Systems change to improve health and health care: Lessons from Addressing Tobacco in Managed Care

摘要

In 2001 the Institute of Medicine released its landmark report, Crossing the Quality Chasm: A New Health System for the 21st Century, which documented major gaps between evidence-based best practice and usual care for most Americans. The authors concluded that closing these quality gaps would require major health systems change: "The current systems of care cannot do the job. Trying harder will not work. Changing systems of care will." (Institute of Medicine, 2001, p. 4). They went on to recommend that national efforts to develop a new health care system start with improving care for 20 high-priority conditions, which could substantially improve national health outcomes, reduce disparities in health and health care, and generate "lessons learned" for other conditions. In its subsequent report, the Institute of Medicine (2003) selected the treatment of tobacco use and dependence as one of these 20 conditions. The 2003 report cited the significant gap between evidence-based care and usual care for smokers and other tobacco users, the enormous potential benefits for the nation's health and health care burden from closing this gap, and the growing evidence from studies like those supported by The Robert Wood Johnson Foundation's Addressing Tobacco inManaged Care program in concluding that replicable systems changes could indeed close the gap.