March 1, 2001 (Washington) -- Two years ago, a blue-ribbon panel committee dropped a bombshell -- the news that up to 98,000 Americans die annually from medical errors. That finding, the reconvened panel says, was just the "tip of the iceberg in the larger story about quality care."
At a news conference here Thursday, the same panel called the diagnosis critical for quality healthcare in America.
"We believe that since the current system can no longer delivery quality care, that the report constitutes, if you will, a blueprint ... to make sure that [better] care is developed across the country," says William Richardson, PhD, chair of the panel that produced both reports. This one is titled, "Crossing the Quality Chasm: A New Health System for the 21st Century." The report calls American healthcare "poorly designed."
Greater access to records, as well as information over the Internet, also were stressed in designing an" approach would emphasize patient control.
"I'd invite patients to read their records. ... I would invest in forms of shared decision making," says panelist Donald Berwick, MD, MPP, of Harvard Medical School in Boston.
The analysis, paid for in part by the federal government, was put together by the Institute of Medicine (IOM), which is part of the National Academy of Sciences.
Ironically, in spite of great scientific advances like mapping the human genome, the panelists found that the gap in effectively delivering treatments to patients has widened into a chasm.
For example, too many patients overuse antibiotics, increasing the problem of bacterial resistance, and too few patients get lifesaving drugs after a heart attack, even though such actions fly in the face of well-known practice guidelines.
"[M]illions of Americans fail to receive effective care. If the healthcare system cannot consistently deliver today's science ... it is even less prepared to respond to the extraordinary scientific advances that will surely emerge during the first half of the 21st century," according to the report.
Chief among the 19-member committee's concerns -- poorly coordinated treatment for people with chronic conditions like breast cancer, asthma, and diabetes.
Patients often have to fight their way through a maze of providers to get the kind of care they need, says Richardson, who points out that 70% of the care in the U.S. is now provided for long-term illnesses, even though the system focuses mainly on short-term, acute problems.
Sen. Jim Jeffords, (R-Vt.), chairman of the government's Health and Education Committee, says he hoped to introduce patient safety legislation this spring, based on the IOM's first report. That sobering document led former President Clinton to undertake a $50 million national effort to reduce medical errors. Jeffords also stresses the idea of putting the nation's $20 billion investment in medical research to better use in terms of enhancing healthcare quality.
In addition to fragmentation in healthcare, patients also must deal with a payment system that often seems to reward inefficiency. For example, one health organization caring for 13,000 diabetic patients identified changes that could have saved some $10 million. But they weren't implemented because healthier diabetics would mean less revenue for the HMO, says committee member Molly Joel Coye, MD, MPH, of the Institute for the Future, an independent, nonprofit research firm in California's Silicone Valley that specializes in forecasting alternative scenarios for the future.
"We can't expect to see major progress in the future on quality if they lose money every time they improve care," Coye says.
Coye also touts the money-saving benefits of developing computer links with physicians.
"An increasing proportion of doctors are emailing with their patients, but as the doctors point out to you, they're not being paid for it," she says.
The report stresses that care should first be safe and effective, but also timely and patient-centered. In order to accomplish those goals, the committee recommends investing $1 billion in an "innovation fund" over the next few years to develop needed improvements.
Such improvements are "urgent, they're important, and we're saying they're achievable," Berwick says.
A coalition of doctors' groups has issued statements supporting the IOM report.
"[A]s good as our healthcare system is, more needs to be done to improve quality," says E. Ratcliffe Anderson, MD, executive vice president and CEO of the American Medical Association.
"Many of the report's recommendations begin to chart a course to the future. But some caution is needed to ensure that we avoid duplication of effort," says Dick Davidson, president of the American Hospital Association.