THE URGENT NEED TO IMPROVE HEALTH-CARE QUALITY - INSTITUTE-OF-MEDICINE NATIONAL ROUND-TABLE ON HEALTH-CARE QUALITY

Objective.-To identify issues related to the quality of health care in the United States, including its measurement, assessment, and improve ment, requiring action by health care professionals or other constitue ncies in the public or private sectors. Participants.-The National Rou ndtable on Health Care Quality, convened by the Institute of Medicine, a component of the National Academy of Sciences, comprised 20 represe ntatives of the private and public sectors, practicing medicine and nu rsing, representing academia, business, consumer advocacy, and the hea lth media, and including the heads of federal health programs. The rou ndtable met 6 times between February 1996 and January 1998. It explore d ongoing, rapid changes in health care and the implications of these changes for the quality of health and health care in the United States . Evidence.-Roundtable members held discussions with a wide variety of experts, convened conferences, commissioned papers, and drew on their individual professional experience. Consensus Process.-At the end of its deliberations, roundtable members reached consensus on the conclus ions described in this article by a series of discussions at committee meetings and reviews of successive draft documents, the first of whic h was created by the listed authors and the Institute of Medicine proj ect director. The drafts were revised following these discussions, and the final document was approved according to the formal report review procedures of the National Research Council of the National Academy o f Sciences. Conclusions.-The quality of health care can be precisely d efined and measured with a degree of scientific accuracy comparable wi th that of most measures used in clinical medicine. Serious and widesp read quality problems exist throughout American medicine. These proble ms, which may be classified as underuse, overuse, or misuse, occur in small and large communities alike, in all parts of the country, and wi th approximately equal frequency in managed care and fee-for-service s ystems of care. Very large numbers of Americans are harmed as a direct result. Quality of care is the problem, not managed care. Current eff orts to improve will not succeed unless we undertake a major, systemat ic effort to overhaul how we deliver health care services, educate and train clinicians, and assess and improve quality.