Helping People Share Decision Making

Second in a series of publications from the Institute of Medicine's Quality of Health Care in America project Today's health care providers have more research findings and more technology available to them than ever before. Yet recent reports have raised serious doubts about the quality of health care in America. Crossing the Quality Chasm makes an urgent call for fundamental change to close the quality gap. This book recommends a sweeping redesign of the American health care system and provides overarching principles for specific direction for policymakers, health care leaders, clinicians, regulators, purchasers, and others. In this comprehensive volume the committee offers: A set of performance expectations for the 21st century health care system. A set of 10 new rules to guide patient-clinician relationships. A suggested organizing framework to better align the incentives inherent in payment and accountability with improvements in quality. Key steps to promote evidence-based practice and strengthen clinical information systems. Analyzing health care organizations as complex systems, Crossing the Quality Chasm also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change.

An evidence-based analysis of the opportunities and challenges of moving towards more person-centred health systems.

Each year, more than 33 million Americans receive health care for mental or substance-use conditions, or both. Together, mental and substance-use illnesses are the leading cause of death and disability for women, the highest for men ages 15-44, and the second highest for all men. Effective treatments exist, but services are frequently fragmented and, as with general health care, there are barriers that prevent many from receiving these treatments as designed or at all. The consequences of this are seriousâ€"for these individuals and their families; their employers and the workforce; for the nation's economy; as well as the education, welfare, and justice systems. Improving the Quality of Health Care for Mental and Substance-Use Conditions examines the distinctive characteristics of health care for mental and substance-use conditions, including payment, benefit coverage, and regulatory issues, as well as health care organization and delivery issues. This new volume in the Quality Chasm series puts forth an agenda for improving the quality of this care based on this analysis. Patients and their families, primary health care providers, specialty mental health and substance-use treatment providers, health care organizations, health plans, purchasers of group health care, and all involved in health care for mental and substanceâ€"use conditions will benefit from this guide to achieving better care.

This book examines the regulation and practice of medical decision-making where the context is that of a multiple pregnancy and where the question is whether or not to carry out a fetal reduction procedure. It concerns three main lines of inquiry: first, the nature of fetal reduction and the legal ground(s) for termination typically relied upon; secondly, the extent to which legal, ethical, and professional norms guide or constrain this particular kind of decision-making; and, thirdly, the adequacy of these norms. The book uses empirical sources to develop its analysis, contributing new insight and the kind of evidence necessary to shape regulation, clinical practice, and future research. The key findings show that fetal abnormality is often given as the justifying ground; that the legal, ethical, and professional norms offer little explicit guidance for fetal reduction: and on the general question of termination, ethical norms suffer from a high level of contestation, the key norms in the UK abortion legislation are unclear and disconnected from practice, and professional norms are only marginally more adequate. Given the indeterminacy of these norms, it is no surprise that the evidence indicates that doctors are only weakly guided by them in making their decisions. Various recommendations are advanced in this book, including the need for a situational emphasis on shared decision-making and patient-centred care.

This report clarifies what is meant by 'shared decision-making' and identifies the skills and resources needed to implement it. It outlines the actions needed to make this vision a reality. It also suggests that tools that help patients make decisions are just as important as guidelines for clinicians.

Through a series of studies, the overarching aim of this book is to investigate if and how the digitalization/digital transformation process affects various welfare services provided by the public sector, and the ensuing implications thereof. Ultimately, this book seeks to understand if it is conceivable for digital advancement to result in the creation of private/non-governmental alternatives to welfare services, possibly in a manner that transcends national boundaries. This study also investigates the possible ramifications of technological development for the public sector and the Western welfare society at large. This book takes its point of departure from the 2016 Organization for Economic Co-operation and Development (OECD) report that targets specific public service areas in which government needs to adopt new strategies not to fall behind. Specifically, this report emphasizes the focus on digitalization of health care/social care, education, and protection services, including the use of assistive technologies referred to as "digital welfare." Hence, this book explores the factors potentially leading to whether state actors could be overrun by other non-governmental actors, disrupting the current status quo of welfare services. The book seeks to provide an innovative, enriching, and controversial take on society at large and how various aspects of the public sector can be, and are, affected by the ongoing digitalization process in a way that is not covered by extant literature on the market. This book takes its point of departure in Sweden given the fact that Sweden is one of the most digitalized countries in Europe, according to the Digital Economy and Society Index (DESI), making it a pertinent research case. However, as digitalization transcends national borders, large parts of the subject matter take on an international angle. This includes cases from several other countries around Europe as well as the United States.

Equity and Excellence : Liberating the NHS: Presented to Parliament by the Secretary of State for Health by Command of Her Majesty