, M.D., M.P.H., University of California Los Angeles, Department of Neurology; Edward Wagner, M.D., Group Health Cooperative of Puget Sound; and Sandra Harmon-Weiss, Aetna US Healthcare. Although these individuals provided many constructive comments and suggestions, responsibility for the final content of this report rests solely with the authoring committee and the Institute of Medicine. Finally, the committee would like to thank the chair, Steven S. Sharfstein, M.D., for his outstanding work, leadership, and dedication to this project.

OCR for page R1
--> Contents     Executive Summary   1 1   Introduction   15     Charge to the Institute of Medicine,   15     Scope and Organization of This Report,   17     Definitions of Serious and Complex Medical Conditions: Alternatives and Implications,   18 2   Challenges in Health Care Delivery for Patients with Serious and Complex Medical Conditions   34     Quality of Health Care,   35     Access to Care,   38     Health Care Cost Containment,   40 3   Conclusions and Recommendations   45     Introduction,   43     Conclusions,   54     References   55     Appendixes     A   Workshop to Define Serious or Complex Medical Conditions,   65 B   Speakers Biographies,   107 C   Workshop Agenda,   110 D   Workshop Participants,   112 E   Committee Biographies,   113

OCR for page R1
This page in the original is blank.

OCR for page R1
This page in the original is blank.

OCR for page R1
This page in the original is blank.