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1 Institute of Medicine (IOM) Reports This summary was prepared by the 2009 JEMF Project Team

2 IOM Reports The Institute of Medicine of the National Academies has sponsored comprehensive reports on health disparities, the health of unique and vulnerable populations, workforce issues, health care quality, genetics and genomics and health, research in health care, and other topics. IOM Reports cite the evidence base and set the national standards in health and health care.

3 IOM Reports Search by topic or keywords on the Institute of Medicine home page: We reviewed IOM reports from the past 10 years and color coded them by topic. See the next slide for the color coding key and IOM reports listed in this document.

4 TopicsSlides  Health Disparities   Health Literacy   Mental Health   Vulnerable Populations   Health Insurance   Research   Complementary & Alternative Medicine   General Public Health   Healthcare Workforce   Genetics & Genomics 

5 Health Disparities In its work around select populations, the IOM examines significant health concerns that may affect groups of individuals categorized by common occupation, environment, health conditions or characteristics, or a shared exposure to a unique health risk. Of particular note are the IOM’s efforts around racial and ethnic disparities in health and health care. From IOM topic “Select Populations and Health Disparities”

6 Focusing on Children’s Health: Community Approaches to Addressing Health Disparities. Workshop Summary Released: September 2, 2009 Socioeconomic conditions are known to have profound and long-term effects on health at all stages of life, from pregnancy through childhood and adulthood. Sensitive and critical periods of development, such as the prenatal period and early childhood, present significant opportunities to influence lifelong health. Yet simply intervening in the health care system is insufficient to influence health outcomes early in life. On January 24, 2008, the Institute of Medicine’s Roundtable on Health Disparities and Board on Children, Youth, and Families co-hosted a public workshop to discuss the important foundations of adult health that are laid prenatally and in early childhood. sHealth.aspx sHealth.aspx

7 Race, Ethnicity, and Language Data: Standardization for Health Care Quality Improvement Released: August 31, 2009 The quality of health care in the United States is not optimal, and the pace of improvement is slow. In addition, disparities persist for specific population groups. A fundamental step in identifying which populations are most at risk is to collect data on race, ethnicity, and English-language proficiency. The Institute of Medicine (IOM) formed the Subcommittee on Standardized Collection of Race/Ethnicity Data for Healthcare Quality Improvement to examine approaches to standardization. In this 2009 report, the subcommittee recommends collection of more granular ethnicity and language need according to national standards in addition to OMB race and Hispanic ethnicity categories. a.aspx a.aspx

8 Toward Health Equity and Patient-Centeredness: Integrating Health Literacy, Disparities Reduction, and Quality Improvement. Workshop Summary Released: February 23, 2009 During a time of economic uncertainty, the national discussion of health reform understandably focuses on insurance coverage and cost. To receive the greatest value for health care, it is important to focus on issues of quality and disparity, and the ability of individuals to make appropriate decisions based on basic health knowledge and services, or health literacy. Three IOM bodies (the Forum on the Science of Health Care Quality Improvement and Implementation, the Roundtable on Health Disparities, and the Roundtable on Health Literacy) jointly convened a workshop to discuss these concerns. Equity-and-Patient-Centeredness-Integrating- Health-Literacy-Disparities-Reduction-and-Quality- Improvement-Workshop-Summary.aspx Equity-and-Patient-Centeredness-Integrating- Health-Literacy-Disparities-Reduction-and-Quality- Improvement-Workshop-Summary.aspx

9 Challenges and Successes in Reducing Health Disparities. Workshop Summary Released: June 17, 2008 In early 2007, the Institute of Medicine convened the Roundtable on Health Disparities to increase the visibility of racial and ethnic health disparities as a national problem, to further the development of programs and strategies to reduce disparities, to foster the emergence of leadership on this issue, and to track promising activities and developments in health care that could lead to dramatically reducing or eliminating disparities. s-and-Successes-in-Reducing-Health- Disparities-Workshop-Summary.aspx s-and-Successes-in-Reducing-Health- Disparities-Workshop-Summary.aspx

10 Examining the Health Disparities Research Plan of the National Institutes of Health: Unfinished Business Released: March 6, 2006 The health of racial and ethnic minorities, poor people, and other disadvantaged groups in the United States is worse than the health of the overall population. National concerns for these differences, termed health disparities, and the associated excess mortality and morbidity have been expressed as a high priority in national health status reviews, including Healthy People 2000 and The National Institutes of Health (NIH) ranks this issue third among its top five priorities. the-Health-Disparities-Research-Plan-of-the- National-Institutes-of-Health-Unfinished- Business.aspx the-Health-Disparities-Research-Plan-of-the- National-Institutes-of-Health-Unfinished- Business.aspx

11 Estimating the Contributions of Lifestyle- Related Factors to Preventable Death: A Workshop Summary Released: June 1, 2005 The Institute of Medicine of the National Academies held a workshop, December 13-14, 2004, to estimate the contributions of lifestyle- related factors to preventable death. g-the-Contributions-of-Lifestyle-Related- Factors-to-Preventable-Death-A-Workshop- Summary.aspx g-the-Contributions-of-Lifestyle-Related- Factors-to-Preventable-Death-A-Workshop- Summary.aspx

