synthesis, comparative effectiveness research (CER), discovery, and evidence implementation on the health system and national levels (see Figure 2-1). Such a system is built at the patient level and scaled to the societal level.
Dr. Abernethy views the critical elements of a RLHS as being linked information, motivated individuals, and systems that are engaged to provide reliable integrated information. She expanded on the patient-centered perspective of a RLHS. “In order to have rapid-learning health care, we have to have rapid-learning health care around patients,” she stressed. “The care of the individual patient is informed by the care of people coming before, and his or her care also informs the care of people in the future in a circuitous way.” (See Box 2-1.)
For purposes of illustrating the way cancer care is currently delivered (i.e., in a data-poor and slow-learning environment), Dr. Abernethy discussed the care she recently gave one of her patients. This 37-year-old woman had newly diagnosed Stage IIIB melanoma. She was considering starting a family and wanted to know what adjuvant treatments might reduce her risk of death at five years, and how such treatment would affect her quality of life and ability to become pregnant. Although the National