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.

National parks are different from other federal lands in the United States. Beginning in 1872 with the establishment of Yellowstone, they were largely set aside to preserve for future generations the most spectacular and inspirational features of the country, seeking the best representative examples of major ecosystems such as Yosemite, geologic forms such as the Grand Canyon, archaeological sites such as Mesa Verde, and scenes of human events such as Gettysburg. But one type of habitat--the desert--fell short of that goal in American eyes until travel writers and the Automobile Age began to change that perception. As the Park Service began to explore the better-known Mojave and Colorado deserts of southern California during the 1920s for a possible desert park, many agency leaders still carried the same negative image of arid lands shared by many Americans--that they are hostile and largely useless. But one wealthy woman--Minerva Hamilton Hoyt, from Pasadena--came forward, believing in the value of the desert, and convinced President Franklin D. Roosevelt to establish a national monument that would protect the unique and iconic Joshua trees and other desert flora and fauna. Thus was Joshua Tree National Monument officially established in 1936, with the area later expanded in 1994 when it became Joshua Tree National Park. Since 1936, the National Park Service and a growing cadre of environmentalists and recreationalists have fought to block ongoing proposals from miners, ranchers, private landowners, and real estate developers who historically have refused to accept the idea that any desert is suitable for anything other than their consumptive activities. To their dismay, Joshua Tree National Park, even with its often-conflicting land uses, is more popular today than ever, serving more than one million visitors per year who find the desert to be a place worthy of respect and preservation. Distributed for George Thompson Publishing

In 1976, a small group of soldiers at Fort Dix were infected with a swine flu virus that was deemed similar to the virus responsible for the great 1918-19 world-wide flu pandemic. The U.S. government initiated an unprecedented effort to immunize every American against the disease. While a qualified success in terms of numbers reached-more than 40 million Americans received the vaccine-the disease never reappeared. The program was marked by controversy, delay, administrative troubles, legal complications, unforeseen side effects and a progressive loss of credibility for public health authorities. In the waning days of the flu season, the incoming Secretary of what was then the Department of Health, Education and Welfare, Joseph Califano, asked Richard Neustadt and Harvey Fineberg to examine what happened and to extract lessons to help cope with similar situations in the future.