Crossing the Field's Quality Chasm: The Institute of Medicine Offers Recommendations on What Needs to Be Done to Improve Service Delivery

Article excerpt

The Institute of Medicine (IOM) released an important report on behavioral healthcare on November 1,2005, titled Improving the Quality of Health Care for Mental and Substance-Use Conditions. Yet as the report's title reflects, the committee that drafted the report abandoned the term "behavioral healthcare." The committee decided to use the acronym "M/SU" to refer to "mental and substance use" throughout the report. Whether or not M/SU becomes the commonly accepted designation, many will welcome the suggested elimination of a term that consumers rarely understand.

The M/SU report is essentially a long overdue follow-up to the IOM's 2001 report titled Crossing the Quality Chasm: A New Health System for the 21st Century. The 2001 report establishes a strategy for improving healthcare overall, but it does not specifically address the unique issues related to the care of M/SU conditions. The new report essentially starts with the framework for quality improvement established by the 2001 report and then develops an adaptation for mental health and addictive disorders.

The IOM has established a rigorous process for developing its reports, and it starts with the selection of a committee, with members chosen for their diverse perspectives and technical expertise. Mary Jane England, MD, president of Regis College (Weston, Massachusetts), served as chair of the 22-member M/SU committee; Dr. England is a child psychiatrist and former president of the Washington Business Group on Health, bringing expertise as both a physician and healthcare policy leader. The committee heard testimony from various stakeholders in the care of M/SU conditions, and a draft report was produced by IOM staff.

The draft report was reviewed by 11 other individuals who were likewise selected for their diverse perspectives and technical expertise. I was fortunate enough to be selected as one of these reviewers. The reviewers are asked to provide candid and critical comments, which are sent confidentially to the IOM for deliberation. The goal is for the final report to meet the IOM's standards for objectivity, evidence, and responsiveness to the study charge.

The 2001 report identifies six aims of high-quality healthcare: It should be safe, effective, patient-centered, timely, efficient, and equitable. These aims were found to be equally relevant for M/SU care, and the M/SU report articulates the many ways in which we are falling short of these aims today. The 2001 report also identifies ten rules to guide the redesign of healthcare, and the M/SU committee determined that these rules can provide the guidance needed for redesigning M/SU care, as well.

The M/SU report succinctly states the many differences between M/SU healthcare and general healthcare:

  Despite the quality problems shared with health care generally, M/SU
  health care is distinctive in significant ways. Those distinctive
  features include the greater stigma attached to M/SU diagnoses; more
  frequent coercion of patients into treatment, especially for
  substance-use problems and conditions; a less developed infrastructure
  for measuring and improving the quality of care; a need for a greater
  number of linkages between multiple clinicians, organizations, and
  systems providing care to patients with M/SU conditions; less
  widespread use of information technology; a more educationally diverse
  workforce; and a differently structured marketplace for the purchase
  of M/SU health care.

The M/SU report does an excellent job of describing the many problems with M/SU care but, more importantly, it provides a number of detailed recommendations for how to rectify those problems. …