12 Guidance for the National Healthcare Disparities Report Released: September 27, 2002 Research has extensively documented the pervasiveness of racial and ethnic disparities in health care. In 1999, as part of a national effort to eliminate health care disparities, Congress required the Agency for Healthcare Research and Quality (AHRQ) to produce an annual report to be called the National Healthcare Disparities Report (NHDR). In this report, titled Guidance for the National Healthcare Disparities Report, an IOM committee was asked to provide guidance to AHRQ to help fulfill the potential of the NHDR. the-National-Healthcare-Disparities-Report.aspx the-National-Healthcare-Disparities-Report.aspx

13 Speaking of Health: Assessing Health Communication Strategies for Diverse Populations Released: July 6, 2002 Communication interventions intended to affect health behavior are an increasingly important strategy for improving the health of the American people. However, effective communication is highly dependent upon the social and cultural milieu that shapes the individuals, families, and communities that are the intended recipients. Because we live in an increasingly diverse nation, it is important to understand more fully how these different messages should be constructed and delivered. This report, Speaking of Health: Assessing Health Communication Strategies for Diverse Populations, addresses the challenge of improving health communications in a racially and culturally diverse society. Health-Assessing-Health-Communication- Strategies-for-Diverse-Populations.aspx Health-Assessing-Health-Communication- Strategies-for-Diverse-Populations.aspx

14 Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care Released: March 20, 2002 Congress, in 1999, requested an IOM study to assess the extent of disparities in the types and quality of health services received by U.S. racial and ethnic minorities and non-minorities; explore factors that may contribute to inequities in care; and recommend policies and practices to eliminate these inequities. The report from that study, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, found that a consistent body of research demonstrates significant variation in the rates of medical procedures by race, even when insurance status, income, age, and severity of conditions are comparable. Treatment-Confronting-Racial-and-Ethnic- Disparities-in-Health-Care.aspx Treatment-Confronting-Racial-and-Ethnic- Disparities-in-Health-Care.aspx

15 Health Literacy Health literacy is defined in Healthy People 2010 as: "The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” Healthy People 2010: From IOM topic “Select Populations and Health Disparities”

16 Measures of Health Literacy. Workshop Summary Released: December 8, 2009 Understanding and using basic health information and being able to navigate the complexities of the health care system are critical to good health. Health literacy can be difficult to assess, however, as it is not only a measure of individuals’ understanding of health information at various points in time but also a measure of how well various health care systems have been organized. The Roundtable on Health Literacy held a workshop on February 26, 2009, to examine what is known about measures of health literacy. of-Health-Literacy.aspx of-Health-Literacy.aspx

17 Health Literacy, eHealth, and Communication: Putting the Consumer First. Workshop Summary Released: March 24, 2009 There is great enthusiasm over the use of emerging interactive health information technologies—often referred to as eHealth—and the potential these technologies have to improve the quality, capacity, and efficiency of the health care system. However, many doctors, advocacy groups, policy makers and consumers are concerned that electronic health systems might help individuals and communities with greater resources while leaving behind those with limited access to technology. In order to address this problem, the Institute of Medicine’s Roundtable on Health Literacy held a workshop. eHealth-and-Communication-Putting-the- Consumer-First-Workshop-Summary.aspx eHealth-and-Communication-Putting-the- Consumer-First-Workshop-Summary.aspx

18 Health Literacy: A Prescription to End Confusion Released: April 8, 2004 Nearly half of all American adults--90 million people-- have difficulty understanding and using health information, and there is a higher rate of hospitalization and use of emergency services among patients with limited health literacy, says a report from the Institute of Medicine titled Health Literacy: A Prescription to End Confusion. Limited health literacy may lead to billions of dollars in avoidable health care costs. A concerted effort by the public health and health care systems, the education system, the media, and health care consumers is needed to improve the nation's health literacy, the report says. Prescription-to-End-Confusion.aspx Prescription-to-End-Confusion.aspx

19 Mental Health Individuals who have substance abuse or mental health problems can face particular health challenges. For example, they frequently experience difficulties in accessing, receiving, and benefiting from care. The IOM examines such concerns in its activities related to neuroscience and mental and behavioral health. From the IOM website under topic “Substance Abuse and Mental Health”

20 Depression in Parents, Parenting, and Children: Opportunities to Improve Identification, Treatment, and Prevention Released: June 9, 2009 Depression is a widespread condition affecting approximately 7.5 million parents in the U.S. each year and may be putting at least 15 million children at risk for adverse health outcomes. Based on evidentiary studies, major depression in either parent can interfere with parenting quality and increase the risk of children developing mental, behavioral and social problems. This report highlights disparities in the prevalence, identification, treatment, and prevention of parental depression among different sociodemographic populations. It also outlines strategies for effective intervention and identifies the need for a more interdisciplinary approach that takes biological, psychological, behavioral, interpersonal, and social contexts into consideration. Parents-Parenting-and-Children-Opportunities-to- Improve-Identification-Treatment-and-Prevention.aspx Parents-Parenting-and-Children-Opportunities-to- Improve-Identification-Treatment-and-Prevention.aspx

21 Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities Released: March 12, 2009 Mental health and substance use disorders among children, youth, and young adults are major threats to the health and well-being of younger populations which often carryover into adulthood. The costs of treatment for mental health and addictive disorders, which create an enormous burden on the affected individuals, their families, and society, have stimulated increasing interest in prevention practices that can impede the onset or reduce the severity of the disorders. This report updates a 1994 Institute of Medicine book, Reducing Risks for Mental Disorders, focusing on the research base and program experience with younger populations that have emerged since that time. Emotional-and-Behavioral-Disorders-Among-Young- People-Progress-and-Possibilities.asp Emotional-and-Behavioral-Disorders-Among-Young- People-Progress-and-Possibilities.asp

