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Karen Adams, Ann C. Greiner, and Janet M. Corrigan, Editors, Committee on the Crossing the Quality ... - page 9 / 29





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1st Annual Crossing the Quality Chasm Summit: A Focus on Communities http://books.nap.edu/catalog/11085.html


promulgating national data standards (IOM, 2002a). Additionally, participants characterized health data as a public good and suggested creating a public utility that would store these data, making them accessible at the community level.

Box ES-5. Care Coordination: Key Strategies

  • Aligning financial incentives

  • Providing educational supports, including multidisciplinary health professions education, teaching of care coordination principles in academic settings, and development of care teams

  • Instituting patient-centered health records, supported by information and communications technology

  • Ensuring accountability and defining roles for care

Care Coordination

To address the problem of care coordination not being routinely reimbursed under most payment schemes today, participants emphasized the need for a shared vision around an operational construct—consistent with the evidence base— defining what good care coordination would be. Once operationalized, care coordination could then be measured, with the goal of quickly disseminating successful reimbursement models.

Effective management of chronic conditions requires the delivery of many services, hand- offs to other specialists, and aggressive follow- up. To address these challenges, participants suggested a two-pronged approach: (1) empowering patients and families to play a central role in the diffusion and exchange of their health information, and (2) formulating clearly defined roles for health care practitioners

and holding each team member accountable for ensuring that a patient’s care is properly managed. Participants emphasized that practicing clinicians, managers, educational leaders, and current students will need preparation and guidance on care coordination principles, such as working in interdisciplinary teams, in both the didactic and clinical components of their initial and ongoing professional training.

Box ES-6. Patient Self-Management Support: Key Strategies

  • Identifying and disseminating evidence-based self- management practices

  • Recognizing the centrality of self-management to good patient care and incorporating it into health care culture

  • Developing programs and tools applicable to diverse populations

  • Providing incentives for the appropriate use of self- management supports integrated into the delivery of health care

  • Making better use of all members of the health care team

Patient Self-Management Support

Despite the strong evidence base for many self- management practices, it is often difficult for practitioners to assess best practices or to distinguish between those that are grounded in evidence and those that are not (Bodenheimer et al., 2002; Lorig et al., 1999, 2001). Participants suggested consolidating this information and disseminating it to providers, patients, and their families through a centralized clearinghouse. Additionally, they favored aggressive expansion of the existing evidence base—both learning


Copyright © 2004 National Academy of Sciences. All rights reserved. This executive summary plus thousands more available at http://www.nap.edu

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