Crossing the Quality Chasm


Book Description

Second in a series of publications from the Institute of Medicine's Quality of Health Care in America project Today's health care providers have more research findings and more technology available to them than ever before. Yet recent reports have raised serious doubts about the quality of health care in America. Crossing the Quality Chasm makes an urgent call for fundamental change to close the quality gap. This book recommends a sweeping redesign of the American health care system and provides overarching principles for specific direction for policymakers, health care leaders, clinicians, regulators, purchasers, and others. In this comprehensive volume the committee offers: A set of performance expectations for the 21st century health care system. A set of 10 new rules to guide patient-clinician relationships. A suggested organizing framework to better align the incentives inherent in payment and accountability with improvements in quality. Key steps to promote evidence-based practice and strengthen clinical information systems. Analyzing health care organizations as complex systems, Crossing the Quality Chasm also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change.




The Country Doctor Revisited


Book Description

An anthology that addresses the changing nature of rural medicine in the United States "These authors courageously document the emotional and literally physical vulnerabilities they experience while delivering care in rural communities. ... This book exquisitely illustrates the complexity of 'dual relationships' and boundary issues in rural practice."--Family Medicine Over the past thirty years, rural health care in the United States has changed dramatically. The stereotypical white-haired doctor with his black bag of instruments and his predominantly white, small-town clientele has imploded: the global age has reached rural America. Independently owned clinics have given way to a massive system of hospitals; new technology now brings specialists right to the patient's bedside; and an increasingly diverse clientele has sparked the need for doctors and nurses with an equally diverse assortment of skills. The Country Doctor Revisited is a fascinating collection of essays, poems, and short stories written by rural health care professionals on the experiences of doctors and nurses practicing medicine in rural environments, such as farms, reservations, and migrant camps. The pieces explore the benefits and burdens of new technology, the dilemmas in making ethically sound decisions, and the trials of caring for patients in a broken system. Alternately compelling, thought provoking, and moving, they speak of the diversity of rural health care providers, the range of patients served in rural communities, the variety of settings that comprise the rural United States, and the resources and challenges health care providers and patients face today.




The Future of the Public's Health in the 21st Century


Book Description

The anthrax incidents following the 9/11 terrorist attacks put the spotlight on the nation's public health agencies, placing it under an unprecedented scrutiny that added new dimensions to the complex issues considered in this report. The Future of the Public's Health in the 21st Century reaffirms the vision of Healthy People 2010, and outlines a systems approach to assuring the nation's health in practice, research, and policy. This approach focuses on joining the unique resources and perspectives of diverse sectors and entities and challenges these groups to work in a concerted, strategic way to promote and protect the public's health. Focusing on diverse partnerships as the framework for public health, the book discusses: The need for a shift from an individual to a population-based approach in practice, research, policy, and community engagement. The status of the governmental public health infrastructure and what needs to be improved, including its interface with the health care delivery system. The roles nongovernment actors, such as academia, business, local communities and the media can play in creating a healthy nation. Providing an accessible analysis, this book will be important to public health policy-makers and practitioners, business and community leaders, health advocates, educators and journalists.




FDA in the Twenty-First Century


Book Description

In its decades-long effort to assure the safety, efficacy, and security of medicines and other products, the Food and Drug Administration has struggled with issues of funding, proper associations with industry, and the balance between consumer choice and consumer protection. Today, these challenges are compounded by the pressures of globalization, the introduction of novel technologies, and fast-evolving threats to public health. With essays by leading scholars and government and private-industry experts, FDA in the Twenty-First Century addresses perennial and new problems and the improvements the agency can make to better serve the public good. The collection features essays on effective regulation in an era of globalization, consumer empowerment, and comparative effectiveness, as well as questions of data transparency, conflicts of interest, industry responsibility, and innovation policy, all with an emphasis on pharmaceuticals. The book also intervenes in the debate over off-label drug marketing and the proper role of the FDA before and after a drug goes on the market. Dealing honestly and thoroughly with the FDA's successes and failures, these essays rethink the structure, function, and future of the agency and the effect policy innovations may have on regulatory institutions abroad.




Medical Wisdom and Doctoring


Book Description

Medical Wisdom and Doctoring aims to fill a need in the current medical literature for a resource that presents some of the classic wisdom of medicine, presented in a manner that can help today's physicians achieve their full potential. This book details the lessons every physician should have learned in medical school but often didn't, as well as classic insights and examples from current clinical literature, medical history, and anecdotes from the author's long and distinguished career in medicine. Medical Wisdom and Doctoring: the Art of 21st Century Practice presents lessons a physician may otherwise need to learn from experience or error, and is sure to become a must-have for medical students, residents and young practitioners.




