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Winner of the 1983 Pulitzer Prize and the Bancroft Prize in American History, this is a landmark history of how the entire American health care system of doctors, hospitals, health plans, and government programs has evolved over the last two centuries. "The definitive social history of the medical profession in America....A monumental achievement."—H. Jack Geiger, M.D., New York Times Book Review
Drawing on the work of the Roundtable on Evidence-Based Medicine, the 2007 IOM Annual Meeting assessed some of the rapidly occurring changes in health care related to new diagnostic and treatment tools, emerging genetic insights, the developments in information technology, and healthcare costs, and discussed the need for a stronger focus on evidence to ensure that the promise of scientific discovery and technological innovation is efficiently captured to provide the right care for the right patient at the right time. As new discoveries continue to expand the universe of medical interventions, treatments, and methods of care, the need for a more systematic approach to evidence development and application becomes increasingly critical. Without better information about the effectiveness of different treatment options, the resulting uncertainty can lead to the delivery of services that may be unnecessary, unproven, or even harmful. Improving the evidence-base for medicine holds great potential to increase the quality and efficiency of medical care. The Annual Meeting, held on October 8, 2007, brought together many of the nation's leading authorities on various aspects of the issues - both challenges and opportunities - to present their perspectives and engage in discussion with the IOM membership.
In less than four months, beginning with a staff of five, an obscure office buried deep within the federal bureaucracy transformed the nation's hospitals from our most racially and economically segregated institutions into our most integrated. These powerful private institutions, which had for a half century selectively served people on the basis of race and wealth, began equally caring for all on the basis of need. The book draws the reader into the struggles of the unsung heroes of the transformation, black medical leaders whose stubborn courage helped shape the larger civil rights movement. They demanded an end to federal subsidization of discrimination in the form of Medicare payments to hospitals that embraced the "separate but equal" creed that shaped American life during the Jim Crow era. Faced with this pressure, the Kennedy and Johnson Administrations tried to play a cautious chess game, but that game led to perhaps the biggest gamble in the history of domestic policy. Leaders secretly recruited volunteer federal employees to serve as inspectors, and an invisible army of hospital workers and civil rights activists to work as agents, making it impossible for hospitals to get Medicare dollars with mere paper compliance. These triumphs did not come without casualties, yet the story offers lessons and hope for realizing this transformational dream.
The anthrax incidents following the 9/11 terrorist attacks put the spotlight on the nation's public health agencies, placing it under an unprecedented scrutiny that added new dimensions to the complex issues considered in this report. The Future of the Public's Health in the 21st Century reaffirms the vision of Healthy People 2010, and outlines a systems approach to assuring the nation's health in practice, research, and policy. This approach focuses on joining the unique resources and perspectives of diverse sectors and entities and challenges these groups to work in a concerted, strategic way to promote and protect the public's health. Focusing on diverse partnerships as the framework for public health, the book discusses: The need for a shift from an individual to a population-based approach in practice, research, policy, and community engagement. The status of the governmental public health infrastructure and what needs to be improved, including its interface with the health care delivery system. The roles nongovernment actors, such as academia, business, local communities and the media can play in creating a healthy nation. Providing an accessible analysis, this book will be important to public health policy-makers and practitioners, business and community leaders, health advocates, educators and journalists.
For decades, the manufacturing industry has employed the Toyota Production System the most powerful production method in the world to reduce waste, improve quality, reduce defects and increase worker productivity. In 2001, Virginia Mason Medical Center, an integrated healthcare delivery system in Seattle, Washington set out to achieve its compe
The Institute of Medicine study Crossing the Quality Chasm (2001) recommended that an interdisciplinary summit be held to further reform of health professions education in order to enhance quality and patient safety. Health Professions Education: A Bridge to Quality is the follow up to that summit, held in June 2002, where 150 participants across disciplines and occupations developed ideas about how to integrate a core set of competencies into health professions education. These core competencies include patient-centered care, interdisciplinary teams, evidence-based practice, quality improvement, and informatics. This book recommends a mix of approaches to health education improvement, including those related to oversight processes, the training environment, research, public reporting, and leadership. Educators, administrators, and health professionals can use this book to help achieve an approach to education that better prepares clinicians to meet both the needs of patients and the requirements of a changing health care system.
