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Executive Summary
* To create a health system that better meets patients' needs requires a fundamental redesign of our care delivery system and a new framework.
* Without a payment mechanism to reflect the value of care provided other than the face-to-face visit, adoption of advanced medical home principles will be challenging.
* The hand-off of the patient between providers and settings of care is a critical time for the patient and its effectiveness impacts patient care outcomes.
* The appropriate utilization of hospital and other health system resources is crucial, especially as hospitals, emergency departments, and other health care venues increasingly face capacity constraints and throughput challenges.
* It becomes the responsibility of the multidisciplinary team of providers to ensure that patients being discharged have an identified personal physician or team who will provide a medical home, and that the handoff to this medical home is thorough and well coordinated.
* An ideal patient care experience is one in which all systems and processes are geared to meet the needs of the patient: a safety-oriented system that provides standardized, evidence-based care supported by technology, but that recognizes and responds to individual needs.
IN 2001, THE INSTITUTE OF Medicine (IOM) published the landmark report Crossing the Quality Chasm: A New Health System for the 21st Century, which provided a comprehensive vision for a health care delivery system designed to produce optimal patient care and outcomes (IOM, 2001). To transform the existing health care delivery system, the IOM identified six aims: health care must be safe, effective, patient-centered, timely, efficient, and equitable. Providers in all settings have been confronted with considerable implications, but the opportunities for ambulatory care clinicians to impact the care of patients in a positive way are especially significant.
To create a health system that better meets patients' needs requires a fundamental redesign of our care delivery system and a new framework. The IOM identified ten rules to guide the transformation (see Table 1). Care that is safe, efficient, evidence based, and coordinated around the unique needs of the patient does not appear on the surface to be controversial. What we, as providers and leaders in health care, must do to improve the patient experience is fairly intuitive. How we change a...