Informing the Future Critical Issues in Health, Sixth Edition (2011) / Chapter Skim
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Building a Sustainable, High-Quality Healthcare System
Building a Sustainable, High-Quality Healthcare System
Pages 5-20
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Making health care fairer and better As the nation's largest health insurer, Medicare has a huge impact on the healthcare system. The program covers 39 million people aged 65 years and older and 8 million people with disabilities.
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A second edition of the report, released in September 2011, makes four additional recommendations on methods to set the work adjustment, calculate labor expenses in the practice expense, and use cost share weights.
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Already under way, the results of this study are expected in Spring 2013. Also at the request of Congress, the IOM examined another key aspect of how the healthcare system performs: the use of systematic reviews of the effectiveness of health interventions and the clinical practice guidelines derived from such reviews.
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Improved systematic reviews also will aid professional medical societies and other organizations that develop clinical practice guidelines. The proposed standards span the entire process, from formulating the topic and building a review team, to collecting and evaluating evidence, and finally to developing and using the systematic review and communicat ing results to others.
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Of the several thousand guidelines now on the books, most suffer from shortcomings in development, including failure to include a variety of disciplines in the development process, lack of transparency in how recommendations are derived and evaluated, and omission of a thor Systematic Reviews and Clinical Practice Guidelines Improve Healthcare Decision Making We need better evidence and guidance to make informed healthcare choices DEVELOPMENT Identify, Assess and Assemble Synthesize Evidence OF SYSTEMATIC Multidisciplinary Team REVIEWS De ne Clinical Problem Produce Systematic Review Report Improved health outcomes and Appraise quality of care Systematic Reviews and Other Evidence DEVELOPMENT OF Assemble Guideline Development CLINICAL PRACTICE Group GUIDELINES Use Guidance to Make Better Informed Decisions Incorporate Expert Opinion Produce Clinical and Patient Preferences Practice Guideline and Characteristics
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The proposed standards reflect the latest scientific evidence, expert consensus, and public input, and they apply across the entire process of guideline development. Using the standards, institutions and researchers who are involved in guideline development will be better able to generate clinical practice guidelines that will earn the trust of healthcare practitioners and ultimately improve healthcare decision mak ing and health outcomes for patients.
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• Identify data needs to set a research and data collection agenda. The IOM offers a set of national priority areas to enhance quality and eliminate disparities, and it provides a more quantitative and transparent method to evaluate measures for inclusion in the reports.
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SOURCE: Future Directions for the National Healthcare Quality and Disparities Reports, p.
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Further, there is no way to distinguish whether a Hispanic child, for example, has a Mexican or Cuban background, even though such distinctions can be associated with differences in use of healthcare services and health outcomes. Collecting more detailed, granular ethnicity data can help in tailoring healthcare delivery to local populations.
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spoken language need list and Braille when written language is elicited Recommended variables for standardized collection of race, ethnicity, and language need. NOTE: Additional categories for health information technology tracking might include whether respondents have not yet responded (unavailable)
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Reinvigorating cancer clinical trials Advances in biomedical research yield new opportunities to improve cancer prevention, detection, and treatment. Translating such discoveries into meaningful advances in cancer care depends on an effective clinical trials system.
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Cover the cost of patient care in clinical trials SOURCE: A National Cancer Clinical Trials System for the 21st Century: Reinvigorating the NCI Cooperative Group Program, p.
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With the support of the Peter G Peterson Foundation, the IOM roundtable hosted a series of meetings of experts under the umbrella theme "The Healthcare Imperative: Lowering Costs and Improving Outcomes." Participants discussed the nature of excess health costs, current evidence on the effectiveness of approaches to their control, opportunities for improving health outcomes, and policy options for achieving these aims.
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These included: • streamlined and harmonized health insurance regulation; • administrative simplification and consistency; • payment redesign to focus incentives on results and value; • quality and consistency in treatment, with a focus on treatments that are medically complex; • evidence that is timely, independent, and understandable; • transparency requirements as to cost, quality, and outcomes; • clinical records that are reliable, sharable, and secure; • data that are protected, but accessible for continuous learning; • culture and activities framed by patient perspective; • medical liability reform; and • prevention at the personal and population levels. In addition to its concern with cost savings, the Roundtable on Value & Science-Driven Health Care also has examined the promise and application of digital technologies in health and health care.
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integrated, analyzed, and broadly applied to inform and improve clinical care decisions, promote patient education and self-management, design public health strategies, and support research and knowledge development efforts in a timely manner. Workshop participants examined the vision of such a learning health system, the current state of the system, the key priorities for future work, and the strategic elements for accelerating progress toward a continuous learning health system.
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Integrative Medicine and the Health of the Public: A Summary of the February 2009 Summit, presents a variety of speakers' and participants' suggestions for advancing the field, including rede signing study protocols to better accommodate multifaceted and interacting causal factors; devel oping pilot projects to identify effective integrated approaches that demonstrate value, sustainability, and scalability; and strengthening and redirecting education and training programs. Throughout the summit, speakers highlighted the need for public policy incentives that would support the necessary developments in research, education, and practice, in particular those that encourage care coordination, team care, patient engagement, and an orientation to prevention and well-being.
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