The IOM Report

In 2001, on the heels of its To Err is Human report1, the Institute of Medicine (IOM) released Crossing the Quality Chasm2, a roadmap for improving healthcare quality in America. The report implored all stakeholders to achieve major gains in six key areas: effectiveness, safety, patient-centeredness, efficiency, timeliness, and equity. It also spurred funding for quality-of-care research and health system re-design. But, by parsing quality as six arguably disparate elements, the IOM report gave stakeholders license to define quality in various (and often competing) ways. Consequently, progress, particularly in patient-centeredness, has lagged far behind where it needs to be. And in these regards, interventional radiology (IR) is no exception.

In such cases, the onus to provide patient-centered value, rather than strictly quality, is especially important. But what is value, how it is different from quality, and why does this all matter for IR?

In his seminal 2010 editorial, “What is value in healthcare?”, Porter3 described value as a ratio: a specific set of patient-centered outcomes achieved along the entire pathway of care relative to the total cost involved along the entire pathway of care. His “specific set of outcomes” refers to a hierarchy of outcomes, with survival being the highest-value outcome, followed by patient-reported functional status, cycle time (time from diagnosis to recovery), and discomfort of treatment.

Porter’s longitudinal view of patients’ travel through the healthcare system is the foundation of his definition. In considering outcomes and costs across the entire care pathway ( from disease prevention to disease recurrence), value-based medicine

In these situations, careful attention to changes in local practice that encourage a more integrated approach necessary. For example, consolidation of hospitals, practices, or payers may create environment in which patients are directed to certain practice locations for certain types of care. In the present, participation in existing tumor boards and multidisciplinary clinical conferences can lay the groundwork for inclusion in IPU in the future. of outpatient non-procedural care in a clinic or office setting builds awareness and acceptance of the role of IR in patient management. Although these activities are often viewed as a low-priority by non-IR partners, they critical foundations for integrated care in the