There was strong consensus among the committee members on the critical need to improve care coordination, support for self-management, and health literacy for all patients and their families. Virtually every conventional medical specialty will need to develop strategies for one or more of these priority areas. To close the gaps between best practice and usual care for the full set of proposed areas will require the collective expertise of a vast array of doctors, nurses, pharmacists, allied health professionals, social workers, and vested laypersons. Improving quality of care for severe and persistent mental illness, such as psychosis, provides an opportunity to focus on the effectiveness of mental health services provided by the public sector (Narrow et al., 2000 Wells, 2002a). Adequate pain control in advanced cancer and stroke rehabilitation require a continuum of care that includes home, community, clinic, and hospital. For example, effective asthma management requires integration of care among primary care providers, pediatricians, schools, hospitals (particularly emergency rooms), and pharmacists. The set of priority areas recommended by the committee involves care that is provided in multiple health care settings and organizations, care that is both privately and publicly funded, and care that is provided by a variety of health care professionals. Thus they encompass a wide variety of health care services, spanning both reactive acute, emergency, and surgical care and the proactive planned care required to prevent and manage chronic disease, pain, and disability.Ĭare provided for a variety of populations representing Americans of all ages and demographic groups, including care that is oriented to individuals and families, as well as populations.Ĭare delivered in a range of publicly and privately financed ambulatory and inpatient health care settings (outpatient and community health centers, home-based care, emergency departments, hospitals, and nursing homes) by a variety of health care practitioners (physicians, nurses, pharmacists, allied health professionals), including both generalists and specialists.ĭiverse Health Care Settings and Professions The full spectrum of health care, from preventive and acute care, to chronic disease management, to long-term and palliative care at the end of life. They represent a range of health care services and challenges, including: The priority areas selected by the committee can be viewed through a variety of lenses. The chapter next profiles each area in detail, including the aim of intervention in that area and the rationale for the area’s selection in light of the three criteria discussed in Chapter 2-impact, improvability and inclusiveness.īreadth of Opportunities Represented by Priority Areas The three types of areas included on the list-cross-cutting areas, specific conditions, and emerging areas-are then described. This chapter first reviews the breadth of opportunities for health care improvement represented by the committee’s recommended list of priority areas. Finally, obesity is included as an “emerging area” that does not at this point satisfy the selection criteria as fully as the other 19 priority areas. The 17 that follow represent the continuum of care across the life span and are relevant to preventive care, inpatient/surgical care, chronic conditions, end-of-life care, and behavioral health, as well as to care for children and adolescents. The first 2 listed above-care coordination and self-management/health literacy-are cross-cutting areas in which improvements would benefit a broad array of patients. The committee made no attempt to rank order the priority areas selected. Stroke-early intervention and rehabilitation Severe and persistent mental illness-focus on treatment in the public sector Pregnancy and childbirth-appropriate prenatal and intrapartum care Nosocomial infections-prevention and surveillance Medication management-preventing medication errors and overuse of antibiotics
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