Today's health care providers have more research findings and more technology available to them than ever before. Yet recent reports have raised serious doubts about the quality of health care in America.

Crossing the Quality Chasm makes an urgent call for fundamental change to close the quality gap. This book recommends a sweeping redesign of the American health care system and provides overarching principles for specific direction for policymakers, health care leaders, clinicians, regulators, purchasers, and others. In this comprehensive volume the committee offers:

• A set of performance expectations for the 21st century health care system.
• A set of 10 new rules to guide patient-clinician relationships.
• A suggested organizing framework to better align the incentives inherent in payment and accountability with improvements in quality.
• Key steps to promote evidence-based practice and strengthen clinical information systems.

Analyzing health care organizations as complex systems, Crossing the Quality Chasm also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change.

Nurses should be fully engaged with other health professionals and assume leadership roles in redesigning care in the United States. To ensure its members are well-prepared, the profession should institute residency training for nurses, increase the percentage of nurses who attain a bachelor's degree to 80 percent by 2020, and double the number who pursue doctorates. Furthermore, regulatory and institutional obstacles-including limits on nurses' scope of practice-should be removed so that the health system can reap the full benefit of nurses' training, skills, and knowledge in patient care.

In this book, the Institute of Medicine makes recommendations for an action-oriented blueprint for the future of nursing.

• The evolving role of EMS as an integral component of the overall health care system.

• EMS system planning, preparedness, and coordination at the federal, state, and local levels.

• EMS funding and infrastructure investments.

• EMS workforce trends and professional education.

• EMS research priorities and funding.

Emergency Medical Services is one of three books in the Future of Emergency Care series. This book will be of particular interest to emergency care providers, professional organizations, and policy makers looking to address the deficiencies in emergency care systems.

Licensed nurses and unlicensed nursing assistants are critical participants in our national effort to protect patients from health care errors. The nature of the activities nurses typically perform â€" monitoring patients, educating home caretakers, performing treatments, and rescuing patients who are in crisis â€" provides an indispensable resource in detecting and remedying error-producing defects in the U.S. health care system.

During the past two decades, substantial changes have been made in the organization and delivery of health care â€" and consequently in the job description and work environment of nurses. As patients are increasingly cared for as outpatients, nurses in hospitals and nursing homes deal with greater severity of illness. Problems in management practices, employee deployment, work and workspace design, and the basic safety culture of health care organizations place patients at further risk.

This newest edition in the groundbreaking Institute of Medicine Quality Chasm series discusses the key aspects of the work environment for nurses and reviews the potential improvements in working conditions that are likely to have an impact on patient safety.

Resources for Teaching Middle School Science, developed by the National Science Resources Center (NSRC), is a valuable tool for identifying and selecting effective science curriculum materials that will engage students in grades 6 through 8. The volume describes more than 400 curriculum titles that are aligned with the National Science Education Standards.

This completely new guide follows on the success of Resources for Teaching Elementary School Science, the first in the NSRC series of annotated guides to hands-on, inquiry-centered curriculum materials and other resources for science teachers.

The curriculum materials in the new guide are grouped in five chapters by scientific areaâ€"Physical Science, Life Science, Environmental Science, Earth and Space Science, and Multidisciplinary and Applied Science. They are also grouped by typeâ€"core materials, supplementary units, and science activity books.

Each annotation of curriculum material includes a recommended grade level, a description of the activities involved and of what students can be expected to learn, a list of accompanying materials, a reading level, and ordering information.

The curriculum materials included in this book were selected by panels of teachers and scientists using evaluation criteria developed for the guide. The criteria reflect and incorporate goals and principles of the National Science Education Standards. The annotations designate the specific content standards on which these curriculum pieces focus.

In addition to the curriculum chapters, the guide contains six chapters of diverse resources that are directly relevant to middle school science. Among these is a chapter on educational software and multimedia programs, chapters on books about science and teaching, directories and guides to science trade books, and periodicals for teachers and students.

Another section features institutional resources. One chapter lists about 600 science centers, museums, and zoos where teachers can take middle school students for interactive science experiences. Another chapter describes nearly 140 professional associations and U.S. government agencies that offer resources and assistance.

