This volume, developed by the Observatory together with OECD, provides an overall conceptual framework for understanding and applying strategies aimed at improving quality of care. Crucially, it summarizes available evidence on different quality strategies and provides recommendations for their implementation. This book is intended to help policy-makers to understand concepts of quality and to support them to evaluate single strategies and combinations of strategies.

Getting the right diagnosis is a key aspect of health care - it provides an explanation of a patient's health problem and informs subsequent health care decisions. The diagnostic process is a complex, collaborative activity that involves clinical reasoning and information gathering to determine a patient's health problem. According to Improving Diagnosis in Health Care, diagnostic errors-inaccurate or delayed diagnoses-persist throughout all settings of care and continue to harm an unacceptable number of patients. It is likely that most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences. Diagnostic errors may cause harm to patients by preventing or delaying appropriate treatment, providing unnecessary or harmful treatment, or resulting in psychological or financial repercussions. The committee concluded that improving the diagnostic process is not only possible, but also represents a moral, professional, and public health imperative. Improving Diagnosis in Health Care, a continuation of the landmark Institute of Medicine reports To Err Is Human (2000) and Crossing the Quality Chasm (2001), finds that diagnosis-and, in particular, the occurrence of diagnostic errorsâ€"has been largely unappreciated in efforts to improve the quality and safety of health care. Without a dedicated focus on improving diagnosis, diagnostic errors will likely worsen as the delivery of health care and the diagnostic process continue to increase in complexity. Just as the diagnostic process is a collaborative activity, improving diagnosis will require collaboration and a widespread commitment to change among health care professionals, health care organizations, patients and their families, researchers, and policy makers. The recommendations of Improving Diagnosis in Health Care contribute to the growing momentum for change in this crucial area of health care quality and safety.

This report is one of five volumes providing detailed information on the QA Tools, RAND's comprehensive, clinically based system for assessing quality of care for children and adults. The QA Tools indicators encompass screening, diagnosis, treatment, and follow-up in 46 clinical areas and cover a variety of modes of providing care, including history, physical examination, laboratory study, medication, and other interventions and contacts. Development of each indicator was based on the ratings of a panel of experts in the relevant fields and on a focused review of the scientific literature, which is clearly documented for each clinical condition. This volume focuses on indicators for care of general medical conditions. Each chapter summarizes the results of the literature review for a particular condition, provides RAND staff's recommended indicators based on that review, and notes the level of scientific evidence supporting each indicator along with the relevant citations. In addition, this work details the process by which the expert panel evaluated the indicators and the final disposition of each indicator. Clinical conditions covered in this volume are: Acne, alcohol dependence, allergic rhinitis, benign prostatic hyperplasia, cataracts, cholelithiasis, dementia, depression, diabetes mellitus, hormone replacement therapy, headache, hip fracture, hysterectomy, inguinal hernia, acute low back pain, orthopedic conditions. Other RAND Health titles on the QA Tools system focus on indicators for children and adolescents, oncology and HIV, cardiopulmonary conditions, and women.

Each year, more than 33 million Americans receive health care for mental or substance-use conditions, or both. Together, mental and substance-use illnesses are the leading cause of death and disability for women, the highest for men ages 15-44, and the second highest for all men. Effective treatments exist, but services are frequently fragmented and, as with general health care, there are barriers that prevent many from receiving these treatments as designed or at all. The consequences of this are seriousâ€"for these individuals and their families; their employers and the workforce; for the nation's economy; as well as the education, welfare, and justice systems. Improving the Quality of Health Care for Mental and Substance-Use Conditions examines the distinctive characteristics of health care for mental and substance-use conditions, including payment, benefit coverage, and regulatory issues, as well as health care organization and delivery issues. This new volume in the Quality Chasm series puts forth an agenda for improving the quality of this care based on this analysis. Patients and their families, primary health care providers, specialty mental health and substance-use treatment providers, health care organizations, health plans, purchasers of group health care, and all involved in health care for mental and substanceâ€"use conditions will benefit from this guide to achieving better care.

This report is one of a series of volumes describing the QA Tools, a comprehensive, clinically based system for assessing care for children and adults. The quality indicators that comprise these Tools cover 46 clinical areas and all 4 functions of medicine-screening, diagnosis, treatment, and follow-up. The indicators also cover a variety of modes of providing care, including history, physical examination, laboratory study, medication, and other interventions and contacts. Development of each indicator was based on a review of the literature. Each volume documents the literature on which the indicators were based, explains how the clinical areas and indicators were selected, and describes what is included in the overall system. The QA Tools were developed with funding from public and private sponsors-the Health Care Financing Administration, the Agency for Health care Research and Quality, the California Health Care Foundation, and the Robert Wood Johnson Foundation.

The National Roundtable on Health Care Quality was established in 1995 by the Institute of Medicine. The Roundtable consists of experts formally appointed through procedures of the National Research Council (NRC) who represent both public and private-sector perspectives and appropriate areas of substantive expertise (not organizations). From the public sector, heads of appropriate Federal agencies serve. It offers a unique, nonadversarial environment to explore ongoing rapid changes in the medical marketplace and the implications of these changes for the quality of health and health care in this nation. The Roundtable has a liaison panel focused on quality of care in managed care organizations. The Roundtable convenes nationally prominent representatives of the private and public sector (regional, state and federal), academia, patients, and the health media to analyze unfolding issues concerning quality, to hold workshops and commission papers on significant topics, and when appropriate, to produce periodic statements for the nation on quality of care matters. By providing a structured opportunity for regular communication and interaction, the Roundtable fosters candid discussion among individuals who represent various sides of a given issue.