The second report from an Institute of Medicine committee calls for a top-to-bottom overhaul of the nation's healthcare system and a broad embrace of technology, not only to reduce medical errors and improve quality but also to keep up with the speed of scientific change.
The report by the Committee on Health Care Quality in America also asked Congress to set up and appropriate $1 billion for a healthcare quality improvement fund to jump start the national deployment in the next three to five years of effective quality improvement tools and programs.
The committee delivered its final report, "Crossing the Quality Chasm: A New Healthcare System for the 21st Century," on March 1.
"I want to make sure the message to the medical community is very clear," said IOM committee member Donald Berwick, M.D., at a press conference. "We are saying that the care is not satisfactory. We are saying that the care the American population gets is not the care they should get.
"We are saying that major improvements are needed. They're urgent. They're important. We are saying they are achievable."
Berwick is president and CEO of the Boston-based not-for-profit Institute for Healthcare Improvement.
"Quality problems are everywhere, affecting many patients. Between the healthcare we have and the care we could have lies not just a gap, but a chasm, " the report states.
"Crossing the Quality Chasm" is the broader sequel to "To Err Is Human," the highly publicized report by the same committee released in late 1999. That report focused on reducing medical errors that its authors estimate claim the lives of up to 98,000 patients each year.
The 335-page report cites the "extreme variability" in implementation of science-backed best practices as one of a number of key contributors to inferior patient care.
Referencing an article by E. Andrew Balas, M.D., and Suzanne Boren published in the 2000 edition
of the Yearbook of Medical Informatics, the report says it takes 17 years on average "for new knowledge generated by randomized controlled trials to be incorporated into practice."
IOM quality committee chairman William Richardson, president and CEO of the Kellogg Foundation of Battle Creek, Mich., says the medical profession needs to recognize "the key to success over the long term is deploying technology to be able to effectively access new information as it comes along."
During the 1970s, Richardson says, medical literature reported results from an average of 500 randomized clinical trials per year.
"In the 1990s, the average number of randomized clinical trials that occurred was 10,000," he says. "The complex systems that we're working with today require more than any professional can carry around in his or her head."
Given this existing inability of the healthcare industry to keep up with science, the report says "we may conclude that it is even less prepared to respond to the extraordinary scientific advances that will surely emerge during the first half of the 21st century."
Berwick says no amount of tweaking on the margins of the current health care system would suffice.
"It's not a matter of the effort or the will or the skill or the dedication of the American clinical community," he says. "They're wonderful. If the doctors and nurses weren't trying as hard as they are, we'd be in a lot worse shape.
"What we are saying is they need help," he says. "The American physician and nurse cannot now alone without redesigning the system give the care they want. The game is over. It's time for a new system in which they can do their work better. This is not about blame, it's about change."