the imperatives for change, the emerging tools that make transformation possible, the vision for a continuously learning health care system, and the path for achieving this vision. The title of the report underscores that care that is based on the best available evidence, takes appropriate account of individual preferences, and is delivered reliably and efficiently—best care—is possible today, and also is generally less expensive than the less effective, less efficient care that is now too commonly provided.

The foundation for a learning health care system is continuous knowledge development, improvement, and application. Although unprecedented levels of information are available, patients and clinicians often lack access to guidance that is relevant, timely, and useful for the circumstances at hand. Overcoming this challenge will require applying computing capabilities and analytic approaches to develop real-time insights from routine patient care, disseminating knowledge using new technological tools, and addressing the regulatory challenges that can inhibit progress.

Engaged patients are central to an effective, efficient, and continuously learning system. Clinicians supply information and advice based on their scientific expertise in treatment and intervention options, along with potential outcomes, while patients, their families, and other caregivers bring personal knowledge on the suitability—or lack thereof—of different treatments for the patient’s circumstances and preferences. Both perspectives are needed to select the right care option for the patient. Communication and collaboration among patients, their families, and care teams are needed to fully address the issues affecting patients.

Health care payment policies strongly influence how care is delivered, whether new scientific insights and knowledge about best care are diffused broadly, and whether improvement initiatives succeed. New models of paying for care and organizing care delivery are emerging to improve quality and value. While evidence is conflicting on which payment models might work best and under what circumstances, it is clear that high-value care requires structuring incentives to reward the best outcomes for patients.

Finally, the culture of health care is central to promoting learning at every level. Creating continuously learning organizations that generate and transfer knowledge from every patient interaction will require systematic problem solving; the application of systems engineering techniques; operational models that encourage and reward sustained quality and improved patient outcomes; transparency on cost and outcomes; and strong leadership and governance that define, disseminate, and support a vision of continuous improvement.

Achieving the vision of continuously learning health care will depend on broad action by the complex network of individuals and organizations that make up the current health care system. Missed opportunities for better health care have real human and economic impacts. If the care in



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