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Top Healthcare Priorities Targeted
Jan. 8, 2003 -- Despite advances in medicine, many Americans often don't get the healthcare they need, says a report from the Institute of Medicine (IOM).
"The United States has the know-how and technology to deliver world-class healthcare to the public, but often fails to translate such expertise into everyday clinical practice," the report says. "For many Americans, this situation results in suffering that could be prevented."
In its report, the IOM identifies 20 high-priority areas that should be targeted to "transform the entire healthcare system," it says. "Low-quality care typically does not stem from a lack of effective treatments, but from inadequate systems to carry them out."
For example, people suffering from multiple chronic conditions -- like hypertension, diabetes, and asthma -- would get better care if doctors' office staff and hospital staff would simply communicate better in coordinating their care.
Children with chronic conditions are "an especially vulnerable population, and the costs to serve them are substantial," says the report. Healthcare providers should work closely with families to coordinate a detailed plan for their care, it adds.
Immunizations are a critical issue, the report points out. Every year, diseases could be prevented if children would get vaccinations. Flu vaccines for nursing-home residents are a critical issue, since they are very susceptible to contagious illnesses because of advanced age and close living quarters.
Black and Hispanic adults -- as well as low-income, inner-city children -- often don't get immunized, and could benefit from outreach efforts from healthcare workers.
The report calls obesity an "emerging area" of concern, responsible for more than 300,000 deaths a year. Obesity "could become the nation's single most preventable cause of premature death and disability," the report says. Only through massive changes -- in social norms and national policies to promote physical activity and healthy diets -- will change occur.
Hospital-acquired infections are another targeted area, killing nearly 90,000 patients in the U.S. every year. Hospitals need to make better use of the prevention guidelines provided by the CDC, the report says.
Other priority areas, according to the Institute of Medicine, include:
- Diabetes, which predisposes people to serious, long-term medical complications including heart disease, hypertension, and blindness.
- End-of-life care for people with advanced organ failures, concentrating on reducing symptoms.
- Cancer screening, which can reduce death rates for several forms of cancer.
- Frailty associated with old age, focusing on preventing falls, treating bedsores, and improving advanced care.
- Hypertension, which can lead to life-threatening complications including stroke, heart attack, and kidney failure. Interventions should emphasize early detection and management.
- Ischemic heart disease, also known as coronary heart disease. Efforts should focus on prevention.
- Major depression, which has a much lower treatment rate than other chronic conditions. Better screening and treatment are needed across the country.
- Medication errors created by physicians and pharmacies could be reduced through use of computer technology.
- Pain control in advanced cancer, since pain typically can be controlled to provide comfort.
- Treatment for mental illness; the federal government needs to play a larger role in assuring higher standards of care in all states.
- Stroke, with efforts focusing on seamlessly integrating care across healthcare settings and treatment specialties.
- Tobacco dependence, one of the nation's most preventable causes of disease and death.
"We spend more than $1 trillion on health care annually, we have extraordinary knowledge and capacity to deliver the best care in the world, but we repeatedly fail to translate this knowledge and capacity into clinical practice," the study says.
SOURCE: "Priority Areas for National Action: Transforming Health Care Quality (2002)", Institute of Medicine.
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