In the August 2013 issue of this newsletter, I provided a brief description of the mission and inner workings of the IOM (see http://www.accp.com/report/index.aspx?iss=0813&art=13). In this month’s ACCP Report, I offer more detail on my involvement with two specific IOM activities—a consensus study committee and a standing roundtable activity—to show the potential influence and impact that clinical pharmacy can have on the national health policy agenda.
Consensus reports are considered the hallmark product of the IOM, with many notable examples, including To Err Is Human: Building a Safer Health System (1999), Crossing the Quality Chasm: A New Health System for the 21st Century (2001), and Best Care at Lower Cost: The Path to Continuously Learning Health Care in America (2009). The IOM applies a distinct research process to provide objective and straightforward answers to difficult questions of national importance. Advice is offered by committees of leading national and international scientists, all of whom serve pro bono, who are asked to set aside preconceptions and rely on evidence in their pursuit of knowledge and truth as they compose these reports. Ultimately, consensus reports reflect committee agreement after extensive deliberations and typically include findings, conclusions, and recommendations based on available scientific evidence.
The Committee on Core Metrics for Better Health at Lower Cost resides under the IOM Executive Office and is now conducting a study directed at exploring the measurement of individual and population health outcomes and costs, identifying fragilities and gaps in available systems, and considering approaches and priorities for developing measures necessary for a continuously learning and improving health system. Specific IOM charges for the committee include the following. (1) Consider candidate measures suggested as reliable and representative reflections of health status, care quality, people’s engagement and experience, and care costs for individuals and populations. (2) Identify current reporting requirements related to progress in health status, health care access and quality, people’s engagement and experience, costs of health care, and public health. (3) Identify data systems currently used to monitor progress on these parameters at the national, state, local, organizational, and individual level. (4) Establish criteria to guide the development and selection of the measures most important to guide current and future-oriented action. (5) Propose a basic, minimum slate of core metrics for use as sentinel indices of performance at various levels with respect to the key elements of health and health care progress: people’s engagement and experience, quality, cost, and health. (6) Indicate how these core indices should relate to, inform, and enhance the development, use, and reporting of more detailed measures tailored to various specific conditions and circumstances. (7) Identify needs, opportunities, and priorities for developing and maintaining the measurement capacity necessary for optimal use of the proposed core metrics. (8) Recommend an approach and governance options for continuously refining and improving the relevance and utility of the metrics over time and at all levels. This is certainly a daunting task; nevertheless, the final report will be released this year after the final committee meeting deliberations in late June 2014.
The Roundtable on Translating Genomic-Based Research for Health represents a different model of IOM activity. The forums and roundtables at the IOM bring together leaders in government and industry, scientists and other experts from academia, practitioners, representatives of public interest groups, and consumers. Forums and roundtables provide both a mechanism and a venue for convening a diverse group of individuals to meet and discuss issues of mutual interest and concern in a neutral setting. Meetings held by forums and roundtables may result in workshop summaries; however, consensus reports or recommendations are outside the purview of these activities.
Members of the Roundtable on Translating Genomic-Based Research for Health met four times in 2013 (and will meet twice in 2014) to continue discussions on emerging and enduring issues in advancing the field of genomics. Several topics were discussed throughout the scheduled workshops and meetings, including development of a knowledgeable health care system for precision medicine; evidentiary issues; education, engagement, and cultural change needed to implement genomic medicine; governance and ethical issues; research strategies to identify therapeutic targets according to genetic factors influencing the span of human life and health; and integration of genomic information into health information technology systems. Planning for an upcoming workshop in August is under way, with a topic focused on the educational needs of non-genetics experts in undergraduate and postgraduate training programs as well as the continuing education of currently practicing clinicians (i.e., physicians, pharmacists, nurses, and physician assistants).
As the inaugural IOM Anniversary Fellow in Pharmacy, I find it humbling and gratifying to contribute to the mission of ACCP through involvement in the important work of the IOM. As this experience draws to a close, I continue to marvel and reflect on the myriad experiences and opportunities for the profession and look forward to welcoming the next fellow into the fold. For those of you who may be interested in pursuing this experience, see the official call for nominations article that immediately follows—I encourage you to seriously consider applying for this career-changing experience.
Until next time, best regards!