Ten years after the landmark legislation, Ezekiel Emanuel leads a crowd of experts, policy-makers, doctors, and scholars as they evaluate the Affordable Care Act's history so far. In March 2010, the Affordable Care Act officially became one of the seminal laws determining American health care. From day one, the law was challenged in court, making it to the Supreme Court four separate times. It transformed the way a three-trillion-dollar sector of the economy behaved and brought insurance to millions of people. It spawned the Tea Party, further polarized American politics, and affected the electoral fortunes of both parties. Ten years after the bill's passage, a constellation of experts--insiders and academics for and against the ACA--describe the momentousness of the legislation. Encompassing Democrats and Republicans, along with legal, financial, and health policy experts, the essays here offer a fascinating and revealing insight into the political fight of a generation, its consequences for health care, politics, law, the economy-and the future.
As our nation enters a new era of medical science that offers the real prospect of personalized health care, we will be confronted by an increasingly complex array of health care options and decisions. The Learning Healthcare System considers how health care is structured to develop and to apply evidence-from health profession training and infrastructure development to advances in research methodology, patient engagement, payment schemes, and measurement-and highlights opportunities for the creation of a sustainable learning health care system that gets the right care to people when they need it and then captures the results for improvement. This book will be of primary interest to hospital and insurance industry administrators, health care providers, those who train and educate health workers, researchers, and policymakers. The Learning Healthcare System is the first in a series that will focus on issues important to improving the development and application of evidence in health care decision making. The Roundtable on Evidence-Based Medicine serves as a neutral venue for cooperative work among key stakeholders on several dimensions: to help transform the availability and use of the best evidence for the collaborative health care choices of each patient and provider; to drive the process of discovery as a natural outgrowth of patient care; and, ultimately, to ensure innovation, quality, safety, and value in health care.
A revolution in American medicine is in full swing, with the race from fee-for-service to fee-for-value at the front line in an epic battle that will transform healthcare delivery for decades to come. In America’s Healthcare Transformation, eminent physician leader Robert A. Phillips brings together key thought leaders and trail-blazing practitioners, who provide a wide-ranging exploration of the strategies, innovations, and paradigm shifts that are driving this healthcare transformation. The contributors offer a panoramic look at the dramatic changes happening in the field of medicine, changes that put the patient at the heart of the process. Among other subjects, the essays evaluate innovative high quality and low cost care delivery solutions from around the United States and abroad, describe fundamental approaches to measuring the safety of care and the impact that guidelines have on improving quality of care and outcomes, and make a strong case that insurance reform will fundamentally and irreversibly drive delivery reform. In addition, America’s Healthcare Transformation reviews the role of health information technology in creating safer healthcare, provides a primer on the development of a culture of safety, and highlights ground-breaking new ways to train providers in patient safety and quality. Finally, the book looks at reports from Stanford Health Care and Houston Methodist which outline how successful behaviorally based strategies, anchored in values, can energize and empower employees to deliver a superior patient experience. Drawing on the wisdom and vision of today’s leading healthcare innovators, America’s Healthcare Transformation provides a roadmap to the future of American healthcare. This book is essential reading for all health care providers, health care administrators, and health policy professionals, and it will be an invaluable resource in the effort to improve the practice of medicine and the delivery of healthcare in our communities and nation.
Improving our nation's healthcare system is a challenge which, because of its scale and complexity, requires a creative approach and input from many different fields of expertise. Lessons from engineering have the potential to improve both the efficiency and quality of healthcare delivery. The fundamental notion of a high-performing healthcare system-one that increasingly is more effective, more efficient, safer, and higher quality-is rooted in continuous improvement principles that medicine shares with engineering. As part of its Learning Health System series of workshops, the Institute of Medicine's Roundtable on Value and Science-Driven Health Care and the National Academy of Engineering, hosted a workshop on lessons from systems and operations engineering that could be applied to health care. Building on previous work done in this area the workshop convened leading engineering practitioners, health professionals, and scholars to explore how the field might learn from and apply systems engineering principles in the design of a learning healthcare system. Engineering a Learning Healthcare System: A Look at the Future: Workshop Summary focuses on current major healthcare system challenges and what the field of engineering has to offer in the redesign of the system toward a learning healthcare system.