22 Improving the Quality of Health Care for Mental and Substance-Use Conditions: Quality Chasm Series Released: November 1, 2005 This report, Improving the Quality of Health Care for Mental and Substance-Use Conditions: Quality Chasm Series, examines the differences in health care for mental and substance-use conditions, finds that the Quality Chasm framework is applicable to health care for mental and substance-use conditions, and describes a multifaceted and comprehensive strategy to apply the Quality Chasm framework. Quality-of-Health-Care-for-Mental-and-Substance- Use-Conditions-Quality-Chasm-Series.aspx Quality-of-Health-Care-for-Mental-and-Substance- Use-Conditions-Quality-Chasm-Series.aspx

23 The Unequal Burden of Cancer: An Assessment of NIH Research and Programs for Ethnic Minorities and the Medically Underserved Released: January 1, 1999 We know more about cancer prevention, detection, and treatment than ever before--yet not all segments of the U.S. population have benefited to the fullest extent possible from these advances. Some ethnic minorities experience more cancer than the majority population, and poor people--no matter what their ethnicity--often lack access to adequate cancer care. This report provides an authoritative view of cancer as it is experienced by ethnic minorities and the medically underserved. Burden-of-Cancer-An-Assessment-of-NIH- Research-and-Programs-for-Ethnic-Minorities-and- the-Medically-Underserved.aspx Burden-of-Cancer-An-Assessment-of-NIH- Research-and-Programs-for-Ethnic-Minorities-and- the-Medically-Underserved.aspx

24 Vulnerable Populations The term "vulnerable populations," refers to social groups with increased relative risk (i.e. exposure to risk factors) or susceptibility to health-related problems. This vulnerability is evidenced in higher comparative mortality rates, lower life expectancy, reduced access to care, and diminished quality of life. Vulnerable populations are often discriminated against, marginalized and disenfranchised from mainstream society, contributing to their lower social status and lack of power in personal, social, and political relationships. Center for Vulnerable Populations Research, vulnerable.html vulnerable.html From the Center for Vulnerable Populations Research:

25 Adolescent Health Services: Missing Opportunities Released: December 9, 2008 Adolescence is a time when youth establish health habits, both good and bad, that often last a lifetime. Yet the U.S. health care system today is not designed to help young people develop healthy routines, behaviors, and relationships to prepare them for adulthood. Adolescent Health Services examines the health status of adolescents and reviews the separate and uncoordinated programs and services that currently exist in multiple public and private health care settings. Health-Services-Missing-Opportunities.aspx Health-Services-Missing-Opportunities.aspx

26 The National Children's Study Research Plan: A Review Released: September 12, 2008 The National Children's Study (NCS) is planned to be the largest long-term study of environmental and genetic effects on children's health ever conducted in the United States. It proposes to examine the effects of environmental influences on the health and development of approximately 100,000 children across the United States, following them from before birth until age 21. By archiving all of the data collected, the NCS is intended to provide a valuable resource for analyses conducted many years into the future. This book evaluates the research plan for the NCS, by assessing the scientific rigor of the study and the extent to which it is being carried out with methods, measures, and collection of data and specimens to maximize the scientific yield of the study. Childrens-Study-Research-Plan-A-Review.aspx Childrens-Study-Research-Plan-A-Review.aspx

27 Challenges in Adolescent Health Care. Workshop Report Released: October 26, 2007 This report summarizes two workshops convened by the Committee on Adolescent Health Care Services and Models of Care for Treatment, Prevention, and Healthy Development, which is conducting a two-year study of adolescent health services in the United States with funding from the Atlantic Philanthropies. This workshop report, which is the first in a series of products associated with this study, takes stock of the current knowledge base on adolescent health services, settings and systems and offers perspectives from researchers, health professionals who work with youth, and youth themselves in describing the current status, strengths, and shortcomings of current delivery systems. Adolescent-Health-Care-Workshop-Report.aspx

28 A Study of Interactions: Emerging Issues in the Study of Adolescence: A Workshop Summary Released: March 22, 2006 Summarizing the major themes discussed at a September 2005 workshop, this report provides an initial overview of key findings from different fields of research on adolescence and highlights fundamental processes that shape adolescent health and development. Interactions-Emerging-Issues-in-the-Study-of- Adolescence-A-Workshop-Summary.aspx Interactions-Emerging-Issues-in-the-Study-of- Adolescence-A-Workshop-Summary.aspx

29 Workshop on Disability in America: A New Look - Summary and Background Papers Released: March 1, 2006 This report from the Institute of Medicine summarizes a workshop convened in August 2005 for the first phase of a project that will take a new look at disability in America and update the 1991 IOM report by that name. The final report, which will include recommendations, is now available and is titled The Future of Disability in America. Disability-in-America-A-New-Look---Summary-and- Background-Papers.aspx Disability-in-America-A-New-Look---Summary-and- Background-Papers.aspx

30 The Future of Disability in America Released: April 23, 2007 To better understand disability in the United States, the Centers for Disease Control, the Department of Education, and the National Institutes of Health (NIH) asked the Institute of Medicine (IOM) to assess the current situation and provide recommendations for improvement, which culminated in the report The Future of Disability in America. Future-of-Disability-in-America.aspx Future-of-Disability-in-America.aspx

