THE NATIONAL ACADEMIES PRESS This PDF is available at http://nap.edu/13444 SHARE Best Care at Lower Cost: The Path to Continuously Learning Health Care in America (2013) DETAILS 436 pages | 6 x 9 | HARDBACK ISBN 978-0-309-26073-2 | DOI 10.17226/13444 CONTRIBUTORS GET THIS BOOK Mark Smith, Robert Saunders, Leigh Stuckhardt, and J. Michael McGinnis, Editors; Committee on the Learning Health Care System in America; Institute of Medicine FIND RELATED TITLES SUGGESTED CITATION Institute of Medicine 2013. Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. Washington, DC: The National Academies Press. https://doi.org/10.17226/13444. 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Best Care at Lower Cost: The Path to Continuously Learning Health Care in America THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. Support for this report was provided by the Blue Shield of California Foundation; the Charina Endowment Fund; and the Robert Wood Johnson Foundation. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. Library of Congress Cataloging-in-Publication Data Best care at lower cost : the path to continuously learning health care in America / Committee on the Learning Health Care System in America, The Institute of Medicine ; Mark Smith ... [et al.], editors. p. ; cm. Includes bibliographical references. ISBN 978-0-309-26073-2 (hardcover) — ISBN 978-0-309-26074-9 (pdf) I. Smith, Mark D., M.D. II. Institute of Medicine (U.S.). Committee on the Learning Health Care System in America. [DNLM: 1. Delivery of Health Care—economics—United States. 2. Costs and Cost Analysis—United States. 3. Efficiency, Organizational—economics— United States. 4. Quality of Health Care—economics—United States. W 84 AA1] 368.38′200973—dc23 2012040484 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2013 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: IOM (Institute of Medicine). 2013. Best care at lower cost: The path to continuously learning health care in America. Washington, DC: The National Academies Press. Copyright National Academy of Sciences. All rights reserved. Best Care at Lower Cost: The Path to Continuously Learning Health Care in America “Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe Advising the Nation. Improving Health. Copyright National Academy of Sciences. All rights reserved. Best Care at Lower Cost: The Path to Continuously Learning Health Care in America The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Acad- emy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engi- neers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineer- ing programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is presi- dent of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Insti- tute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org Copyright National Academy of Sciences. All rights reserved. Best Care at Lower Cost: The Path to Continuously Learning Health Care in America COMMITTEE ON THE LEARNING HEALTH CARE SYSTEM IN AMERICA MARK D. SMITH (Chair), President and Chief Executive Officer, California HealthCare Foundation, Oakland JAMES P. BAGIAN, Professor of Engineering Practice, University of Michigan, Ann Arbor ANTHONY S. BRYK, President, Carnegie Foundation for the Advancement of Teaching, Stanford, CA GAIL H. CASSELL, Former Vice President, Scientific Affairs, Eli Lilly and Company, Carmel, IN JAMES B. CONWAY, Senior Fellow, Institute for Healthcare Improvement, Boston, MA HELEN B. DARLING, President, National Business Group on Health, Washington, DC T. BRUCE FERGUSON, JR., Professor and Inaugural Chairman, Department of Cardiovascular Sciences, East Carolina University, Greenville, NC GINGER L. GRAHAM, Former President and Chief Executive Officer, Amylin Pharmaceuticals, and Former Group Chairman, Guidant Corporation, Boulder, CO GEORGE C. HALVORSON, Chairman and Chief Executive Officer, Kaiser Permanente, Oakland, CA BRENT C. JAMES, Chief Quality Officer, Intermountain Health Care, Inc., Salt Lake City, UT CRAIG A. JONES, Director, Vermont Blueprint for Health, Burlington GARY S. KAPLAN, Chairman and Chief Executive Officer, Virginia Mason Health System, Seattle, WA ARTHUR A. LEVIN, Director, Center for Medical Consumers, New York, NY EUGENE LITVAK, President and Chief Executive Officer, Institute for Healthcare Optimization, Newton, MA DAVID O. MELTZER, Director, Center for Health and the Social Sciences, University of Chicago, IL MARY D. NAYLOR, Director, NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia RITA F. REDBERG, Professor of Medicine, University of California, San Francisco PAUL C. TANG, Vice President and Chief Innovation and Technology Officer, Palo Alto Medical Foundation, and Consulting Associate Professor of Medicine, Stanford University, Palo Alto, CA v Copyright National Academy of Sciences. All rights reserved. Best Care at Lower Cost: The Path to Continuously Learning Health Care in America IOM Staff ROBERT SAUNDERS, Study Director LEIGH STUCKHARDT, Program Associate JULIA C. SANDERS, Senior Program Assistant BRIAN W. POWERS, Senior Program Assistant (through July 2012) VALERIE ROHRBACH, Senior Program Assistant CLAUDIA GROSSMAN, Senior Program Officer ISABELLE VON KOHORN, Program Officer BARRET ZIMMERMANN, Program Assistant J. MICHAEL MCGINNIS,