When excuses run dry: transforming the U.S. health care system

Mainstream media have reported on the wide variation in clinical practice documented for years by health service researchers. Raising awareness of the quality and cost implications of clinical variation, however, is not enough to adopt clinical behavior based on the principles of evidence-based medicine (EBM). Preoccupation with EBM's limitations--which can be overcome--and failure to address its misperceptions inhibit transformation to an evidence-based system of care and payment. Three reinforcing efforts are needed: aligning payment with quality; increasing the engagement of consumers; and accelerating investment in and adoption of information technology. Real transformation in health care requires changes in both culture and attitudes.