NQF
THE NATIONAL QUALITY FORUM
The Linkages between Clinical Care and Public Health
Helen Burstin, MD, MPH Senior Vice President, Performance Measures National Quality Forum Policy Roundtable Academy Health 2007
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Growing Sense of Awareness & Urgency
Over 100 million Americans now live with one or more chronic illnesses 55% overall adherence to recommended care On average:
One medication error per day per hospital patient Every 7th admission unnecessary
Every 5th lab test unnecessary
2
New Ecology of Medical Care
1000 people
800 have symptoms
327 consider seeking medical care 217 visit a physician’s office 113 visit primary care physician’s office 65 visit CAM provider
21 visit a hospital OPD 14 receive home health 13 visit an ED 8 in a hospital <1 in an academic health center
NEJM 2000, Green et al
3
Health Care System: Where is the overlap?
Clinical Care
Public Health
4
Public Health & Clinical Care: Learning from Crisis
What have we learned about the clinical care and public health interface after Katrina?
5
Linking Disparities and Quality
Inequitable: Uninsurance, Poverty, Language, Culture, Bias Ineffective, Unsafe, Untimely, Not Patient Centered, Inefficient
Actual Care for the Disadvantaged
Actual Care for the Advantaged
Actual Care
High Quality Care
Disparities Chasm
+
Quality Chasm
=
Actual Care for the Disadvantaged
Quality Improvement for the Disadvantaged
Ineffective, Unsafe, Untimely, Not Patient Centered, Inefficient, Inequitable
High Quality Care
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Clinical Care & Public Health: Health IT
How can we increase linkages between EHRs and public health systems Would this help to enhance the clinical-public health interface? How could interconnected health IT systems allow for tracking of quality by populations?
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The Patient at the Center of Care
Courtesy of Paul Wallace, Kaiser
8
Panelists
Ron Davis, MD, Director, Center for Health Promotion and Disease Prevention, Henry Ford Health System, President-Elect of the AMA Paul Jarris, MD, Executive Director, Association of State and Territorial Health Officials
9