treatment of patients who do not have coexisting health problems. Thus, it is clearly not possible to base all care on sound scientific evidence, and certainly not exclusively on randomized controlled trials, which narrowly define study populations and exclude or control for factors that are inevitably relevant in real-world care settings. Nonetheless, the committee believes health care organizations and professionals could do a far better job than they do today in determining the most appropriate therapies on the basis of the strength of the scientific evidence; the stakes involved; clinical judgment; and, especially where the evidence is equivocal, shared patient and clinician decision making. In the ideal system of the future, the knowledge base about effective care and its use in health care settings will constantly expand through improved methods of accessing, summarizing, and assessing information and making it available at the point of care for the patient.

Knowing which services are likely to be effective also requires that health care systems continuously monitor the results of the care they provide and use that information to improve care for all patients. At a minimum, health care practitioners and organizations could be far more reflective and systematic than is generally the case today in studying their own patterns of care and outcomes, a vision that Codman (1914) had nearly a century ago when he recommended that all surgeons and hospitals carefully follow their patients after discharge from the hospital to learn whether the treatment they had received had been helpful.

Patient-Centeredness

This aim focuses on the patient’s experience of illness and health care and on the systems that work or fail to work to meet individual patients’ needs. Similar terms are person-centered, consumer-centered, personalized, and individualized. Like these terms, patient-centered encompasses qualities of compassion, empathy, and responsiveness to the needs, values, and expressed preferences of the individual patient.

Patients and their families are now better educated and informed about their health care than ever before. As noted earlier, the explosive growth in the use of the Internet by Americans of all ages (National Public Radio Online, 2000) includes intense interest in health information (Brown, 1998; Cyber Dialogue, 2000). In an October 1998 survey of Internet users, 27 percent of female and 15 percent of male Internet users said that they accessed medical information weekly or daily (Eysenbach et al., 1999; Georgia Tech Research Corporation, 1998). Increasingly, individuals make many of their own decisions about diagnosis and treatment and bring information to their physicians with the expectation of help in interpreting or judging its value for themselves. These new health care consumers represent new opportunities for responding to patient needs and reestablishing clinician-patient relationships that are at the heart of good health care.

Many patients have expressed frustration with their inability to participate in



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