31 Ethical Considerations for Research Involving Prisoners Released: July 12, 2006 Because prisoners face restrictions on liberty and autonomy, limited privacy, and often inadequate health care, they require specific protections when involved in research, particularly in today’s correctional settings. Given these issues, the Department of Health and Human Services’ Office for Human Research Protections commissioned the Institute of Medicine to review the ethical considerations regarding research involving prisoners. Ethical Considerations for Research Involving Prisoners emphasizes five broad actions to provide prisoners involved in research with critically important protections. Considerations-for-Research-Involving- Prisoners.aspx Considerations-for-Research-Involving- Prisoners.aspx

32 Cancer in Elderly People: Workshop Proceedings Released: March 22, 2007 The IOM's National Cancer Policy Forum sponsored a public workshop addressing several issues related to cancer and aging; including cancer rehabilitation, increased prevalence of cancer survivors, end of life care, the role of nurses, and Medicare costs in geriatric oncology. People-Workshop-Proceedings.aspx People-Workshop-Proceedings.aspx

33 Quality Through Collaboration: The Future of Rural Health Released: November 1, 2004 Rural America is a vital component of American society. Representing nearly 20 percent of the population, rural communities, like urban landscapes, are rich in cultural diversity. However, the smaller, poorer, and more isolated a rural community is, the more difficult it is to ensure the availability of high- quality health services. The Institute of Medicine report, Quality Through Collaboration: The Future of Rural Health examines the quality of health care in rural America. Collaboration-The-Future-of-Rural-Health.aspx Collaboration-The-Future-of-Rural-Health.aspx

34 Children's Health, the Nation's Wealth: Assessing and Improving Child Health Released: June 24, 2004 Children's health has clearly improved over the past several decades. Yet major questions still remain about how to assess the status of children's health, what factors should be monitored, and the appropriate measurement tools that should be used. Children's Health, The Nation's Wealth provides a detailed examination of the information about children's health that is needed to help policy makers and program providers at the federal, state, and local levels. the-Nations-Wealth-Assessing-and-Improving- Child-Health.aspx the-Nations-Wealth-Assessing-and-Improving- Child-Health.aspx

35 Ethical Conduct of Clinical Research Involving Children Released: March 24, 2004 To address concerns about the adequacy of the current system for protecting child participants in research given a public commitment to expanding pediatric clinical research, the Institute of Medicine convened the Committee on Clinical Research Involving Children. of-Clinical-Research-Involving-Children.aspx of-Clinical-Research-Involving-Children.aspx

36 Lesbian Health: Current Assessment and Directions for the Future Released: April 7, 2003 Women's health, as a field of study, is a developing discipline. Health theories in general have been based on studies of men. However, in recent years, more attention has shifted to women's health, realizing the disparities between men and women in relation to their health. During the last two decades, a similar shift has occurred for a group of women--lesbian women--to further identify and specify their health needs. Lesbian Health: Current Assessment and Directions for the Future takes a frank look at the political pressures, community attitudes, and professional concerns uniquely affecting the study of lesbian health issues. Current-Assessment-and-Directions-for-the- Future.aspx Current-Assessment-and-Directions-for-the- Future.aspx

37 Adolescent Risk and Vulnerability: Concepts and Measurements Released: October 18, 2001 Adolescent Risk and Vulnerability is a summary of a workshop held in 2001 by the Board on Children, Youth, and Families. The workshop's goal was to put into perspective the total burden of vulnerability that adolescents have, taking advantage of the growing societal concern for adolescents, the need to set priorities for adolescents' needs, and the opportunity to apply decision-making perspectives to this critical area. and-Vulnerability-Concepts-and- Measurements.aspx and-Vulnerability-Concepts-and- Measurements.aspx

38 Exploring the Biological Contributions to Human Health: Does Sex Matter? Released: April 24, 2001 The Institute of Medicine formed a committee to evaluate and consider the current understanding of sex differences and determinants at the biological level and to identify current and potential barriers to the conduct of research in this area. the-Biological-Contributions-to-Human- Health-Does-Sex-Matter.aspx the-Biological-Contributions-to-Human- Health-Does-Sex-Matter.aspx

39 Children of Immigrants: Health, Adjustment, and Public Assistance Released: January 1, 1999 Children of Immigrants represents some of the very best and most extensive research efforts to date on the circumstances, health, and development of children in immigrant families and the delivery of health and social services to these children and their families. of-Immigrants-Health-Adjustment-and- Public-Assistance.aspx of-Immigrants-Health-Adjustment-and- Public-Assistance.aspx

40 Gender Differences in Susceptibility to Environmental Factors: A Priority Assessment Released: January 1, 1998 In 1996 the Office for Research on Women's Health at the National Institutes of Health asked the Institute of Medicine to conduct a workshop study to review some of the current federal research programs devoted to women's health and to clarify the state of knowledge regarding gender-related differences in susceptibility. This book contains a general outline of research needs, a summary of the workshop proceedings (as well as summaries of the speakers' presentations), and an analysis of the participating federal agencies' research portfolios. Differences-in-Susceptibility-to-Environmental- Factors-A-Priority-Assessment.aspx Differences-in-Susceptibility-to-Environmental- Factors-A-Priority-Assessment.aspx

