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The Medical Professionalism Blog

The Institute of Medicine’s Report – Best Care at Lower Cost: Changing the Paradigm and Creating a New Vision for Choosing Wisely® in U.S. Health Care

On September 6, 2012, the Institute of Medicine (IOM) released a long-awaited report: Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. Recognizing that our health care system does not deliver the quality of care we would expect based on the tremendous financial resources allocated to it, the report focused on ways to achieve higher-quality care while reducing cost. The report identified four areas where there are opportunities to create a continuously learning health system and improve care:

  • science and informatics;
  • patient-clinician relationships;
  • incentives; and,
  • culture.

What resonated with me most was not just the recognition that better care can be achieved while reducing cost, but that there is a real paradigm shift in the language used and emphasis placed on leadership, collaboration and culture. Leadership, collaboration and culture are centerpieces of the Choosing Wisely campaign.

The IOM report challenges our current approach to health care and forces us to think differently about how we talk about care. Even in choosing the title of the report, the authors were deliberate in the language they used and tell us that the title of the report:

“underscores that care that is based on the best available evidence, takes appropriate account of individual preferences, and is delivered reliably and efficiently–best care–is possible today and is generally less expensive than the less effective, less efficient care that is now too commonly provided.”

It is hard to imagine a thoughtful conversation on “less expensive care” 10 years ago – it was the third rail of health care discourse. Being able to talk about care that is less expensive as possibly the best care is a real paradigm shift. For too long, we have held the belief that more expensive care equated to better quality and outcomes.

The Archives of Internal Medicine series “Less is More” has been an important driver of the shifting conversation. The series, overseen by Rita Redberg, a cardiologist, researcher and editor at Archives, focuses on articles and research demonstrating that overuse is not good medicine—that it is not only wasteful and disrespectful to patients—but in some situations can be harmful. When resources are utilized beyond published clinical evidence and guidelines prescribed by specialty societies, the results are not quality medicine.

In focusing on quality improvement opportunities, the IOM report showcases the leadership and collaboration of specialty societies and patient and consumer groups in launching the Choosing Wisely campaign. The report also does an excellent job highlighting the importance of a leadership-instilled culture of learning, something that we are trying to achieve through the campaign.

As Choosing Wisely progresses, it will grow to be not just about the leaders, but how the leaders speak about and create awareness of their recommendations and the importance of the reduction of waste. Publications like the IOM report provide fortitude for the leaders to lead, as well as providing practicing physicians with the evidence needed to do what is in the best interest of their patients.

Will the new IOM report generate the media and public interest seen when Crossing the Quality Chasm was published? That has yet to be seen, but I am confident it will get the attention of the health care community and be a wonderful prescription for the long-term recovery of the health care system – step by steady step.

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