Customer Reviews


9 Reviews
5 star:
 (5)
4 star:
 (4)
3 star:    (0)
2 star:    (0)
1 star:    (0)
 
 
 
 
 
Average Customer Review
Share your thoughts with other customers
Create your own review
 
 
Most Helpful First | Newest First

35 of 36 people found the following review helpful
4.0 out of 5 stars This book will not get you there, December 9, 2001
By 
George Dawson (St. Paul, MN USA) - See all my reviews
(REAL NAME)   
Verified Purchase(What's this?)
This review is from: Crossing the Quality Chasm: A New Health System for the 21st Century (Hardcover)
This book is written as the product of an Institute of Medicine initiative to reduce the mortality and morbidity from errors in the American healthcare system. The Institute of Medicine is a private organization created by congressional charter to advise the federal government on specific matters. Their mission statement is to "advance and disseminate knowledge to improve human health." This book is the final report of the Committee on the Quality of Health Care in America. Their homepage is available by searching the Internet using the full committee name. Membership of the committee and sponsors of the project are available at that web site.
The format of the book is to present evidence for quality problems in healthcare in America and make recommendations. The operational definition of quality used in the book is "The degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge." There are thirteen recommendations presented initially and are discussed in relevant chapters. The recommendations vary in scope from suggesting that multiple parties need to be committed to quality as a way to decrease the burden of disease to suggestions that specific agencies fund pilot studies to look at how reimbursement can be aligned with quality. Six major parameters are discussed as guiding quality and it is suggested that 15 specific conditions be a focus for improving quality.
There is no difficulty in identifying literature studies that demonstrate quality problems in hospital and clinical populations. A survey of current research is included in Appendix A. A review of the tables in this appendix show the types of quality markers that are typically studied in the literature. The authors make the argument that errors due to quality lapses or deficiencies need to be actively worked on and that the current high error rates are not acceptable. Health care has become a major political issue and the political factions are shaping up to be government and business on one side and physicians and other health care providers on the other. There has been a major revamping of the health care system in the past decade to control costs. That required the active cooperation of the insurance industry and government. There is still medical inflation and limited access with 40 million Americans uninsured. Should we believe that another cooperative effort between industry and government will improve quality any more than it has controlled cost or improved access?
The authors acknowledge weaknesses in their suggestions about changing the face of American medicine, but they minimize the adverse impact of the current funding mechanisms for medical care and the issue of information systems integration and security. A good example can be found in their application of engineering principles to clinical settings - - where teams see patients for four hours of direct contact time and the remaining time is for documentation and returning calls. That plan would not be economically feasible in many settings. The high cost and lack of flexibility of the current reimbursement schemes are not mentioned as a potential reason why these plans won't work.
Information technology is seen as a way to enhance both productivity and safety. The authors suggest that e-mail can lead to productive exchanges between physicians and patients. Many physicians have been doing this for years. Many have also stopped with the advent of security concerns about medical privacy. With larger IT systems the critical issue is backward compatability with older systems. That usually requires custom designs that are extremely expensive. Those problems usually need to be solved before bedside computing and decision support can be developed. Security is acknowledged as a problem that needs to be solved. In spite of a federal initiative in this area, the important precedent to remember is how the financial privacy of Americans was protected. The authors point out that medical privacy requirements need to be more stringent than other industries. At the same time they point out that some opinions suggest that there is a trade off between privacy protections and the need to advance information technology in health care. If they are suggesting that the Internet should be at the heart of this infrastructure and the Internet is not secure, what does that mean?
A practical approach might be to focus on the areas where data is entered into computer systems and make sure that non-human analysis occurs at those levels. For example, all hospitals enter pharmacy orders into computer systems. Many hospitals require that physicians write separate discharge orders. Both of these points are areas where there could be immediate improvements in accuracy. A focused study and solution could be engineered now. The necessary software and hardware requirements could be placed on a central web site and available for download by hospital and clinic IT staff. Existing reviewers could be charged with documenting the baseline level of errors and the degree of improvement.
This book succeeds as a broad survey of what has been done about quality in certain settings. It contains some interesting ideas about what can possibly be accomplished by applying conceptual advances from other fields. It does not discuss the significant drawbacks of evidence based medicine. It lacks a practical plan for transitioning to a new system and in effect creates a new chasm. With a work like this, whether you like the conclusions depends a lot on your interpretation of the evidence and your personal experience. As a practicing physician and a previous quality reviewer I have significant areas of disagreement with what is presented in this book. Areas of controversy are not elaborated upon. I suppose you could say that level of analysis is not required, but recommendations about the future of health care in America should at least meet the criteria of "evidence based" and all the evidence should be discussed.
George Dawson, MD
Help other customers find the most helpful reviews 
Was this review helpful to you? Yes No


5.0 out of 5 stars Understand the US Healthcare System better, especially if you work in it, February 27, 2013
By 
Verified Purchase(What's this?)
This review is from: Crossing the Quality Chasm: A New Health System for the 21st Century (Hardcover)
The IOH, Institute of Health, published two exhaustive reports on healthcare: To Err is Human and Crossing the Quality Chasm. They are dry, academic, ponderous and difficult to read. However they are two of the most important books written about healthcare in the United States and mandatory reading for anyone in the field of medicine. Virtually every other book on improving healthcare quotes or uses the research from these two books.

