Publications from the National Academies of Sciences, Engineering, and Medicine provide objective and straightforward advice to decision makers and the public. This site includes Health and Medicine Division (HMD) publications released after 1998. A complete list of HMD’s publications from its establishment in 1970 to the present is available as a PDF.
Integrating Research and Practice: Health System Leaders ...
Released: September 23, 2014
In April and June 2014 the Institute of Medicine’s (IOM) Roundtable on Value & Science-Driven Health Care convened two workshops aimed at accelerating progress toward real-time knowledge generation through the seamless integration of clinical practice and research, one of the fundamental concepts of a continuously learning health system. These meetings were sponsored by the Patient-Centered Outcomes Research Institute, and prompted by the development of the PCORnet and similar efforts to accelerate real-time learning. A major premise that served as the foundation for the two workshops is that the continuous and seamless assessment of the effectiveness and efficiency of care is basic to a continuously learning and constantly improving health care system. This publication summarizes the presentations and discussions that occurred during the two workshops, highlighting the key lessons presented, practical strategies, and the needs and opportunities for future leadership.
Observational Studies in a Learning Health System ...
Released: September 24, 2013
Clinical research is constantly advancing, although perhaps not fast enough to meet the challenges and seize the opportunities presented. New tools are emerging. While challenges remain, these tools have the potential to accelerate the research process and to allow an approach to clinical research that applies the most appropriate methods given the requirements of the situation. This approach includes the leveraging of the information collected in the process of delivering care to drive processes for new insights and continuous improvement, which is at the heart of a learning health system. An IOM workshop, sponsored by the Patient Centered Outcomes Research Institute, was convened to identify the leading approaches to observational studies, chart the course for the use of this growing utility, and guide and grow their use in the most responsible fashion possible.
Large Simple Trials and Knowledge Generation in a Learning ...
Released: September 24, 2013
Despite a robust clinical research enterprise, a gap exists between the evidence needed to support care decisions and the evidence available. Streamlined approaches to clinical research provide options for progress on these challenges. Large simple trials (LSTs), for example, generally have simple randomization, broad eligibility criteria, enough participants to distinguish small to moderate effects, focus on outcomes important to patient care, and use simplified approaches to data collection. Significant opportunities, including the wide-spread adoption of electronic health records, could accelerate the potential for the use of LSTs to efficiently generate practical evidence for medical decision making and product development. To address these opportunities, as well as challenges, the IOM held a workshop to highlight the pros and cons of the design characteristics of LSTs, explored the utility of LSTs on the basis of case studies of past successes, and considered the challenges and opportunities for accelerating the use of LSTs in the context of a U.S. clinical trials enterprise.
Partnering with Patients to Drive Shared Decisions, Better ...
Released: August 15, 2013
In an efficient health care system, care choices are democratized and based on the best evidence. Though the infrastructure and cultural changes necessary to transform the patient role are significant, empowering patients to become partners in—rather than customers of—the health care system is a critical step on the road to achieving the best care at lower cost. Increased patient engagement in care decisions, value, and research is crucial to the pursuit of better care, improved health, and lower health care costs. This publication details discussions at the February 2013 IOM workshop which gathered patients and experts in areas such as decision science, evidence generation, communication strategies, and health economics to consider the central roles for patients in bringing about progress in all aspects of the U.S. health care system.
Core Measurement Needs for Better Care, Better Health, and ...
Released: June 24, 2013
Initiatives are under way throughout the nation to improve health care quality, improve the health of the American population, and reduce health care costs. These initiatives take on increased urgency in the face of shortfalls with respect to what is possible in health and health care. Despite spending almost one-fifth of the economy’s output on health care, the quality and safety of care remains uneven. While there are multiple obstacles to improving the nation’s health care system, one essential element for sustained progress is the capacity to reliably and consistently measure progress across all aspects of health and the health care system. To consider these issues, the IOM held a workshop, sponsored by the Blue Shield of California Foundation, to explore in depth the core measurement needs for population health, health care quality, health care costs, and engaged people. An IOM study panel is being developed to build on this work and propose a core measure set.
Digital Data Improvement Priorities for Continuous Learning in ...
Released: September 28, 2012
Digital health data are the lifeblood of a continuous learning health system. A steady flow of reliable data is necessary to coordinate and monitor patient care, analyze and improve systems of care, conduct research to develop new products and approaches, assess the effectiveness of medical interventions, and advance population health. The totality of available health data is a crucial resource that should be considered an invaluable public asset in the pursuit of better care, improved health, and lower health care costs. This publication summarizes discussions at the March 2012 IOM workshop to identify and characterize the current deficiencies in the reliability, availability, and usability of digital health data and consider strategies, priorities, and responsibilities to address such deficiencies.
Patients Charting the Course: Citizen Engagement in the ...
Released: October 03, 2011
As past, current, or future patients, the public should be the health care system’s unwavering focus and serve as change agents in its care. Taking this into account, the quality of health care should be judged not only by whether clinical decisions are informed by the best available scientific evidence, but also by whether care is tailored to a patient’s individual needs and perspectives. However, too often it is provider preference and convenience, rather than those of the patient, that drive what care is delivered. As part of its Learning Health System series of workshops, the Roundtable on Value & Science-Driven Health Care hosted a workshop to assess the prospects for improving health and lowering costs by advancing patient involvement in the elements of a learning health system.
Learning What Works: Infrastructure Required for Comparative ...
Released: July 25, 2011
It is essential for patients and clinicians to know which treatments work best for whom if they are to make informed, collaborative care decisions. Despite this need, only a small fraction of health-related expenditures in the U.S. have been devoted to comparative effectiveness research. As part of its Learning Health System series of workshops, the IOM’s Roundtable on Value & Science-Driven Health Care hosted a workshop to discuss capacity priorities to build the evidence base necessary for care that is more effective and delivers higher value for patients.
Engineering a Learning Healthcare System: A Look at the ...
Released: July 08, 2011
Lessons from engineering have the potential to improve both the efficiency and quality of healthcare delivery. The fundamental notion of a high-performing healthcare system—one that increasingly is more effective, more efficient, safer, and higher quality—is rooted in continuous improvement principles that medicine shares with engineering. As part of its Learning Health System series of workshops, the IOM’s Roundtable on Value & Science-Driven Health Care hosted a workshop, jointly with the National Academy of Engineering, on lessons from systems and operations engineering that could be applied to health care.
Digital Infrastructure for the Learning Health System: The ...
Released: May 23, 2011
Like many other industries, health care is increasingly turning to digital information and the use of electronic resources. The IOM’s Roundtable on Value & Science-Driven Health Care hosted three workshops to explore current efforts and opportunities to accelerate progress in improving health and health care with information technology systems.