Authoritative, extensive, and thoroughly indexedâ€"and the only guide of its kindâ€"Resources for Teaching Middle School Science will be the most used book on the shelf for science teachers, school administrators, teacher trainers, science curriculum specialists, advocates of hands-on science teaching, and concerned parents.

Training Physicians for Public Health Careers focuses on the critical roles that physicians play in maintaining and strengthening the public health system, identifies what these physicians need to know to engage in effective public health actions, explores the kinds of training programs that can be used to prepare physicians for public health roles, and examines how these training programs can be funded. Medical schools, schools of public health, health care and public health care professionals, medical students and students of public health will find this of special interest.

In Unequal Treatment, a panel of experts documents this evidence and explores how persons of color experience the health care environment. The book examines how disparities in treatment may arise in health care systems and looks at aspects of the clinical encounter that may contribute to such disparities. Patients' and providers' attitudes, expectations, and behavior are analyzed.

How to intervene? Unequal Treatment offers recommendations for improvements in medical care financing, allocation of care, availability of language translation, community-based care, and other arenas. The committee highlights the potential of cross-cultural education to improve providerâ€"patient communication and offers a detailed look at how to integrate cross-cultural learning within the health professions. The book concludes with recommendations for data collection and research initiatives. Unequal Treatment will be vitally important to health care policymakers, administrators, providers, educators, and students as well as advocates for people of color.

Priorities for the National Vaccine Plan examines the extraordinarily complex vaccine enterprise, from research and development of new vaccines to financing and reimbursement of immunization services. The book makes recommendations about priority actions in the update to the National Vaccine Plan that are intended to achieve the objectives of disease prevention and enhancement of vaccine safety. It is centered on the plan's five goals in the areas of vaccine development, safety, communication, supply and use, and global health.

Historically, drug repurposing has been largely an unintentional, serendipitous process that took place when a drug was found to have an offtarget effect or a previously unrecognized on-target effect that could be used for identifying a new indication. Perhaps the most recognizable example of such a successful repositioning effort is sildenafil. Originally developed as an anti-hypertensive, sildenafil, marketed as Viagra and under other trade names, has been repurposed for the treatment of erectile dysfunction and pulmonary arterial hypertension. Viagra generated more than $2 billion worldwide in 2012 and has recently been studied for the treatment of heart failure.

Given the widespread interest in drug repurposing, the Roundtable on Translating Genomic-Based Research for Health of the Institute of Medicine hosted a workshop on June 24, 2013, in Washington, DC, to assess the current landscape of drug repurposing activities in industry, academia, and government. Stakeholders, including government officials, pharmaceutical company representatives, academic researchers, regulators, funders, and patients, were invited to present their perspectives and to participate in workshop discussions. Drug Repurposing and Repositioning is the summary of that workshop. This report examines enabling tools and technology for drug repurposing; evaluates the business models and economic incentives for pursuing a repurposing approach; and discusses how genomic and genetic research could be positioned to better enable a drug repurposing paradigm.

Understanding how and why teen motor vehicle crashes happen is key to developing countermeasures to reduce their number. Applying this understanding to the development of prevention strategies holds significant promise for improving safety but many of these efforts are thwarted by a lack of evidence as to which prevention strategies are most effective. Preventing Teen Motor Crashes presents data from a multidisciplinary group that shared information on emerging technology for studying, monitoring, and controlling driving behavior. The book provides an overview of the factual information that was presented, as well as the insights that emerged about the role researchers can play in reducing and preventing teen motor crashes.

Detailed plans for the NCS were developed by 2007 and reviewed by a National Research Council / Institute of Medicine panel. At that time, sample recruitment for the NCS Main Study was scheduled to begin in 2009 and to be completed within about 5 years. However, results from the initial seven pilot locations, which recruited sample cases in 2009-2010, indicated that the proposed household-based recruitment approach would be more costly and time consuming than planned. In response, the Program Office implemented a number of pilot tests in 2011 to evaluate alternative recruitment methods and pilot testing continues to date.