41 From Generation to Generation: The Health and Well-Being of Children in Immigrant Families Released: January 1, 1998 From Generation to Generation explores what we know about the development of white, black, Hispanic, and Asian children and youth from numerous countries of origin. Describing the status of immigrant children and youth as "severely understudied," the committee both draws on and supplements existing research to characterize the current status and outlook of immigrant children. Generation-to-Generation-The-Health-and- Well-Being-of-Children-in-Immigrant- Families.aspx Generation-to-Generation-The-Health-and- Well-Being-of-Children-in-Immigrant- Families.aspx

42 Health Insurance For many, lack of health care is a persistent barrier to good health. The IOM examines the twin issues of health insurance coverage and access as well as taking a broad view of health care services. The IOM considers subjects such as the organization, financing, effectiveness, workforce, and delivery of health care. From the IOM topic Health Services, Coverage, and Access

43 America's Uninsured Crisis: Consequences for Health and Health Care Released: February 23, 2009 For decades, the health insurance crisis has grown without any decisive action by policy makers to stop it. Now is the time for action, say the report’s authors, recommending that the President work with Congress and other public and private sector leaders on an urgent basis to achieve health insurance coverage for everyone and, in order to make that coverage sustainable, to reduce the costs of health care and the rate of increase in health care spending. Uninsured-Crisis-Consequences-for-Health-and- Health-Care.aspx Uninsured-Crisis-Consequences-for-Health-and- Health-Care.aspx

44 Coverage Matters: Insurance and Health Care Released: October 11, 2001 This is the first of six reports on the problems of uninsurance in the United States and addresses the extent to which Americans are without coverage, identifies social, economic, and policy factors that contribute to the situation, and reports the relative probability of being uninsured for various groups. Matters-Insurance-and-Health-Care.aspx Matters-Insurance-and-Health-Care.aspx

45 Care Without Coverage: Too Little, Too Late Released: May 21, 2002 Care Without Coverage: Too Little, Too Late, the second report in a series of six from the Institiute of Medicine's Committee on the Consequences of Uninsurance, examines the real consequences for adults who lack health insurance. Without-Coverage-Too-Little-Too-Late.aspx Without-Coverage-Too-Little-Too-Late.aspx

46 Health Insurance is a Family Matter Released: September 18, 2002 Health Insurance Is a Family Matter is the third of a series of six reports on the problems of uninsurance in the United States and addresses the impact on the family of not having health insurance. The report examines the consequences for family health, financial stability, and general well-being. In the report, the Committee concludes that the financial, physical, and emotional well-being of all members of a family may be adversely affected if any family member lacks coverage. Insurance-is-a-Family-Matter.aspx Insurance-is-a-Family-Matter.aspx

47 A Shared Destiny: Community Effects of Uninsurance Released: April 2, 2003 A Shared Destiny: Community Effects of Uninsurance is the fourth of a series of six reports on the problems of uninsurance in the United States. The report examines how the quality, quantity, and scope of health services within the community can be affected adversely by having a large or growing uninsured population. Destiny-Community-Effects-of- Uninsurance.aspx Destiny-Community-Effects-of- Uninsurance.aspx

48 Hidden Costs, Value Lost: Uninsurance in America Released: June 18, 2003 Hidden Costs, Value Lost: Uninsurance in America, the fifth of a series of six reports on the consequences of uninsurance in the United States, illustrates some of the economic and social losses to the country of maintaining so many people without health insurance. The report explores the potential economic and societal benefits that could be realized if everyone had health insurance on a continuous basis, as people over age 65 currently do with Medicare. Value-Lost-Uninsurance-in-America.aspx Value-Lost-Uninsurance-in-America.aspx

49 Insuring America's Health: Principles and Recommendations Released: January 13, 2004 This report is the culmination of a series that offers the most comprehensive examination to date of the consequences of lack of health insurance on individuals, their families, communities and the whole society. The principles to guide health finance reform that are recommended in this sixth and final report of the series are based on the evidence reviewed in the Committee's previous five reports and on new analyses of past and present federal, state, and local efforts to reduce uninsurance. Americas-Health-Principles-and- Recommendations.aspx Americas-Health-Principles-and- Recommendations.aspx

50 General Public Health Since its founding, the IOM has advanced the best ways to ensure the public’s health. Studies range from core principles and needs in the field of public health to specific issues such as vaccine safety and smoking cessation. Our scope includes population-based public health measures and the public health infrastructure. From IOM topic “Public Health”

51 State of the USA Health Indicators. Letter Report Released: December 9, 2008 In 2008, the nonprofit State of the USA, Inc. (SUSA) asked the Institute of Medicine’s Committee on the State of the USA Health Indicators to provide guidance on 20 key indicators to be used on the organization’s website that would be valuable in assessing health. Taken together, the selected indicators reflect the overall health of the nation and the efficiency and efficacy of U.S. health systems. The complete list of 20 can be found in the report brief and report. Health-Indicators-Letter-Report.aspx Health-Indicators-Letter-Report.aspx

52 Knowing What Works in Health Care: A Roadmap for the Nation Released: January 24, 2008 Solutions to some of the nation’s most pressing health policy problems hinge on the ability to identify which diagnostic, treatment, and prevention services work best for various patients and circumstances. A new Institute of Medicine report, Knowing What Works in Health Care: A Roadmap for the Nation, provides a blueprint for a national program to assess the effectiveness of clinical services and to provide credible, unbiased information about what really works in health care. Works-in-Health-Care-A-Roadmap-for-the- Nation.aspx Works-in-Health-Care-A-Roadmap-for-the- Nation.aspx

