Not until about 100 years ago could a typical patient expect to benefit from the medical care provided by a typical physician. Today most patients benefit from medical care, but all patients could benefit more if clinicians routinely provided care consistent with the latest scientific knowledge. One report suggests that only 55% of US adults receive care consistent with current recommendations.1 In 2001, the Institute of Medicine concluded that a chasm lies “between the healthcare we have and the healthcare we should have.”2 Moreover, the results of efforts to improve medical quality have been modest and uneven to date.3