Practice Under Pressure


Book Description

Through ninety-five in-depth interviews with primary care physicians (PCPs) working in different settings, as well as medical students and residents, Practice Under Pressure provides rich insight into the everyday lives of generalist physicians in the early twenty-first centuryùtheir work, stresses, hopes, expectations, and values. Timothy Hoff supports this dialogue with secondary data, statistics, and in-depth comparisons that capture the changing face of primary care medicineùlarger numbers of younger, female, and foreign-born physicians.




Computational Technology for Effective Health Care


Book Description

Despite a strong commitment to delivering quality health care, persistent problems involving medical errors and ineffective treatment continue to plague the industry. Many of these problems are the consequence of poor information and technology (IT) capabilities, and most importantly, the lack cognitive IT support. Clinicians spend a great deal of time sifting through large amounts of raw data, when, ideally, IT systems would place raw data into context with current medical knowledge to provide clinicians with computer models that depict the health status of the patient. Computational Technology for Effective Health Care advocates re-balancing the portfolio of investments in health care IT to place a greater emphasis on providing cognitive support for health care providers, patients, and family caregivers; observing proven principles for success in designing and implementing IT; and accelerating research related to health care in the computer and social sciences and in health/biomedical informatics. Health care professionals, patient safety advocates, as well as IT specialists and engineers, will find this book a useful tool in preparation for crossing the health care IT chasm.




Wrongs and Remedies in the Twenty-first Century


Book Description

When potential litigants first approach a lawyer they are generally interested in finding out one thing only: are they likely to be able to win damages or any other kind of remedy and what kind of quantum of damages are they likely to receive? It becomes the lawyer's main task to try to argue for a remedy and to persuade the court that the plaintiff has a good cause of action. Textbooks about contract and tort frequently treat damages and other remedies as an after-thought when in fact it is the issue of remedies which is a constant and ever-present consideration for the plaintiff and his or her lawyer. This new book, containing contributions from many of the UK's leading specialists, brings to the fore a range of issues which are of topical interest to litigators and to teachers of law. In some instances the issues are currently the subject of reform proposals and these essays usefully highlight the principal issues facing the reformers and the objections which have been raised by those opposed to reform. In addition four of the essays tackle a strand of tort law which is of rapidly growing importance - the area of professional negligence. The contributors are among the best-known writers in this field and their essays combine practical and academic perspectives which usefully highlight contemporary trends in professional negligence litigation. The first chapter in the book also offers a unique and controversial overview of tort law in the UK by Professor Patrick Atiyah, who argues for a complete rethink of the system of personal injuries litigation in the UK, starting with its abolition. Not for the first time, Professor Atiyah thinks the unthinkable.




Medicine: Idolatry in the Twenty First Century


Book Description

A honest look at our present day medical system and its relationship to idolatrous religious practices throughout history involving such activities as child sacrifices. Is modern-day medicine the new religion?




The Johns Hopkins University School of Medicine Curriculum for the Twenty-first Century


Book Description

"Our basic philosophy of medical education must be directed not toward creating a neurosurgeon, a family practitioner, a cardiologist, or a general pediatrician but toward creating an undifferentiated 'stem cell' physician who is so well prepared that he or she is fully capable of taking any career path after medical school. Every indication is that our goal is being met. The new curriculum is preparing students for the demands and responsibilities of a new era of medicine, science, and medical arts." -- from the Foreword, by Michael M. E. Johns, M.D. The curriculum taught in many U.S. medical schools today has been altered little since 1910. Now, spurred in part by the recent sweeping changes in health care delivery, medical schools are re-evaluating their curricula. The goal is to develop a program of medical education that not only reflects the latest scientific advances but also prepares physicians in the fields and specialties society now needs. This book provides an extensive description of the process and outcome of developing a completely new curriculum at the Johns Hopkins University School of Medicine. The book is organized around the subjects and courses taught: basic sciences, physician and society, medical informatics, and clinical medicine. Chapters also consider evaluation and reform of the curriculum. The contributors, Johns Hopkins faculty members who participated in developing the components of the curriculum, discuss differences between the old and new courses and programs, reasons for the changes, and the process used to plan and implement them. Throughout, the material is presented in a way that permits easy generalization and adaptation to other medical schools. Contributors: Catherine D. De Angelis, M.D. Diane M. Becker, Sc.D. Gert H. Brieger, M.D., Ph.D. Leon Gordis, M.D. H. Franklin Herlong, M.D. K. Joseph Hurt Michael M. E. Johns, M.D. Langford Kidd, M.D., F.R.C.P. Michael J. Klag, M.D. Harold P. Lehmann, M.D., Ph.D. Nancy Ryan Lowitt, M.D., Ed.M. Lucy A. Mead, Sc.M. Thomas D. Pollard, M.D. Henry M. Seidel, M.D. John H. Shatzer Jr., Ph.D. Patricia A. Thomas, M.D., F.A.C.P. Victor Velculescu Charles M. Wiener, M.D.