U.S. Should Target 20 Key Health Care Areas

Institute of Medicine Recommendations

January 7, 2003
American health care of elders should focus more on preventing falls and pressure ulcers, maximizing function and developing advanced care plans, according to a report from the Institute of Medicine (IOM).

The Institute also called for improvements in end-of-life care of those with advanced organ system failure. With heart, lung and liver failures accounting for about one-fifth of all fatalities in America, improving care requires continuity of care over time and across settings, close monitoring and rapid responses.

"The United States has the know-how and technology to deliver world-class health care to the public, but often fails to translate such expertise into everyday clinical practice. For many Americans, this situation results in suffering that could be prevented," the institute said.

To help bring about major improvements in health care quality and delivery for all Americans, the U.S. Department of Health and Human Services and other public and private stakeholders should focus on 20 priority areas, the report says.

"Collective action in these areas could help transform the entire health care system," it said.

The committee that wrote the report developed and used an eight-step process to select the top 20 areas, which range from broad interventions to preventive services to palliative care for the dying. The selection process employed three criteria:

• the breadth of impact on patients, families, and communities;
• improvability, or the likelihood of closing large quality gaps; and
• inclusiveness, which deals with both the diversity of people affected and the likelihood of improvements having positive effects throughout the health care industry.

The 20 domains should serve as a starting point to dramatically increase the level of quality across the board, says the report, which is part of the Institute's series of recent studies looking at health care quality in America. In the selected areas, low-quality care typically does not stem from a lack of effective treatments, but from inadequate systems to carry them out. Policy-makers also could use the committee's scientific framework to identify other priorities in the future.

The report is available on the IOM Web site.