Patients Charting the Course Citizen Engagement and the Learning Health System: Workshop Summary (2011) / Chapter Skim
Currently Skimming:
1 The Learning Health System
1 The Learning Health System
Pages 33-46
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From page 33... ...
It implies that careful listening should be the starting point for every patient encounter. And it suggests that the success of and innovations in healthcare delivery should depend on direct consumer engagement in the design of healthcare models and their aims.
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From page 34... ...
At $2.5 trillion, $7,500 a person, and 17 percent of gross domestic product in 2009, that investment totaled twice the expenditure levels of other industrial countries, yet the United States consistently rates poorly (currently 37th) on overall health system performance and on key component measures such as infant mortality (39th)
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From page 35... ...
For each of these elements, the workshops have explored priorities and approaches integral to harnessing interests and expertise across healthcare sectors to drive improvements in the value of medical care delivered in the United States. The following publications summarizing these workshops offer perspectives on the issues involved, and identify priorities and projects in need of cooperative stakeholder engagement: • The Learning Healthcare System (2007)
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From page 36... ...
Across the range of issues engaged in the Learning Health System workshops and the Innovation Collaboratives, greater public interest and patient engagement have emerged as essential and potentially transformative elements for driving health system change. Empowering and supporting the public in these new roles requires the creation of a healthcare culture that supports continuous improvement and learning; elicits and considers public perspectives on key healthcare issues; and better characterizes needed partnerships, resources, tools, and communication approaches.
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From page 37... ...
In terms of both effectiveness and efficiency, the nation's P healthcare system is underperforming. The United States has the highest per capita health expenditures -- twice the average for other developed countries -- yet consistently rates no better than the middle tier of developed nations on such key indicators as infant mortality, life expectancy, and overall health system performance.
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From page 38... ...
Emerging from the Roundtable's work on reducing healthcare costs and improving outcomes and on advancing the infrastructure required for comparative effectiveness research (CER) are many immediate opportunities to improve the overall value of health care delivered (IOM, 2010c, 2011b)
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From page 39... ...
Underscoring the importance of developing the point of care as a knowledge engine, provisions in the ACA also target healthcare delivery systems as a vehicle for driving improvements in system performance and efficiency. Building the capacity to learn as a natural outgrowth of clinical care will foster a health system that continually improves the quality of health care delivered.
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From page 40... ...
While some systems differ in their financial infrastructure, designed as either integrated, prepaid, or privately insured, others specialize in innovation, incentive schemes, or primary care and other specialties. For example, the Veterans Health Administration, an integrated, prepaid, wholly central system, differs largely from privatized health coverage programs such as health maintenance or preferred provider organizations, yet both are successful in their own light.
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From page 41... ...
Moreover, it has been estimated that about one-third of healthcare expenditures do not improve patient outcomes (McGlynn et al., 2003; OECD, 2009; Truffer et Life expectancy in years 84 JPN ISL 82 CHE AUS ITA FRA ESP CAN SUE NOR NZL DEU NLD 80 FIN KOR LUX IRL PRT USA AUT GRC GBR 78 BEL DNK CZE 76 POL MEX R² = 0.55 SVK 74 HUN TUR 72 0 2000 4000 6000 8000 Health spending per capita (USD PPP) FIGURE 1-1 Healthcare outcomes in the United States compared with other countries.
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From page 42... ...
Still, addressing healthcare expenditures is only one facet of the larger issue of healthcare reform. Classic problems of overuse, underuse, and misuse of interventions still exist as critical challenges for U.S.
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From page 43... ...
A Vision of a Learning Health System The charter of the Roundtable on Value & Science-Driven Health Care describes a learning health system as a system designed to generate and apply the best evidence for collaborative healthcare choices for each patient and provider; to drive the process of discovery as a natural outgrowth of patient care; and to ensure innovation, quality, safety, and value in health care. In working toward this vision, discussions in previous efforts of the Roundtable and, more generally, the IOM have identified key features of a learning health system (Box 1-2)
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From page 44... ...
Science generates evidence that informs and shapes care delivery, and policy encompasses the choices individuals make that define the rules of the game. Together, these three drivers make a holistic, systematic perspective on health care possible.
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From page 45... ...
The official establishment of the Office of the National Coordinator for Health Information Technology and the Federal Coordinating Council for Comparative Effectiveness Research has proven instrumental in fostering the adoption of electronic health records and the assessment of research on health care treatments and strategies, respectively. Setting the Agenda Moving forward with a learning health system will require identifying, understanding, and assessing both challenges and opportunities.
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From page 46... ...
2009. Initial national priorities for comparative effectiveness research.
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