JAMA Features Reflections on "Crossing the Quality Chasm" 20 Years Later
This issue of JAMA includes two articles that reflect on the recommendations of the Institute of Medicine’s 2001 Crossing the Quality Chasm report that, 20 years ago, asked healthcare stakeholders to collaborate in order to provide care that is safe, effective, patient-centered, timely, efficient, and equitable. Both articles discuss how to make more progress toward these goals, while a third article from an HSR&D researcher is about the importance of patient safety in ambulatory care.
Authored by Janet Corrigan, PhD and Carolyn Clancy, MD, “Assessing Progress in Health Care Quality through the Lens of COVID-19” talks about the enormous stress test the U.S. healthcare system is undergoing due to the pandemic, and how it has exposed vulnerabilities that should lead the way to a stronger system. For example, COVID-19 has further highlighted the enormous untapped potential of information technology. The pandemic also shined a light on the need for a closer collaboration between the healthcare and public health sectors. The authors suggest that the U.S. would benefit from an agreement among federal and state governments and healthcare delivery systems on emergency preparedness planning and implementation.
Authored by Hardeep Singh, MD, MPH and Pascale Carayon, PhD, “A Roadmap to Advance Patient Safety in Ambulatory Care” discusses the importance of addressing patient safety in the outpatient setting. Although errors in ambulatory settings are less likely to lead to immediate harm than errors in acute/inpatient care, their consequences still may be significant. Medication errors, diagnostic errors, and communication and coordination breakdowns are the most common causes of preventable harm among outpatients. Initiatives to reduce these errors should target scientific advances, practice improvements, digital health, policy changes, and strategies to partner with patients and families that might reduce patient harm in the ambulatory setting.
Authored by Sheila Leatherman, MSW and Don Berwick, MD, MPP, “Accelerating Global Improvements in Health Care Quality” talks about the critical importance of access to effective and safe health services around the globe, referring to the “To Err is Human” and “Crossing the Quality Chasm” reports, both by the IOM (now the National Academy of Medicine), which pointed out the need for redesigning health systems and services. The authors also suggest next steps needed to accelerate progress in the U.S. and around the globe, including achieving substantial improvements in global healthcare quality and forming a consortium of multi-lateral organizations (public and private) to assist national, regional, and organizational healthcare leadership in meeting improvement goals.
Dr. Clancy is VA’s Assistant Under Secretary for Discovery, Education and Affiliate Networks (DEAN), Washington, DC. Dr. Singh is part of HSR&D’s Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Houston, TX. Dr. Berwick is part of the Institute for Healthcare Improvement (IHI), Boston, MA.
JAMA. December 22/29, 2020;324(24):2467-2566.