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Healthcare Systems: Crossing the Chasm Cheat Sheet (DRAFT) by [deleted]

This is a draft cheat sheet. It is a work in progress and is not finished yet.

Introd­uction - Crossing the Quality Chasm

Model that encourages focusing on the chronic conditions that account for the largest percentage of health care expenses, and urges greater investment in and rewards for IT infras­tru­cture to support eviden­ce-­based care.

Specif­ically, the report cites an important body of work supporting the need for improved health care systems. Essential components of the model include clinical inform­ation systems that provide decision support for practi­tioners and prepared, proactive teams that offer self-m­ana­gement support to informed patients.
Model for Effective Chronic Illness Care, developed at Health Partners in Minnesota and at Group Health Cooper­ative of Puget Sound (Boden­heimer, Wagner and Grumbach, 2002).

10 Simple Rules for 21st Century Healthcare

1. Care based on continuous healing relati­ons­hips. Patients should receive care whenever needed and in many forms, not just face-t­o-face visits.
2. Custom­ization based on patient needs and values. The care should meet the most common needs, but be able respond to individual patient choices and prefer­ences.
3. The patient as the source of control. Patients should be given the necessary inform­ation and opport­unity to exercise control over health care decisions that affect them.
4. Shared knowledge and the free flow of inform­ati­on.
Patients should have unfettered access to their own medical inform­ation and to clinical knowledge.
5. Eviden­ce-­based decision making. Patients should receive care based on the best available scientific knowledge.
6. Safety as a system proper­ty. Patients should be safe from injury caused by the care system.
7. The need for transp­are­ncy. The care system should make inform­ation available to patients and their families, allowing them to make informed decisions when selecting a health plan, hospital, or clinical practice, or choosing among altern­ative treatm­ents. This include inform­ation describing the system's perfor­mance on safety, eviden­ce-­based practice and patient satisf­action.
8. Antici­pation of needs. The health system should anticipate patient needs, rather than simply reacting to events.
9. Continuous decrease in waste. The health system should not waste resources or patient time.
10. Cooper­ation among clinic­ians. Clinicians and instit­utions should actively collab­orate and commun­icate to ensure an approp­riate exchange of inform­ation and coordi­nation of care.

Crossing the Chasm

6 Aims of the Crossing

IOM outlined six specific aims that must fulfill to deliver quality care:
1. Safe: Care should be as safe for patients in health care facilities as in their homes;
2. Effect­ive: The science and evidence behind health care should be applied and serve as the standard in the delivery of care;
3. Effici­ent: Care and service should be cost effective, and waste should be removed from the system;
4. Timely: Patients should experience no waits or delays in receiving care and service;
5. Patient center­ed: The system of care should revolve around the patient, respect patient prefer­ences, and put the patient in control;
6. Equita­ble: Unequal treatment should be a fact of the past; dispar­ities in care should be eradic­ated.

IOM Defined Sets of Measur­ement for Aims

1. Safety: Overall mortality rates or the percentage of patients receiving safe care;
2. Effect­ive­ness: How well eviden­ced­-based practices are followed, such as the percentage of time diabetic patients receive all recomm­ended care at each visit;
3. Effici­ency: Analysis of the costs of care by patient, provider, organi­zation, and community;
4. Timeli­ness: Waits and delays in receiving care, service, or results;
5. Patient center­ed: Patient and family satisf­action;
6. Equita­ble: Differ­ences in quality measures by race, gender, income, and other popula­tio­n-based demogr­aphic and socioe­conomic factors.