Vital Directions for Health and Health Care

Abstract

IMPORTANCE Recent discussion has focused on questions related to the repeal and replacement of portions of the Affordable Care Act (ACA). However, issues central to the future of health and health care in the United States transcend the ACA provisions receiving the greatest attention. Initiatives directed to certain strategic and infrastructure priorities are vital to achieve better health at lower cost.OBJECTIVES To review the most salient health challenges and opportunities facing the United States, to identify practical and achievable priorities essential to health progress, and to present policy initiatives critical to the nation's health and fiscal integrity.EVIDENCE REVIEW Qualitative synthesis of 19 National Academy of Medicine-commissioned white papers, with supplemental review and analysis of publicly available data and published research findings. FINDINGSThe US health system faces major challenges. Health care costs remain high at $3.2 trillion spent annually, of which an estimated 30% is related to waste, inefficiencies, and excessive prices; health disparities are persistent and worsening; and the health and financial burdens of chronic illness and disability are straining families and communities. Concurrently, promising opportunities and knowledge to achieve change exist. Across the 19 discussion papers examined, 8 crosscutting policy directions were identified as vital to the nation's health and fiscal future, including 4 action priorities and 4 essential infrastructure needs. The action priorities-pay for value, empower people, activate communities, and connect care-recurred across the articles as direct and strategic opportunities to advance a more efficient, equitable, and patient-and community-focused health system. The essential infrastructure needs-measure what matters most, modernize skills, accelerate real-world evidence, and advance science-were the most commonly cited foundational elements to ensure progress. CONCLUSIONS AND RELEVANCEThe action priorities and essential infrastructure needs represent major opportunities to improve health outcomes and increase efficiency and value in the health system. As the new US administration and Congress chart the future of health and health care for the United States, and as health leaders across the country contemplate future directions for their programs and initiatives, their leadership and strategic investment in these priorities will be essential for achieving significant progress.

Crossing the Research to Quality Chasm: A Checklist for Researchers and Clinical Leadership Partners

“…Researchers should remember that research to bridge the quality chasm is bidirectional: real-world innovations are often leading the way in care improvement, 1 and researchers can gain valuable opportunities to add to their own knowledge by participating. As a researcher, it is important to understand how to strategically participate in operational programs in ways that best leverage your expertise and build your career.…”

“…The U.S. health care system faces a daunting set of challenges, including high costs, disparities in access, and significant gaps between evidence and practice. 1 But despite these concerns, less than 0.1% of the over $3.2 trillion spent on health care in the U.S. goes toward research to improve how we deliver care. 1 , 2 …”

“… 1 But despite these concerns, less than 0.1% of the over $3.2 trillion spent on health care in the U.S. goes toward research to improve how we deliver care. 1 , 2 …”

“…Delivery science research seeks to overcome barriers, leverage facilitators, and implement innovations to improve care. 2 While partnerships between clinical and operations leaders and delivery science researchers can play a significant role in creating new evidence and quickly closing gaps between evidence and practice, 1 , 3 these collaborations are often limited in both number and scope. To achieve the goal of creating a learning health system, 4 researchers and health system leaders must work together to develop and evaluate new programs, learn from real-world experiments in health care delivery and policy, disseminate knowledge, and implement more effective and efficient care strategies (Fig.…”

Goal-concordant care in the ICU: a conceptual framework for future research

“…The term “goal-concordant care” is increasingly used to describe the objective of interventions aimed at improving clinician–patient communication [ 1 ]. The US National Academy of Medicine calls for clinicians to work “with patients and families to ensure that care provided matches closely with each individual’s goals” [ 2 ]. The German Interdisciplinary Association for Intensive Care and Emergency Care recognizes that patients may reject proposed therapeutic goals if they do not align with patient preferences [ 3 ].…”