How Can Primary Care Cross the Quality Chasm?

In their book, The Innovator's Prescription, Christensen, Grossman and Hwang write that "the inadvertent result of [the NIH review system] of sending proposals for review by the scientists with the deepest expertise in the specific topic is that it has "silotized" the structure of scientific work into ever narrower disciplines and subdisciplines. . . But if the proposal intends to push knowledge in a different direction-- crossing the boundary into a different scientific domain--the proposal tends not to be viewed as positively. This is in part because most reviewers aren't comfortable vouching for the scientific potential of something beyond the boundaries of their own domain, and in part because it doesn't deepen knowledge in the direction in which their work and reputation are building." (page 372) Until the NIH agenda is transformed to "optimizing practice through research", the agenda will be developed without attention to the intermediate needs of care delivery process improvement. Without research addressing care delivery process improvement, the inefficient agenda-setting process will persist and health care improvement will continue to evolve at an agonizingly slow pace.

The book is well worth reading by anyone who has a stake in the transformation of health care despite the fact that the authors have overlooked the potential of lifestyle interventions to reduce health care expenditures--a person who isn't sick doesn't have health care costs.

Competing interests:   None declared