Over the past century, the health of the U.S. population has improved dramatically. Life expectancy has increased by almost 60 percent, maternal mortality has declined by almost 99 percent, and infant mortality has dropped by more than 90 percent (Guyer et al., 2000). While these increases in survival have been due to many factors, such as public health efforts (CDC, 1999, 2011b), technical improvements in health care have played an increasingly significant role. The health care field today has a better understanding of the causes of individual diseases, as well as new techniques, treatments, and interventions for managing these diseases.
At the same time, the resulting complexity has implications for both patients and providers. The complexity of different health care options—in terms of treatments, diagnostics, and care management—increases the difficulty of the care decisions patients face. When making these decisions, patients often lack clear and understandable information on their options, the risks and benefits of each, and the actions they can take in managing their condition. For those working in the health care enterprise, the current complexity of clinical decision making challenges human cognitive capacity to manage information. One notable example of this complexity is advances in genetics, which offer unprecedented opportunities for personalized treatments but add to the already expansive array of clinical considerations for patients and providers. Moreover, administrative complexities, from complicated workflows to fragmented financing, add inefficiency and waste at the system level and prevent health care from centering its efforts on the patients it serves.
Advances in clinical knowledge have allowed for dramatic improvements in the health of the U.S. population. One area in which these improvements are notable is the treatment of heart attack, or myocardial infarction. During most of the twentieth century, little could be done for a patient who had just suffered a heart attack. The most common intervention was to prescribe weeks of bed rest in the hope that the patient would heal on his or her own. Some patients did heal, but many lost skeletal muscle mass and the ability to care for themselves after the prolonged time in bed (Certo, 1985).
Recent decades have seen a transformation in cardiac care. Today, diagnostics recognize the different types of heart attacks, allowing for customized treatments for patients. Pharmaceutical therapies, such as beta-blockers and thrombolytics, improve survival and reduce the chances of subsequent heart attacks for many groups of patients. Finally, interventions such as percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) can reopen or bypass blockages in blood vessels and