TABLE 3.

Opportunities for Health and Quality as Defined by the Six IOM Aims and the Eight Population Segments

	Safe (No Harm)	Effective (No Needless Failures)	Efficient (No Waste)	Patient Centered (No Helplessness or Unjustified Routines)	Timely (No Needless Delays)	Equitable (No Unjustified Variation)
1. Healthy	Minimal and known risk from false positive or false negative screenings	Primary preventive actions and interventions; evidence-based screenings; evidence-based use of short-term medications	No administrative redundancy or excess; no ineffective testing and screening	Lifestyle reflects informed preferences; 24/7 access to clinical guidance and information; services reflect patients' goals, concerns, and situations	Convenient and responsive scheduling; no waiting for health care services; immediate access to results of screenings; immediate access to clinical guidance and information	Equal access to health care services; equal access to healthy lifestyle choices, health education, and maintenance; opportunities tailored to situation; CLASa
2.Maternal and infant health	Minimal and known risk from false positive or false negative screenings; no perinatal or maternal injury or death from health care; minimal infertility; no undesired pregnancy	Evidence-based prenatal care, delivery, and postnatal care; evidence-based primary and secondary preventive interventions for both mother and child	Backup experts available; planned rapid transfer of seriously ill newborns; evidence-based fertility services	Informed and shared decisions reflecting parents' values (constrained by legal limits)	Convenient and responsive scheduling, no waiting for health care services; immediate access to results of tests; immediate access to clinical guidance and other information; timely education and support; rapid transfers when needed	Equal access to health care services; equal access to healthy lifestyle choices, health education, and maintenance; opportunities tailored to situation; CLASa; equal opportunity for important treatments
3. Acutely ill but curable	No medication errors; no surgical errors; minimal and known risk of complications of diagnosis/treatment	Evidence-based diagnosis and treatment; effective symptom prevention and relief	No administrative redundancy or delays; no redundant services	Shared decision making; patient and family informed; care in best setting for patient	Little waiting; adequate notice of expected events	CLASa; equal opportunity for important treatments
4. Chronic conditions, generally normal function	Minimal and known risk from false positive and false negative screenings; minimal and known risk from diagnosis/treatment options; no medication errors	Evidence-based secondary and primary prevention and rehabilitation	Care continuum management across multiple providers	Lifestyle reflecting informed decisions; self-monitored care; patient and family education	Little waiting for health care services; adequate notice of expected events; convenient and responsive scheduling; immediate access to test results, clinical guidance, and other information; short time to diagnosis and treatment for positive screens and worsening conditions	CLASa; equal opportunity for important treatments
5. Stable, significant disability (often not elderly)	No medication or transfer errors; reliable, skilled, responsive personal care; safe environment, including safe equipment; safe and timely transportation	Reliable personal care; effective rehabilitation; appropriate prevention screenings and interventions	Community-based services; regular assessment and care planning; care coordinated among all providers and personal caregivers; family caregiver training and support	Self-care to degree possible; caregiver services and support	Timely mobility devices; quick response to intercurrent problems	CLASa; equal opportunity for important treatments; no bias due to disability
6. Short period of decline near death (mostly cancer)	Avoiding interventions with net harm; adherence to negotiated treatment decisions; trained staff	Pain and symptom prevention and relief; emotional and spiritual support; consideration of survival limits in decision making	Home-based care; avoidance of unduly burdensome treatments	Care in accord with preferences; self-directed life closure; advance care planning; bereavement support; life closure counseling and support	Home-based care; 24/7 on-call team with rapid response to home for crises	CLASa; equal opportunity for important treatments and supportive services; no bias due to personal characteristics
7. Exacerbations, organ system failure	No medication errors; safe medical equipment; safe environment; avoiding interventions with net harm	Prevention of exacerbations and aggressive treatment of early exacerbations; monitoring to prevent exacerbations	Care plan tailored to living situation and survival limits, including trials of treatment; prevention of exacerbations	Decisions in accord with informed preferences, including advance care planning for contingencies; 24/7 access to care; bereavement support	Rapid response to home for crises; immediate access to medical guidance	CLASa; equal opportunity for important treatments and supportive services; no bias due to personal characteristics
8. Long dwindling course (mostly frailty and dementia)	Safe environment; no pressure ulcers, restraints, or avoidable injury from falls; minimal medication adverse effects; no transfer injuries	Home-based care; nutritional support; reliable facility care when needed; support for caregivers; appropriate preventive services; comfort and respect	No unwarranted medical treatments; services in accordance with advance care plan	Advance care planning consistent with patient's wishes; resolution of family issues; support of family caregivers	Home evaluation and treatment available promptly; 24/7 rapid response to home for crises	CLASa; equal opportunity for important treatments; no bias due to personal characteristics

^aCLAS = culturally and linguistically appropriate services.