March 2001

I N S T I T U TE OF M E D I C I N E
Shaping the Future for Health

CROSSING THE Q UALITY CHASM:
A NEW HEALTH SYSTEM FOR THE 21ST CENTURY

T

he U.S. health care delivery system does not provide consistent, highquality medical care to all people. Americans should be able to count on receiving care that meets their needs and is based on the best scientific knowledge--yet there is strong evidence that this frequently is not the case. Health care harms patients too frequently and routinely fails to deliver its potential benefits. Indeed, between the health care that we now have and the health care that we could have lies not just a gap, but a chasm.
A number of factors have combined to create this chasm. Medical science and technology have advanced at an unprecedented rate during the past half-century. In tandem has come growing complexity of health care, which today is characterized by more to know, more to do, more to manage, more to watch, and more people involved than ever before. Faced with such rapid changes, the nation’s health care delivery system has fallen far short in its ability to translate knowledge into practice and to apply new technology safely and appropriately. And if the system cannot consistently deliver today’s science and technology, it is even less prepared to respond to the extraordinary advances that surely will emerge during the coming decades.
The public’s health care needs have changed as well. Americans are living longer, due at least in part to advances in medical science and techno logy, and with this aging population comes an increase in the incidence and prevalence of chronic conditions. Such conditions, including heart disease, diabetes, and asthma, are now the leading cause of illness, disability, and death. But today’s health system remains overly devoted to dealing with acute, episodic care needs. There is a dearth of clinical programs with the multidisciplinary infrastructure required to provide the full complement of services needed by people with common chronic conditions.
The health care delivery system also is poorly organized to meet the challenges at hand. The delivery of care often is overly complex and uncoordinated, requiring steps and patient “handoffs” that slow down care and decrease rather than improve safety. These cumbersome processes waste resources; leave unaccountable voids in coverage; lead to loss of information;

Faced with such rapid changes, the nation’s health care delivery system has fallen far short in its ability to translate knowledge into practice and to apply new technology safely and appropriately.

CARE SYSTEM

Supportive payment and regulatory environment

Organizations that facilitate the work of patientcentered teams

High performing patientcentered teams

Outcomes:
• Safe
• Effective
• Efficient
• Personalized
• Timely
• Equitable

REDESIGN IMPERATIVES: SIX CHALLENGES
•
Reengineered care processes
•
Effective use of information technologies
•
Knowledge and skills management
•
Development of effective teams
•
Coordination of care across patientconditions, services, sites of care over time

and fail to build on the strengths of all health professionals involved to ensure that care is appropriate, timely, and safe. Organizational problems are particularly apparent regarding chronic conditions. The fact that more than 40 percent of people with chronic conditions have more than one such condition argues strongly for more sophisticated mechanisms to coordinate care. Yet health care organizations, hospitals, and physician groups typically operate as separate “silos,” acting without the benefit of complete information about the patient’s condition, medical history, services provided in other settings, or medications provided by other clinicians.

Making change possible.

Strategy for Reinventing the System

Advances must begin with all health care