53 1st Annual Crossing the Quality Chasm Summit: A Focus on Communities Released: September 14, 2004 On January 6 and 7, 2004, the Institute of Medicine (IOM) hosted the 1st Annual Crossing the Quality Chasm Summit, convening a diverse group of national and community health care leaders to pool their knowledge and resources with regard to strategies for improving patient care for five common chronic illnesses: asthma, depression, diabetes, heart failure, and pain control in advanced cancer. Crossing-the-Quality-Chasm-Summit-A-Focus-on- Communities.aspx Crossing-the-Quality-Chasm-Summit-A-Focus-on- Communities.aspx

54 Measuring What Matters: Allocation, Planning, and Quality Assessment for the Ryan White CARE Act Released: November 7, 2003 In response to a congressional mandate, an IOM committee was formed to reevaluate whether CARE allocation strategies are an equitable and efficient way of distributing resources to jurisdictions with the greatest needs and to assess whether quality of care can be refined and expanded. What-Matters-Allocation-Planning-and-Quality- Assessment-for-the-Ryan-White-CARE-Act.aspx What-Matters-Allocation-Planning-and-Quality- Assessment-for-the-Ryan-White-CARE-Act.aspx

55 Leading Health Indicators for Healthy People 2010: Final Report Released: April 7, Health-Indicators-for-Healthy-People Final-Report.aspx

56 Priority Areas for National Action: Transforming Health Care Quality Released: January 7, 2003 In this report, the committee recommends a set of 20 priority areas that the U.S. Department of Health and Human Services (DHHS) and other groups in the public and private sectors should focus on to improve the quality of health care delivered to all Americans. The priority areas selected represent the entire spectrum of health care from preventive care to end of life care. They also touch on all age groups, health care settings and health care providers. Collective action in these areas could help transform the entire health care system. for-National-Action-Transforming-Health-Care- Quality.aspx for-National-Action-Transforming-Health-Care- Quality.aspx

57 Health and Behavior: The Interplay of Biological, Behavioral, and Societal Influences Released: May 21, 2001 Health and Behavior reviews our improved understanding of the complex interplay among biological, psychological, and social influences and explores findings suggested by recent research-including interventions at multiple levels that we can employ to improve human health. and-Behavior-The-Interplay-of-Biological- Behavioral-and-Societal-Influences.aspx and-Behavior-The-Interplay-of-Biological- Behavioral-and-Societal-Influences.aspx

58 Measuring the Quality of Health Care Released: February 1, 1998 This report first describes quality of care based on the IOM's 1990 definition and then outlines the burden of harm from poor quality. It then describes major approaches to and recent advances in quality measurement. Finally, it describes some of the challenges facing this field. g-the-Quality-of-Health-Care.aspx g-the-Quality-of-Health-Care.aspx

59 Research Underlying health and health care is an important science base. The IOM work in biomedical and health research pertains to both the discovery and application of new knowledge. From IOM topic “Biomedical and Health Research”

60 Integrity in Scientific Research: Creating an Environment That Promotes Responsible Conduct Released: July 15, 2002 This report focuses on the research environment and attempts to define and describe those elements that allow and encourage unique individuals, regardless of their role in the research organization or their backgrounds on entry, to act with integrity. in-Scientific-Research-Creating-an- Environment-That-Promotes-Responsible- Conduct.aspx in-Scientific-Research-Creating-an- Environment-That-Promotes-Responsible- Conduct.aspx

61 Preserving Public Trust: Accreditation and Human Research Participant Protection Programs Released: April 17, 2001 Preserving Public Trust: Accreditation and Human Research Participant Protection Programs, responds, at the request of DHHS, to the increasing concern over patient safety and shutdowns of research operations in the United States. g-Public-Trust-Accreditation-and-Human- Research-Participant-Protection- Programs.aspx g-Public-Trust-Accreditation-and-Human- Research-Participant-Protection- Programs.aspx

62 Toward Environmental Justice: Research, Education, and Health Policy Needs Released: March 1, 1999 Is environmental degradation worse in poor and minority communities? Do these communities suffer more adverse health effects as a result? The committee addresses these questions and explores how current fragmentation in health policy could be replaced with greater coordination among federal, state, and local parties. Environmental-Justice-Research- Education-and-Health-Policy-Needs.aspx Environmental-Justice-Research- Education-and-Health-Policy-Needs.aspx

63 Responsible Research: A Systems Approach to Protecting Research Participants Released: October 3, 2002 Broader federal oversight is needed to ensure that all people who take part in research studies, regardless of whether they are publicly or privately funded, have the same necessary protections for their health and well-being, says the report, Responsible Research: A Systems Approach to Protecting Research Participants. ble-Research-A-Systems-Approach-to- Protecting-Research-Participants.aspx ble-Research-A-Systems-Approach-to- Protecting-Research-Participants.aspx

64 Complementary and Alternative Medicine Complementary and alternative medicine (CAM) refers to a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine.

