which health care is practiced are changing and that therefore quality improvement should also be changing. One impediment is the belief among individual physicians that clinical judgment dominates. The notion that the two have been “divorced” is a depiction of perspectives from 10 to 20 years ago. Kramer now believes the fields are moving in the right direction, albeit slowly.

Another person asked about the relationship between cost-effectiveness and quality of life. Kramer responded that the two are separate but connected. Although quality of life remains difficult to capture, increasing attention is being paid to quality of life and more economists and quality-of-life experts are being incorporated into study teams.

The IOM Forum on the Science of Health Care Quality Improvement and Implementation should focus on the urgent need to build a science base for quality improvement, said Clancy, in response to a question about what this group can do to really change health care.

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