Best Care at Lower Cost The Path to Continuously Learning Health Care in America (2013) / Chapter Skim
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5 A Continuously Learning Health Care System
5 A Continuously Learning Health Care System
Pages 133-146
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From page 133... ...
. On the measurement front, the Joint Commission established a performance measurement program for hospitals, including in its measures the level of prescribing of beta-blockers after heart attack hospitalizations; the Health Care Financing Administration (now the Centers for Medicare & Medicaid Services)
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From page 134... ...
. The health care environment itself places unnecessary burdens on health care professionals, siloing care activities, insufficiently meeting patient needs, and failing to disseminate knowledge broadly.
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From page 135... ...
Improving quality and controlling costs requires moving from this unsustainable and flawed organizational arrangement to a system that gains knowledge from every care delivery experience and is engineered to promote continuous improvement. In short, the nation needs a health care system that learns, and the committee believes a learning health care system is both possible and necessary for the nation today.
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From page 136... ...
Moreover, the quality of care depends not only on the effectiveness of a given treatment but also on the way that treatment is delivered. Thus it is necessary to build knowledge about different methods of delivering care and provide clinicians and health care organizations with tools to improve care processes.
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From page 137... ...
The people served by the health care system -- patients, caregivers, and the public -- must serve as both the system's unwavering focus and its fully engaged agents for change. This implies that patient perspectives and needs should be fundamental in the design of health care delivery and in its daily operations.
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From page 138... ...
Patient-Clinician Partnerships Engaged, empowered patients -- A learning health care system is 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 Incentives aligned for value -- A learning health care system has incentives actively aligned to encourage continuous improvement, identify and reduce waste, and reward high-value care.
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From page 139... ...
The increasing rate at which new interventions and medical technologies are developed, along with new data on individual variations in conditions and their optimum treatment, requires the development of a new engine for generating clinical knowledge. An array of clinical effectiveness research strategies, ranging from controlled clinical trials to research drawn from clinical practice, can provide the evidence needed to guide high-quality patient care.
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From page 140... ...
In a learning health care system, the data, information, and knowledge produced from both biomedical research and clinical encounters is captured, stored, exchanged, and managed using tools that are reliable and secure, and that support continuous quality improvement and health management for a population of patients. New technological tools are used to translate evidence and guidelines into a format that is usable by clinicians and integrated seamlessly at the point of care, such as through clinical decision support software.
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From page 141... ...
System analysis tools such as root cause analyses and standard protocols for clinical processes are used to identify and overcome human error and support consistent performance. Teamwork and coordination among professionals help integrate care and reduce adverse events at the interfaces between different care processes.
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From page 142... ...
Transparency in this regard empowers providers to improve their performance and helps organizations eliminate waste and improve care processes. Further, patients and consumers lack the information they need to make health care decisions, from which course of medical treatment to pursue to the selection of health care providers.
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From page 143... ...
These time pressures, stresses, and inefficiencies limit clinicians from focusing on additional tasks and initiatives, even those that have important goals for improving care. Similarly, professionals working in health care organizations are overwhelmed by the sheer volume of initiatives currently under way to improve various aspects of the care process, initiatives that appear to be unconnected with the organization's priorities.
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From page 144... ...
2003. National and state trends in quality of care for acute myocardial infarction between 1994-1995 and 1998-1999: The Medicare health care quality im provement program.
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From page 145... ...
1999. 1999 update: ACC/AHA guidelines for the management of patients with acute myocardial infarction: Executive summary and recommendations: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Commit tee on Management of Acute Myocardial Infarction)
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