This report from the Institute of Medicine describes how U.S. health care could achieve much improved health care outcomes at lower costs.  The report finds that as much as one-third of our current health care expenditures (an estimated $750 billion in 2009) are unnecessary, duplicative, and wasteful.  At the same time, the current U.S. health care system had an estimated 75,000 needless deaths if every state in the U.S. had delivered care at the same level of safety and quality as the best performing states.

The report describes the following characteristics of a continuously learning health care system:

  • Real-time access to knowledge: continuously and reliably captures, curates, and delivers the best available evidence to guide, support, tailor, and improve clinical decision making and care safety and quality
  • Digital capture of the care experience: captures the care experience on digital platforms for real-time generation and application of knowledge for care improvement
  • Engaged, empowered patients: anchored on patient needs and perspectives and promotes the inclusion of patients, families, and other caregivers as vital members of the continuously learning care team
  • Incentives aligned for value: incentives are actively aligned to encourage continuous improvement, identify and reduce waste, and reward high-value care
  • Full transparency: systematically monitors the safety, quality, processes, prices, costs, and outcomes of care, and makes information available for care improvement and informed choices and decision making by clinicians, patients, and their families
  • Leadership-instilled culture of learning: stewarded by leadership committed to a culture of teamwork, collaboration, and adaptability in support of continuous learning as a core aim
  • Supportive systems competencies: complex care operations and processes are constantly refined through ongoing team training and skill building, systems analysis and information development, and creation of the feedback loops for continuous teaching and system improvement


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