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The Learning Healthcare System: Workshop Summary Appendix D IOM Roundtable on Evidence-Based Medicine The Institute of Medicine’s Roundtable on Evidence-Based Medicine provides a neutral venue for key stakeholders—patients, health providers, payers, employers, manufacturers, health information technology, researchers, and policy makers—to work cooperatively on innovative approaches to generating and applying evidence to drive improvements in the effectiveness and efficiency of medical care in the United States. Participants seek the development of a learning healthcare system that is designed to generate and apply the best evidence for the collaborative health care choices of each patient and provider; to drive the process of discovery as a natural outgrowth of patient care; and to ensure innovation, quality, safety, and value in health care. They have set a goal that, by the year 2020, ninety percent of clinical decisions will be supported by accurate, timely, and up-to-date clinical information, and will reflect the best available evidence. This is not currently the case. Today, far too often care that is important is not delivered, and care that is delivered is not important. Despite per capita health expenditures much higher than any other nation—now more than $2 trillion—the United States ranks far down the list on international comparisons on many basic measures of health status. As leaders in their fields, Roundtable members work with their colleagues to identify issues not being adequately addressed, the nature of the barriers and possible solutions, and the priorities for action. They marshal the energy and resources of the sectors represented on the Roundtable to work for sustained public-private cooperation for change. Anchoring this work is a focus on three dimensions of the challenge:
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The Learning Healthcare System: Workshop Summary Accelerating progress toward the long-term vision of a learning healthcare system, in which evidence is both applied and developed as a natural product of the care process. Expanding the capacity to meet the acute need for evidence to support medical care that is maximally effective and produces the greatest value. Improving public understanding of the nature of evidence, the dynamic character of evidence development, and the importance of insisting on medical care that reflects the best evidence. For the purpose of the Roundtable activities, we define evidence-based medicine broadly to mean that, to the greatest extent possible, the decisions that shape the health and health care of Americans—by patients, providers, payers and policymakers alike—will be grounded on a reliable evidence base, will account appropriately for individual variation in patient needs, and will support the generation of new insights on clinical effectiveness. Evidence is generally considered to be information from clinical experience that has met some established test of validity, and the appropriate standard is determined according to the requirements of the intervention and clinical circumstance. Processes that involve the development and use of evidence should be accessible and transparent to all stakeholders. A common commitment to certain principles and priorities guides the activities of the Roundtable and its members, including the commitment to: the right health care for each person; putting the best evidence into practice; establishing the effectiveness, efficiency and safety of medical care delivered; building constant measurement into our health care investments; the establishment of health care data as a public good; shared responsibility distributed equitably across stakeholders, both public and private; collaborative stakeholder involvement in priority setting; transparency in the execution of activities and reporting of results; and subjugation of individual political or stakeholder perspectives in favor of the common good. Roundtable Sponsors Agency for Healthcare Research and Quality America’s Health Insurance Plans AstraZeneca Blue Shield of California Foundation Burroughs Wellcome Fund California Healthcare Foundation Centers for Medicare & Medicaid Services Food and Drug Administration Johnson & Johnson sanofi-aventis Stryker Veterans Health Administration
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