Pharmacy & Therapeutics Society: KEYNOTE ADDRESS

The Institute of Medicine’s Agenda for Health Care Quality: Past, Present, and Future

Keynote Speaker: Harvey V. Fineberg, MD, PhD, President, Institute of Medicine.

The pathways to improving the quality of health care in the U.S. involve two strategies: developing better drug interventions and devising better ways to do things using existing technologies.

Dr. Fineberg cited the IOM reports mentioned by Dr. Boot-man as the key elements in improving the quality of health care. Quality is considered a “systems” problem requiring a systems solution, and action is needed to solve problems at all levels.
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Crossing the Quality Chasm outlined a blueprint for quality change. It established a common set of attributes and a definition of quality that virtually all health care professionals would adopt. It stressed the fundamental policy that the solution to problems of quality rests in making improvements in the system of care and nothing else. The report stated that one needed to act on several levels, for example, at an individual and a community level, where the interaction of physicians and patients is critical; at the organizational level; and in the environment of care. The quality chasm series, which emphasized leadership by example, examined all federal programs to introduce quality change in health care.

Health Professions Education: A Bridge to Quality (2003) stated that doctors, nurses, pharmacists, and other health care professionals are not being adequately prepared to provide the highest quality and safest medical care possible, and there is insufficient assessment of their ongoing proficiency. Educators and accreditation, licensing, and certification organizations should ensure that students and working professionals develop and maintain proficiency in five core areas:

• delivering patient-centered care
• working as part of interdisciplinary teams
• practicing evidence-based medicine
• focusing on quality improvement
• using information technology

Meaningful health care changes are difficult to produce; they require (1) motivation for change (a system of reward and punishment), (2) an understanding of patients’ cultures and values; (3) leaders who can make the changes, and (4) financial resources.

The IOM proposes 10 ideas to accomplish the changes required in our health care system:
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• finding a middle ground politically and recognizing our social responsibility to provide universal coverage (with 43 million uninsured people, there is a need for means-based payments)
• paying for disease prevention or reimbursing for preventive services
• putting people first and ending unequal treatment of patients
• finding and deploying an information technology infrastructure
• using evidence-based guidelines as the presumptive clinical strategy with individualized decision-making
• rationing health care intelligently by defining the “basket of services” in the universal care package so that all citizens have access to such services
• insisting on transparency; supporting mandatory data reporting and public dissemination of data; refining adjustment standards over time
• experimenting with care models for chronic diseases (125 million people have at least one chronic disease) and using team-based care for patients
• strengthening partnerships between payers and providers
• providing education for, and building, quality of care