Fostering Rapid Advances in Health Care Learning from System Demonstrations (2003) / Chapter Skim
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1. The Time for Change Has Come
1. The Time for Change Has Come
Pages 17-26
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From page 17... ...
called for a national commitment to improve quality after concluding that "today in America, there is no guarantee that any individual will receive high-quaTity care for any particular health problem." And the conclusions of both of these national panels had been supported by the results of an extensive literature review conducted by researchers at the RAND Corporation, which encompassed publications in peer-reviewed journals between 1993 and mid-1997 and revealed evidence of systemic quality problems throughout the health care sector (Schuster et al., 1998~. Moreover, these findings had been corroborated by studies that looked in more detail at the treatment of specific diseases (e.g., cancer)
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. Moreover, the growing numbers of uninsured place increased demand on public hospitals, academic health centers, community health centers, and other safety net providers that offer a sizable proportion of services to those who lack health insurance and cannot afford to pay.
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The committee concluded that the demonstration projects as a set, and individually if possible, must be bold and transformational. Recognizing the gravity of the problems confronting the health care sector, as well as the need for a major redesign of health care processes, the committee focused on projects that would address the fundamental building blocks of the health care system.
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Stimulus for continued innovation Criteria related to likelihood of successful implementation Resonates with public and policy makers Broad base of support Recognizes and addresses barriers Builds on existing compelencies . entire population (e.g., prevention initiatives to address obesity)
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The DeparDnent of Health and Human Services should select demonstration sites that have a high likelihood of making rapid progress. The~committee identified five major categories of demonstrations—chronic care, primary care, ICT infrastructure, state health insurance, and liability.
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Evaluation and Dissemination A cntical step, whether earned out by AH[RQ or another organization, is to identify up front what would constitute success in each of the five demonstration categories and to ~ansBox 1-3 Components of a Learning Collaborative Multiple organizations that make a commitment, signed by the top leader, to achieve measurable improvements on a given set of metrics and to support staff in their efforts to do so Shared goals and related performance measures Education and training on how a collaborative functions A coordinated, supportive network through which demonstration project staff can actively learn from each other Informal coaching for project staff Reporting of performance measures back to the collaborative and to the larger evaluation effort SOURCE: Adapted from Oswald (20021.
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This would also be an appropriate time to identify environmental obstacles that must be confronted for best practices to take hold, including those that cut across a number of different demonstrations and therefore necessitate priority action. It is clear that future widescale implementation of the best practices resulting from the demonstrations will require more than Medicaid waivers, Medicare demonstration authority, or communities and states that are uniquely supportive of a given demonstration.
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Safety is a serious concern, with many suffering preventable adverse drug events that could have been avoided through the use of computerized medication order entry systems (Bates et al., 1999~. Cost Is a mayor Issues given that Medicare and some other insurance plans provide little or no insurance coverage for prescription drugs.
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Princeton, NJ: The Robert Wood Johnson Foundation.
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