Answering the Call

The most careful analysis of the performance of American medicine comes to an unhappy conclusion: chronic illness is not effectively managed, and new technology is not effectively integrated into practice. The recent report, "Crossing the Quality Chasm," from the prestigious Institute of Medicine of the National Academy of Sciences, finds that "substantial investments have been made in clinical research and development over the last 30 years, resulting in an enormous increase in the medical knowledge base and the availability of many more drugs and devices. Unfortunately, Americans are not reaping the full benefit of these investments. The lag between the discovery of more efficacious forms of treatment and their incorporation into routine patient care is unnecessarily long, in the range of about 15 to 20 years. Even then, adherence of clinical practice to the evidence is highly uneven."

Indeed, the opening paragraph of this report is quite striking. "The American health system is in need of fundamental change. Many patients, doctors, nurses, and health care leaders are concerned that the care delivered is not, essentially, the care we should receive. The frustration levels of both patients and clinicians have probably never been higher. Yet the problems remain. Health care today harms too frequently and routinely fails to deliver its potential benefits.

The Institute of Medicine (IOM) report does not stop at identifying the existence of this problem, but it goes on to identify the cause of the problem. It lies in our systems of care. It lies in our approach. "Yet, there remains a dearth of clinical programs with the infrastructure required to provide the full complement of services needed by people with heart disease, diabetes, asthma, and other common chronic conditions... Americans can have a health care system of the quality they need, want, and deserve... This higher level of care cannot be achieved by further stressing current systems of care. The current care systems cannot do the job. Trying harder will not work. Changing systems of care will."

And so we have a stinging indictment of our system of care and the ability of that system to meet our needs. Make no mistake, the IOM is saying that our approach to chronic diseases is irretrievably flawed. To their credit, they do not stop there. The IOM makes very concrete suggestions for making our approach more effective. Care for the chronically ill needs to be a collaborative, multidisciplinary process. The experts required to most effectively address the chronic diseases in question must come together to form a team. Then, those experts should do two very specific things to improve quality.

• They should organize evidence-based care processes based on best practices.
• They should develop the information infrastructure needed to support the provision of care and the ongoing measurement of care processes and patient outcomes.

The Cardiovascular Center of Excellence represents a very innovative and serious attempt to address the legitimate concerns raised by the IOM report. We have assembled the multidisciplinary care team, and we have organized evidence-based care processes to intensively treat patients with hypertension, dyslipidemia, metabolic syndrome, coronary artery disease and heart attack, peripheral vascular disease and stroke.