65 Use of Dietary Supplements by Military Personnel Released: June 9, 2008 The use of dietary supplements has become increasingly popular among members of the military. While some supplements may provide benefits to health, others could carry adverse effects that might compromise the readiness and performance of service members. The U.S. Department of Defense, the Samueli Institute, the National Institutes of Health (NIH), with additional support from the Food and Drug Administration (FDA), requested that the Institute of Medicine (IOM) review the use of dietary supplements by military personnel, recommending a framework to identify the need for management of dietary supplement use within the military, and developing an approach to report adverse health events. Supplements-by-Military-Personnel.aspx Supplements-by-Military-Personnel.aspx

66 Complementary and Alternative Medicine in the United States Released: January 12, 2005 At the request of the National Institutes of Health (NIH) and the Agency for Healthcare Research and Quality, the IOM produced the report titled Complementary and Alternative Medicine in the United States, which assesses what is known about Americans' reliance on those therapies and also assists the NIH in developing research methods and setting priorities for evaluating products and approaches within CAM. y-and-Alternative-Medicine-in-the-United- States.aspx y-and-Alternative-Medicine-in-the-United- States.aspx

67 Dietary Supplements: A Framework for Evaluating Safety Released: April 1, 2004 Although vitamin and supplement manufacturers are restricted from claiming that using their products leads to therapeutic benefits, surveys show that many people take supplements for purposes such as treating colds or alleviating depression. According to other survey data, the majority of consumers believe these products to be either reasonably or completely safe. To bolster the FDA's ability to evaluate the safety of dietary supplements, the Institute of Medicine report Dietary Supplements: A Framework for Evaluating Safety outlines a science- based process for assessing supplement ingredients, even when data about a substance's safety in humans is scarce. Supplements-A-Framework-for-Evaluating- Safety.aspx Supplements-A-Framework-for-Evaluating- Safety.aspx

68 Health Care Workforce Chief among the resources of our health care system is the workforce that assumes the task. The IOM recognizes the importance of the health care workforce and examines such issues as the preparedness of certain sectors to meet patient demand and the protection of health care workers against threats like pandemics, among others. From IOM topic “Healthcare Workforce”

69 In the Nation's Compelling Interest: Ensuring Diversity in the Health Care Workforce Released: February 5, 2004 The report examines institutional and policy-level strategies - defined as specific policies and programs of health professions schools, their associations and accreditation bodies, health care systems/organizations, and state and federal governments - to increase diversity among health professionals. Compelling-Interest-Ensuring-Diversity-in-the- Health-Care-Workforce.aspx Compelling-Interest-Ensuring-Diversity-in-the- Health-Care-Workforce.aspx

70 Who Will Keep the Public Healthy? Workshop Summary Released: August 4, 2003 On May 22, 2003 in Washington, DC the Institute of Medicine held a workshop to explore the recently released report, Who Will Keep the Public Healthy? Educating Public Health Professionals for the 21st Century. Representatives of the public health practice and academic communities joined to review the report and to discuss how to proceed to implement the recommendations of this report. This summary is a report of that meeting. It includes suggestions from the six workgroups for next steps necessary to move forward in implementing the recommendations. Keep-the-Public-Healthy-Workshop- Summary.aspx Keep-the-Public-Healthy-Workshop- Summary.aspx

71 Health Professions Education: A Bridge to Quality Released: April 18, 2003 On June 17-18, 2002 over 150 leaders and experts from health professions education, regulation, policy, advocacy, quality, and industry attended the Health Professions Education Summit to discuss and help the committee develop strategies for restructuring clinical education to be consistent with the principles of the 21st-century health system. Professions-Education-A-Bridge-to-Quality.aspx Professions-Education-A-Bridge-to-Quality.aspx

72 The Right Thing to Do, The Smart Thing to Do: Enhancing Diversity in Health Professions. Released: August 31, 2001 The Symposium on Diversity in the Health Professions in Honor of Herbert W. Nickens, M.D. was convened in March 2001 to provide a forum for health policymakers, health professions educators, education policymakers, researchers, and others to address three significant and contradictory challenges. The Right Thing to Do, The Smart Thing to Do: Enhancing Diversity in Health Professions illustrates how the health care industry and health care professions are fighting to retain the public’s confidence so that the U.S. health care system can continue to be the world’s best. to-Do-The-Smart-Thing-to-Do-Enhancing-Diversity- in-Health-Professions-Summary-of-the-Symposium- on-Diversity-in-Health-Professions-in-Honor-of- Herbert-W-Nickens-MD.aspx to-Do-The-Smart-Thing-to-Do-Enhancing-Diversity- in-Health-Professions-Summary-of-the-Symposium- on-Diversity-in-Health-Professions-in-Honor-of- Herbert-W-Nickens-MD.aspx Summary of the Symposium on Diversity in Health Professions in Honor of Herbert W. Nickens, M.D.

73 Genetics and Genomics By studying the relationship between genes, environment, and behaviors, researchers and practitioners can learn why some people get sick, while others do not. Family health history information can also help to identify people who may have a higher risk for certain diseases. Better understanding of genetic and family history information can help researchers and practitioners identify, develop, and evaluate screening and other interventions that can improve health and prevent disease. Centers for Disease Control and Prevention, “Genomics and Health” From CDC website “Genomics and Health”

74 Policy Issues in the Development of Personalized Medicine in Oncology. Workshop Summary Released: February 8, 2010 As cancer care becomes more personalized, patients will receive preventive or therapeutic interventions based on their susceptibilities or predicted responses. But before the use of personalized cancer care can reach its full potential, the health care system must resolve a number of policy issues. To explore these policy challenges, the National Cancer Policy Forum held this workshop in June in-the-Development-of-Personalized-Medicine-in- Oncology.aspx in-the-Development-of-Personalized-Medicine-in- Oncology.aspx

