Second in a series of publications from the Institute of Medicine's Quality of Health Care in America project Today's health care providers have more research findings and more technology available to them than ever before. Yet recent reports have raised serious doubts about the quality of health care in America. Crossing the Quality Chasm makes an urgent call for fundamental change to close the quality gap. This book recommends a sweeping redesign of the American health care system and provides overarching principles for specific direction for policymakers, health care leaders, clinicians, regulators, purchasers, and others. In this comprehensive volume the committee offers: A set of performance expectations for the 21st century health care system. A set of 10 new rules to guide patient-clinician relationships. A suggested organizing framework to better align the incentives inherent in payment and accountability with improvements in quality. Key steps to promote evidence-based practice and strengthen clinical information systems. Analyzing health care organizations as complex systems, Crossing the Quality Chasm also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change.

Social justice is a matter of life and death. It affects the way people live, their consequent chance of illness, and their risk of premature death. We watch in wonder as life expectancy and good health continue to increase in parts of the world and in alarm as they fail to improve in others.

Black and Hispanic students are not learning enough in our public schools, and their typically poor performance is the most important source of ongoing racial inequality in America today—thus, say Abigail and Stephan Thernstrom, the racial gap in school achievement is the nation's most critical civil rights issue and an educational crisis; it's no wonder that "No Child Left Behind," the 2001 revision of the Elementary and Secondary Education Act, made closing the racial gap in education its central goal. An employer hiring the typical Black high school graduate or the college that admits the average Black student is choosing a youngster who has only an eighth-grade education. In most subjects, the majority of twelfth-grade Black students do not have even a "partial mastery" of the skills and knowledge that the authoritative National Assessment of Educational Progress calls "fundamental for proficient work" at their grade. No Excuses marshals facts to examine the depth of the problem, the inadequacy of conventional explanations, and the limited impact of Title I, Head Start, and other familiar reforms. Its message, however, is one of hope: Scattered across the country are excellent schools getting terrific results with high-needs kids. These rare schools share a distinctive vision of what great schooling looks like and are free of many of the constraints that compromise education in traditional public schools. In a society that espouses equal opportunity we still have a racially identifiable group of educational have-nots—young African Americans and Latinos whose opportunities in life will almost inevitably be limited by their inadequate education. When students leave high school without high school skills, their futures—and that of the nation—are in jeopardy. With successful schools already showing the way, no decent society can continue to turn a blind eye to such racial and ethnic inequality.

This powerful call to arms offers a realistic vision for getting locally produced, healthy food onto everyone’s table, “[blending] a passion for sustainable living with compassion for the poor” (Dr. Jane Goodall) In Closing the Food Gap, food activist and journalist Mark Winne poses questions too often overlooked in our current conversations around food: What about those people who are not financially able to make conscientious choices about where and how to get food? And in a time of rising rates of both diabetes and obesity, what can we do to make healthier foods available for everyone? To address these questions, Winne tells the story of how America’s food gap has widened since the 1960s, when domestic poverty was “rediscovered,” and how communities have responded with a slew of strategies and methods to narrow the gap, including community gardens, food banks, and farmers’ markets. The story, however, is not only about hunger in the land of plenty and the organized efforts to reduce it; it is also about doing that work against a backdrop of ever-growing American food affluence and gastronomical expectations. With the popularity of Whole Foods and increasingly common community-supported agriculture (CSA), wherein subscribers pay a farm so they can have fresh produce regularly, the demand for fresh food is rising in one population as fast as rates of obesity and diabetes are rising in another. Over the last three decades, Winne has found a way to connect impoverished communities experiencing these health problems with the benefits of CSAs and farmers’ markets; in Closing the Food Gap, he explains how he came to his conclusions. With tragically comic stories from his many years running a model food organization, the Hartford Food System in Connecticut, alongside fascinating profiles of activists and organizations in communities across the country, Winne addresses head-on the struggles to improve food access for all of us, regardless of income level.

'Punchily written ... He leaves the reader with a sense of the gross injustice of a world where health outcomes are so unevenly distributed' Times Literary Supplement 'Splendid and necessary' Henry Marsh, author of Do No Harm, New Statesman There are dramatic differences in health between countries and within countries. But this is not a simple matter of rich and poor. A poor man in Glasgow is rich compared to the average Indian, but the Glaswegian's life expectancy is 8 years shorter. The Indian is dying of infectious disease linked to his poverty; the Glaswegian of violent death, suicide, heart disease linked to a rich country's version of disadvantage. In all countries, people at relative social disadvantage suffer health disadvantage, dramatically so. Within countries, the higher the social status of individuals the better is their health. These health inequalities defy usual explanations. Conventional approaches to improving health have emphasised access to technical solutions – improved medical care, sanitation, and control of disease vectors; or behaviours – smoking, drinking – obesity, linked to diabetes, heart disease and cancer. These approaches only go so far. Creating the conditions for people to lead flourishing lives, and thus empowering individuals and communities, is key to reduction of health inequalities. In addition to the scale of material success, your position in the social hierarchy also directly affects your health, the higher you are on the social scale, the longer you will live and the better your health will be. As people change rank, so their health risk changes. What makes these health inequalities unjust is that evidence from round the world shows we know what to do to make them smaller. This new evidence is compelling. It has the potential to change radically the way we think about health, and indeed society.

This review was organized to bring a systematic assessment of different quality improvement strategies & their effects to the process of identifying & managing hypertension. Findings suggest that quality improvement strategies appear, in general, to be associated with the improved identification & control of hypertension. It is not possible to discern with complete confidence which specific quality improvement strategies have the greatest effects, since most of the studies included more than one quality improvement strategy. Illustrations.