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.

For 100 years, the Congressional Research Service (CRS) has been charged with providing nonpartisan and authoritative research and analysis to inform the legislative debate in Congress. This has involved a wide range of services, such as written reports on issues and the legislative process, consultations with Members and their staff, seminars on policy and procedural matters, and congressional testimony. The Government and Finance Division at CRS took a step back from its intensive day-to-day service to Congress to analyze important trends in the evolution of the institution-its organization and policymaking process-over the last many decades. Changes in the political landscape, technology, and representational norms have required Congress to evolve as the Nation's most democratic national institution of governance. The essays in this print demonstrate that Congress has been a flexible institution that has changed markedly in recent years in response to the social and political environment.