Order from Chaos

Accelerating Care Integration

Lack of care coordination and integration was identified as a major contributor to the frequency of avoidable errors in patient care in the Institue of Medicine report To Err Is Human. Care integration was presented as the cornerstone for achieving high quality in the subsequent IOM report Crossing the Quality Chasm. AHRQ has included care integration and patient safety in its scope of work since early in this decade. Federal government administration arguments for the Patient Protection and Affordable Care Act of 2010 included numerous references to this issue.

The care delivery system is struggling to escape the straitjacket of physician autonomy and economic independence, a payment system that reinforces fragmentation and independent decision making, and a regulatory framework that places legal responsibility on the individual professional without corresponding accountability of the team or the system. The medical education system reinforces these expectations and does little to prepare new physicians for the team-based, interdependent work that is required to achieve high-quality and safe care. This is the challenge.

In the following report, barriers are identified to care integration and actions are discussed that could facilitate moving past them. Major barriers are explored and ideas for accelerating the integration agenda in the United States are identified.