In this past year, Fund staff published a paper in Health Affairs arguing that the problems experienced by the U.S. health care system are unlikely to be solved without strong leadership from the federal government.⁽¹⁾ Noting that U.S. health care costs, already highest in the world, continue to rise and that strategies to shift and minimize costs have not worked, authors Stephen Schoenbaum, M.D., Karen Davis, and Anne-Marie Audet, M.D., argued for a greater federal role in establishing an agenda to set national priorities, develop guidelines for health care, and help implement measures to track provider performance. The paper was the subject of a lively Fund-sponsored debate, shown live via webcast, that featured four of the nation's leading health care quality experts. Since the article's publication, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has issued a position paper calling for establishment of a new federal office for quality within the Department of Health and Human Services. In addition, members of Congress are working on legislation to institute some of the government functions advocated in the article, including the setting of national priorities for quality.

Another report by Fund researchers, Mirror, Mirror on the Wall: Looking at the Quality of American Health Care Through the Patient's Lens,⁽²⁾ examined how the health system works from the perspective of patients. Its findings confirmed what several other recent studies have shown: that the U.S. performs worse than its peer nations on several dimensions of quality.

The quality of children's health care is the focus of the newest entry in the Fund's well-received and much-downloaded series of chartbooks on health care quality. Produced by Sheila Leatherman, research professor at the University of North Carolina at Chapel Hill, and Douglas McCarthy, president of Issues Research, Inc., this comprehensive resource provides easy-to-use information distilled from some 500 studies on preventive care, treatment of chronic conditions, mental health, and other areas of health care. In the chartbook, Leatherman and McCarthy report that while a number of advances in children's care have been made, many serious problems persist. One-third of children with asthma fail to receive appropriate medications, for example, and three-fourths of children with severe mental health problems are not evaluated or treated. The Fund partnered with a number of organizations to disseminate the chartbook, including the National Initiative for Children's Healthcare Quality, the American Academy of Pediatrics, and others. The chartbook has also received attention in the United Kingdom: Leatherman was invited to meet with advisors to Prime Minister Tony Blair to discuss the implications of the chartbook's findings for the U.K.

Leatherman and McCarthy are now at work on a third chartbook that will focus specifically on the elderly. The team will also launch a new series of "quality snapshots," to be published twice a year, that will maintain a spotlight on key quality-of-care issues.