The US health care system has serious quality problems. The Institute of Medicine (IOM) has characterized them as underuse (individuals fail to receive services that save lives or prevent disability), misuse (individuals are injured when avoidable complications of health care are not prevented), and overuse (individuals are exposed to the risks of health services from which they cannot benefit). Studies have also noted large geographic variation in the quality of care. For example, hospital discharge rates vary across regions, as does adherence to recommended screenings for people with diabetes. Low-quality care is costly: It leads to sicker patients, more disabilities, and higher spending, and it lowers consumer confidence in the health care industry.
In its report Crossing the Quality Chasm: A New Health System for the 21st Century, the IOM found that the current health care delivery system is poorly organized to address these challenges: “The delivery of care often is overly complex and uncoordinated, requiring steps and patient ‘handoffs’ that slow down care and decrease rather than improve safety. These cumbersome processes waste resources; leave unaccountable voids in coverage; lead to loss of information; and fail to build on the strengths of all health professionals involved to ensure that care is appropriate, timely, and safe.”
The report made recommendations for improving the quality of care and fostering innovation within the health care system. It recommended a national vision built upon six aims for improved health care: It should be safe, effective, patient-centered, timely, efficient, and equitable. These elements were subsequently incorporated into the National Quality Strategy’s (NQS) six priorities (outlined in the section below).