The Urgent Need to Improve Health Care Quality

Institute of Medicine National Roundtable on Health Care Quality

Published In: JAMA, The Journal of the American Medical Association, v. 280, no. 11, Sep. 16, 1998, p. 1000-1005

Posted on RAND.org on January 01, 1998

by Mark R. Chassin, Robert W. Galvin

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The objective of this study was to identify issues related to the quality of health care in the United States, including its measurement, assessment, and improvement, requiring action by health care professionals or other constituencies in the public or private sectors. Roundtable members concluded that the quality of health care can be precisely defined and measured with a degree of scientific accuracy comparable with that of most measures used in clinical medicine. Serious and widespread quality problems exist throughout American medicine. These problems, which may be classified as underuse, overuse, or misuse, occur in small and large communities alike, in all parts of the country, and with approximately equal frequency in managed care and fee-for-service systems of care. Very large numbers of Americans are harmed as a direct result. Quality of care is the problem, not managed care. Current efforts to improve will not succeed unless we undertake a major, systematic effort to overhaul how health care services are delivered, educate and train clinicians, and assess and improve quality.

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