The U.S. health care system has serious quality problems. The National Academy of Medicine (formerly the Institute of Medicine) 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). Research has also noted large geographic variations 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— in both financial and human terms —and it lowers consumer confidence in the health care industry.
The Academy has reported that: “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 Academy has recommended a national vision for improving the quality of care and fostering innovation within the health care system built upon six quality domains. Health care should be safe, effective, patient-centered, timely, efficient, and equitable. These elements were subsequently incorporated into the National Quality Strategy’s (NQS) six priorities.