Healthcare is under a radical transformation based on enormous economic and demand pressures. In order to be successful we have to understand the system, warts and all. We have to have solutions based on empirical peer reviewed data. These IOH reports do just that. While they may seem dated and many of the initiatives advocated by these books are well underway, these books remain 'bibles' of a sort for understanding the US medical system. I strongly recommend reading this books because so much of the current reform, language, and subsequent published literature is based on these two reports.

I recently attended a training by Intermountain Healthcare in UT - the hospital system discussed during the election debates. The CFO quoted from these books. That is just one illustration of how influential and important these books are. Even if you don't work in medicine these books will help you manage and direct your own care. Read also "Overtreated" by Shannon Brownlee, which also uses IOH data and research.

Not easy reads but few important reads are.
Help other customers find the most helpful reviews 
Was this review helpful to you? Yes No


5.0 out of 5 stars A Seriously Dysfunctional System, September 6, 2012
This review is from: Crossing the Quality Chasm: A New Health System for the 21st Century (Hardcover)
Health care harms patients too frequently and routinely fails to deliver its potential benefits. A chasm lies between what we now have and what we could have. The system has fallen far short in its ability to translate knowledge into practice and apply new technology to overcome the limitations of collections of paper records that are often poorly organized, illegible, and not easy to retrieve. There is a dearth of clinical programs with the multidisciplinary infrastructure required to best help people with common chronic conditions. The delivery of care is often overly complex and uncoordinated - wasting resources, leaving unaccountable voids, loss of information. Payments methods are not aligned with encouraging quality of services.

Overuse of services is common - eg. hysterectomy, CABG w/o appropriate reasons, providing antibiotics for viral infections for which they are not effective. Failure to receive care due to lack of insurance is another major concern. Still another is failure to provide recommended care even after a proper diagnosis.

The authors conclude that we should set a minimum goal of reducing errors by 50% over the next five years.
Help other customers find the most helpful reviews 
Was this review helpful to you? Yes No


4.0 out of 5 stars quality, April 29, 2012
Verified Purchase(What's this?)
This review is from: Crossing the Quality Chasm: A New Health System for the 21st Century (Hardcover)
Great reference for anyone interested in quality in our health care system. it is unfortunate that many of the policy makers haven't really read this and digested what the lessons were. It was written a decade ago and we are still struggling with recommendations that were made then. I would recommend this to anyone interested in this topic.
Help other customers find the most helpful reviews 
Was this review helpful to you? Yes No


4.0 out of 5 stars Very informative, January 2, 2013
Verified Purchase(What's this?)
This review is from: Crossing the Quality Chasm: A New Health System for the 21st Century (Hardcover)
The healthcare challenge is one that will take a lot to change. I think the book outlines the issues really well and makes you think about what is required to change the healthcare system. The question now is how do undertake such a massive overhaul?
Help other customers find the most helpful reviews 
Was this review helpful to you? Yes No


4.0 out of 5 stars Needed for school, September 13, 2013
Verified Purchase(What's this?)
This review is from: Crossing the Quality Chasm: A New Health System for the 21st Century (Hardcover)
Bought this book for my husbands schooling. He is a man of few words, so when I asked him how he like the book he said "It served its purpose". Hopefully the other reviews are more informative.
Help other customers find the most helpful reviews 
Was this review helpful to you? Yes No


10 of 16 people found the following review helpful
5.0 out of 5 stars Essential Reading for Everyone in Health Care, December 1, 2001
Verified Purchase(What's this?)
This review is from: Crossing the Quality Chasm: A New Health System for the 21st Century (Hardcover)
If you are in anyway involved in health care, this is essential reading. Physicians, hospital administrators, purchasers, health plan execs, and grad students must immediately put this on the top of their reading list. Lives may depend on it.
In it, the highly respected Institute of Medicine builds a powerful case for how the current health care system is severely broken and how it has produced a "chasm" between what we known must be done for patients (based on current science of medicine) and what is actually done. The information conveyed is shocking but true. Even more importantly, the Institute gives us a plan for building a new, more accountable quality-driven approach to health care.
Read it and perhaps you too will be motivated to take action to improve health care delivery in America.
Help other customers find the most helpful reviews 
Was this review helpful to you? Yes No


5.0 out of 5 stars Excellent : Crossing the Quality Chasm, April 3, 2010
By 
Verified Purchase(What's this?)
This review is from: Crossing the Quality Chasm: A New Health System for the 21st Century (Hardcover)
Excellent reference to learn of the history/movement that prompted the EMR environment we are in today
Help other customers find the most helpful reviews 
Was this review helpful to you? Yes No


0 of 2 people found the following review helpful
5.0 out of 5 stars Defines quality healthcare, September 30, 2008
This review is from: Crossing the Quality Chasm: A New Health System for the 21st Century (Hardcover)
Great book which is still relevant in these changing times. Healthcare is still a long way from delivering quality and this book explains the gaps
Help other customers find the most helpful reviews 
Was this review helpful to you? Yes No


Most Helpful First | Newest First

Details

Crossing the Quality Chasm: A New Health System for the 21st Century
Crossing the Quality Chasm: A New Health System for the 21st Century by Institute of Medicine (Hardcover - July 18, 2001)
$54.95 $36.16
In Stock
Add to cart Add to wishlist
Search these reviews only
Send us feedback How can we make Amazon Customer Reviews better for you? Let us know here.