75 Systems for Research and Evaluation for Translating Genome-Based Discoveries for Health. Workshop Summary Released: November 11, 2009 The correlation between genetic variations and variations in disease risk has been a subject of study for more than 100 years. Initially, research focused on single genes that give rise to rare genetic diseases such as cystic fibrosis or Huntington’s disease. With new studies, however, numerous associations have been found between genes and more common diseases, for example breast cancer, type II diabetes, coronary artery disease, asthma, and bipolar disorder. This rapidly advancing field of genomics has stirred great interest in “personalized” health care. The hope is that using genomic information in care will lead to reduced health care costs and improved health results, as preventive measures and treatments are tailored to patients’ genetic susceptibilities. On February 12, 2009, the Institute of Medicine’s Roundtable on Translating Genomic-Based Research for Health hosted a workshop to examine how to evaluate the clinical use of genomic information and the impact of genetic information in caring for patients. Translating-Genome-Based-Discoveries-Health.aspx Translating-Genome-Based-Discoveries-Health.aspx

76 Innovations in Service Delivery in the Age of Genomics. Workshop Summary Released: May 13, 2009 New discoveries in genomics—that is, the study of the entire human genome—are changing how we diagnose and treat diseases. As the trend shifts from genetic testing largely being undertaken for rare genetic disorders to, increasingly, individuals being screened for common diseases, general practitioners, pediatricians, obstetricians, gynecologists, and other providers need to be knowledgeable about and comfortable using genetic information to improve their patients’ health. To address these changes, the Roundtable on Translating Genomic-Based Research for Health held the public workshop “Innovations in Service Delivery in the Age of Genomics” on July 27, Service-Delivery-in-the-Age-of-Genomics- Workshop-Summary.aspx Service-Delivery-in-the-Age-of-Genomics- Workshop-Summary.aspx

77 Cancer-Related Genetic Testing and Counseling. Workshop Proceedings Released: August 20, 2007 The Institute of Medicine’s National Cancer Policy Forum held a workshop and released the proceedings entitled Cancer-Related Genetic Testing and Counseling. The workshop focused on the fact that genetic testing and counseling are becoming more complex and important for informing patients and families of the risks and benefits of certain courses of action, but at the same time organized expert programs are in short supply. The workshop covered the scientific and clinical aspects of genetic testing and counseling as well as workforce and reimbursement issues, among others. Related-Genetic-Testing-and-Counseling- Workshop-Proceedings.aspxhttp://www.iom.edu/Reports/2007/Cancer- Related-Genetic-Testing-and-Counseling- Workshop-Proceedings.aspx

78 Nutrigenomics and Beyond: Informing the Future Workshop Summary Released: May 22, 2007 Nutrition science is uniquely poised to serve as the crossroads for many disciplines and, using genomics tools, can bridge this knowledge to better understand and address diet-related chronic diseases and molecular responses to dietary factors. To address these issues, the Institute of Medicine held a two-day workshop, and released Nutrigenomics and Beyond: Informing the Future Workshop Summary, which explores the state of the science, examines its potential, and discusses how that potential might best be realized. -and-Beyond--Informing-the-Future-Workshop- Summary.aspx -and-Beyond--Informing-the-Future-Workshop- Summary.aspx

79 Diffusion and Use of Genomic Innovations in Health and Medicine. Workshop Summary Released: June 19, 2008 The Institute of Medicine’s Roundtable on Translating Genomic-Based Research for Health, established in 2007, held its first workshop to address the following questions: (1) Are there different pathways by which new scientific findings move from the research setting into health care? (2) If so, what are the implications of those different pathways for genomics? (3) What can we learn from the translation of other new technologies as we seek to understand the translation of genome science into health care? Use-of-Genomic-Innovations-in-Health-and- Medicine-Workshop-Summary.aspx Use-of-Genomic-Innovations-in-Health-and- Medicine-Workshop-Summary.aspx

80 Genes, Behavior, and the Social Environment: Moving Beyond the Nature/Nurture Debate Released: August 11, 2006 Genes, Behavior, and the Social Environment examines a number of well-described gene- environment interactions, reviews the state of the science in researching such interactions, and recommends priorities not only on research itself but also on its workforce, resource, and infrastructural needs. Behavior-and-the-Social-Environment-Moving- Beyond-the-NatureNurture-Debate.aspx Behavior-and-the-Social-Environment-Moving- Beyond-the-NatureNurture-Debate.aspx

81 Implications of Genomics for Public Health. Workshop Summary Released: March 28, 2005 This workshop summary, titled Implications of Genomics for Public Health, summarizes speaker presentations on major scientific and policy issues related to genomics and public health, major supports for and challenges to the translation of genetic research into population health benefits, and approaches for the integration of genomic information into strategies for promoting health and preventing disease. of-Genomics-for-Public-Health-Workshop- Summary.aspx of-Genomics-for-Public-Health-Workshop- Summary.aspx

82 Cancer and the Environment: Gene- Environment Interactions. Workshop Summary Released: August 9, 2002 Both environmental and genetic factors are known to be involved in the development of cancer. On May 16-17, 2001, the Roundtable on Environmental Health Sciences, Research and Medicine convened a workshop on Cancer and the Environment: Gene- Environment Interactions to address the link between environmental factors and the development of cancer in the light of recent advances in genomics and, more specifically, in toxicogenomics and gene- environment interactions. the-Environment-Gene-Environment- Interactions-Workshop-Summary.aspx the-Environment-Gene-Environment- Interactions-Workshop-Summary.aspx


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