At the request of Congress, The National Children's Study 2014 reviews the revised study design and proposed methodologies for the NCS Main Study. This report assesses the study's plan to determine whether it is likely to produce scientifically sound results that are generalizable to the United States population and appropriate subpopulations. The report makes recommendations about the overall study framework, sample design, timing, content and need for scientific expertise and oversight.

The National Children's Study has the potential to add immeasurably to scientific knowledge about the impact of environmental exposures, broadly defined, on children\'s health and development in the United States. The recommendations of this report will help the NCS will achieve its intended objective to examine the effects of environmental influences on the health and development of American children.

Safety of Silicone Breast Implants presents a well-documented, thoughtful exploration of the safety of these devices, drawing conclusions from the available research base and suggesting further questions to be answered. This book also examines the sensitive issues surrounding women's decisions about implants. In reaching conclusions, the committee reviews:

• The history of the silicone breast implant and the development of its chemistry.
• The wide variety of U.S.-made implants and their regulation by the Food and Drug Administration.
• Frequency and consequences of local complications from implants.
• The evidence for and against links between implants and autoimmune disorders, connective tissue disease, neurological problems, silicone in breast milk, or a proposed new syndrome.
• Evidence that implants may be associated with lower frequencies of breast cancer.

Safety of Silicone Breast Implants provides a comprehensive, well-organized review of the science behind one of the most significant medical controversies of our time.

The Medical Follow-up Agency is a living tribute to the vision, energy, and effectiveness of Michael E. DeBakey, M.D. Dr. DeBakey created the idea for the agency, obtained the appropriate approvals, staffed its initial creation, and 50 years later, spoke on the occasion of its golden anniversary. This sequence of events must be unique in the history of veterans' health and medical research.

This book looks at worker safety in the changing workplace and the challenge of ensuring a supply of top-notch OSH professionals. Recommendations are addressed to federal and state agencies, OSH organizations, educational institutions, employers, unions, and other stakeholders.

The committee reviews trends in workforce demographics, the nature of work in the information age, globalization of work, and the revolution in health care deliveryâ€"exploring the implications for OSH education and training in the decade ahead.

The core professions of OSH (occupational safety, industrial hygiene, and occupational medicine and nursing) and key related roles (employee assistance professional, ergonomist, and occupational health psychologist) are profiled-how many people are in the field, where they work, and what they do. The book reviews in detail the education, training, and education grants available to OSH professionals from public and private sources.

The research plan for the NCS was developed from 2005 to 2007 in collaboration among the Interagency Coordinating Committee, the NCS Advisory Committee, the NCS Program Office, Westat, the Vanguard Center principal investigators, and federal scientists. The current design of the study, however, uses a separate pilot to assess quality of scientific output, logistics, and operations and a "Main Study" to examine exposure-outcome relationships. The NCS proposed the use of a multilayered cohort approach for the Main Study, which was one of the topics for discussion at the workshop that is the subject of this publication.

In the fall of 2012, NICHD requested that the Committee on National Statistics (CNSTAT) of the NRC and the IOM convene a joint workshop, to be led by CNSTAT. The workshop was to focus on issues related to the overall design (including the framework for implementation) of the NCS. The committee was provided a background paper which it used to select the challenges that were discussed at the workshop. Design of the National Children's Study: A Workshop Summary presents an overview of the workshop held on January 11, 2013. The publication includes summaries of the four sessions of the workshop, a list of participants, and the agenda.

The book covers three main areas:

• What do biological, behavioral, and social sciences contribute to our understanding of healthâ€"including cardiovascular, immune system and brain functioning, behaviors that influence health, the role of social networks and socioeconomic status, and more.
• What can we learn from applied research on interventions to improve the health of individuals, families, communities, organizations, and larger populations?
• How can we expeditiously translate research findings into application?

• The role and impact of the emergency department within the larger hospital and health care system.

• Patient flow and information technology.

• Workforce issues across multiple disciplines.

• Patient safety and the quality and efficiency of emergency care services.

• Basic, clinical, and health services research relevant to emergency care.

• Special challenges of emergency care in rural settings.

Hospital-Based Emergency Care is one of three books in the Future of Emergency Care series. This book will be of particular interest to emergency care providers, professional organizations, and policy makers looking to address the deficiencies in emergency care systems.

