The Patient Protection and Affordable Care Act (herein known as the Affordable Care Act [ACA]) was signed into law on March 23, 2010. Several provisions of the law went into effect in 2010 (including requirements to cover children up to age 26 and to prohibit insurance companies from denying coverage based on preexisting conditions for children). Other provisions will go into effect during 2014, including the requirement for all individuals to purchase health insurance. In 2014, insurance purchasers will be allowed, but not obliged, to buy their coverage through newly established health insurance exchanges (HIEs)--marketplaces designed to make it easier for customers to comparison shop among plans and for low and moderate income individuals to obtain public subsidies to purchase private health insurance. The exchanges will offer a choice of private health plans, and all plans must include a standard core set of covered benefits, called essential health benefits (EHBs). The Department of Health and Human Services requested that the Institute of Medicine (IOM) recommend criteria and methods for determining and updating the EHBs. In response, the IOM convened two workshops in 2011 where experts from federal and state government, as well as employers, insurers, providers, consumers, and health care researchers were asked to identify current methods for determining medical necessity, and share decision-making approaches to determining which benefits would be covered and other benefit design practices. Essential Health Benefits summarizes the presentations in this workshop. The committee's recommendations will be released in a subsequent report.

As the United States devotes extensive resources to health care, evaluating how successfully the U.S. system delivers high-quality, high-value care in an equitable manner is essential. At the request of Congress, the Agency for Healthcare Research and Quality (AHRQ) annually produces the National Healthcare Quality Report (NHQR) and the National Healthcare Disparities Report (NHDR). The reports have revealed areas in which health care performance has improved over time, but they also have identified major shortcomings. After five years of producing the NHQR and NHDR, AHRQ asked the IOM for guidance on how to improve the next generation of reports. The IOM concludes that the NHQR and NHDR can be improved in ways that would make them more influential in promoting change in the health care system. In addition to being sources of data on past trends, the national healthcare reports can provide more detailed insights into current performance, establish the value of closing gaps in quality and equity, and project the time required to bridge those gaps at the current pace of improvement. Table of Contents Front Matter Summary 1 Introduction 2 Re-Envisioning the NHQR and NHDR 3 Updating the Framework for the NHQR and NHDR 4 Adopting a More Quantitative and Transparent Measure Selection Process 5 Enhancing Data Resources 6 Improving Presentation of Information 7 Implementing Recommended Changes Acronyms Appendix A: Previous IOM Recommendations for the National Healthcare Reports Appendix B: Key Findings of the NHQRs and NHDRs Appendix C: Previous Conceptual Framework Appendix D: Measurement Opportunities for the Framework's Components of Quality Care Appendix E: HHS Interagency Workgroup for the NHQR and NHDR Appendix F: The Expected Population Value of Quality Indicator Reporting (EPV-QIR): A Framework for Prioritizing Healthcare Performance Measurement Appendix G: IOM Subcommittee on Standardized Collection of Race/Ethnicity Data for Healthcare Quality Improvement: Recommendations Appendix H: Additional Assessments of Data Presentation in the NHQR and NHDR Appendix I: An Illustrative Funding Example Appendix J: Committee Member and Staff Biographies

The goal of eliminating disparities in health care in the United States remains elusive. Even as quality improves on specific measures, disparities often persist. Addressing these disparities must begin with the fundamental step of bringing the nature of the disparities and the groups at risk for those disparities to light by collecting health care quality information stratified by race, ethnicity and language data. Then attention can be focused on where interventions might be best applied, and on planning and evaluating those efforts to inform the development of policy and the application of resources. A lack of standardization of categories for race, ethnicity, and language data has been suggested as one obstacle to achieving more widespread collection and utilization of these data. Race, Ethnicity, and Language Data identifies current models for collecting and coding race, ethnicity, and language data; reviews challenges involved in obtaining these data, and makes recommendations for a nationally standardized approach for use in health care quality improvement.

Medical residents in hospitals are often required to be on duty for long hours. In 2003 the organization overseeing graduate medical education adopted common program requirements to restrict resident workweeks, including limits to an average of 80 hours over 4 weeks and the longest consecutive period of work to 30 hours in order to protect patients and residents from unsafe conditions resulting from excessive fatigue. Resident Duty Hours provides a timely examination of how those requirements were implemented and their impact on safety, education, and the training institutions. An in-depth review of the evidence on sleep and human performance indicated a need to increase opportunities for sleep during residency training to prevent acute and chronic sleep deprivation and minimize the risk of fatigue-related errors. In addition to recommending opportunities for on-duty sleep during long duty periods and breaks for sleep of appropriate lengths between work periods, the committee also recommends enhancements of supervision, appropriate workload, and changes in the work environment to improve conditions for safety and learning. All residents, medical educators, those involved with academic training institutions, specialty societies, professional groups, and consumer/patient safety organizations will find this book useful to advocate for an improved culture of safety. Table of Contents Front Matter Abstract Summary 1 Background and Overview 2 Current Duty Hours and Monitoring Adherence 3 Adapting the Resident Educational and Work Environment to Duty Hour Limits 4 Improving the Resident Learning Environment 5 Impact of Duty Hours on Resident Well-Being 6 Contributors to Error in the Training Environment 7 Strategies to Reduce Fatigue Risk in Resident Work Schedules 8 System Strategies to Improve Patient Safety and Error Prevention 9 Resources to Implement Improvements for Patient Safety and Resident Training Appendix A Statement of Task Appendix B Comparison of Select Scheduling Possibilities Under Committee Recommendations and Under 2003 ACGME Duty Hour Rules Appendix C International Experiences Limiting Resident Duty Hours Appendix D Glossary, Acronyms, and Abbreviations Appendix E Committee Member Biographies Appendix F Public Meeting Agendas Index