Over the past decade, lesbians have organized to call for attention to the health issues of this community, resulting in several federally funded research initiatives. This book offers a comprehensive view of what is known about lesbian health needs and what questions need further investigation, including:

• How do we define who is lesbian?
• Are there unique health issues for lesbians?
• Are lesbians at higher or lower risk for such health problems as AIDS, sexually transmitted diseases, breast cancer, mental disorders, and substance abuse?
• How does homophobia affect lesbian health and the funding of research on lesbian health?
• How do lesbian health needs fit into the health care system and the larger society?
• What risk and protective factors shape the physical and mental health of lesbians?

The book discusses how to determine which questions to ask about sexual orientation, the need to obtain information without violating privacy, the importance of considering racial and ethnic diversity in the study of lesbians, strategies for exchanging information among researchers and disseminating findings to the public, and mechanisms for supporting greater numbers of researchers.

Lesbian Health takes a frank look at the political pressures, community attitudes, and professional concerns uniquely affecting the study of lesbian health issues. The book explores many other issues including the potential for transferring findings in this field to other population groups, including other rare populations and women in general.

Because of complaints from returning Vietnam veterans about their own health and that of their children combined with emerging toxicologic evidence of adverse effects of phenoxy herbicides and TCDD, the National Academy of Sciences (NAS) was asked to perform a comprehensive evaluation of scientific and medical information regarding the health effects of exposure to Agent Orange, other herbicides used in Vietnam, and the various components of those herbicides, including TCDD. Updated evaluations are conducted every two years to review newly available literature and draw conclusions from the overall evidence.Veterans and Agent Orange: Update 2012 reviews peer-reviewed scientific reports concerning associations between health outcomes and exposure to TCDD and other chemicals in the herbicides used in Vietnam that were published in October 2010-September 2012 and integrates this information with the previously established evidence database. This report considers whether a statistical association with herbicide exposure exists, taking into account the strength of the scientific evidence and the appropriateness of the statistical and epidemiological methods used to detect the association; the increased risk of disease among those exposed to herbicides during service in the Republic of Vietnam during the Vietnam era; and whether there exists a plausible biological mechanism or other evidence of a causal relationship between herbicide exposure and the disease.

Sports-Related Concussions in Youth: Improving the Science, Changing the Culture reviews the science of sports-related concussions in youth from elementary school through young adulthood, as well as in military personnel and their dependents. This report recommends actions that can be taken by a range of audiences - including research funding agencies, legislatures, state and school superintendents and athletic directors, military organizations, and equipment manufacturers, as well as youth who participate in sports and their parents - to improve what is known about concussions and to reduce their occurrence. Sports-Related Concussions in Youth finds that while some studies provide useful information, much remains unknown about the extent of concussions in youth; how to diagnose, manage, and prevent concussions; and the short- and long-term consequences of concussions as well as repetitive head impacts that do not result in concussion symptoms.

The culture of sports negatively influences athletes' self-reporting of concussion symptoms and their adherence to return-to-play guidance. Athletes, their teammates, and, in some cases, coaches and parents may not fully appreciate the health threats posed by concussions. Similarly, military recruits are immersed in a culture that includes devotion to duty and service before self, and the critical nature of concussions may often go unheeded. According to Sports-Related Concussions in Youth, if the youth sports community can adopt the belief that concussions are serious injuries and emphasize care for players with concussions until they are fully recovered, then the culture in which these athletes perform and compete will become much safer. Improving understanding of the extent, causes, effects, and prevention of sports-related concussions is vitally important for the health and well-being of youth athletes. The findings and recommendations in this report set a direction for research to reach this goal.

Preventing Childhood Obesity provides a broad-based examination of the nature, extent, and consequences of obesity in U.S. children and youth, including the social, environmental, medical, and dietary factors responsible for its increased prevalence. The book also offers a prevention-oriented action plan that identifies the most promising array of short-term and longer-term interventions, as well as recommendations for the roles and responsibilities of numerous stakeholders in various sectors of society to reduce its future occurrence. Preventing Childhood Obesity explores the underlying causes of this serious health problem and the actions needed to initiate, support, and sustain the societal and lifestyle changes that can reverse the trend among our children and youth.