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Azimuddin A, Tzeng CWD, Prakash LR, Bruno ML, Arvide EM, Dewhurst WL, Newhook TE, Kim MP, Ikoma N, Snyder RA, Lee JE, Perrier ND, Katz MH, Maxwell JE. Postoperative Global Period Cost Reduction Using 3 Successive Risk-Stratified Pancreatectomy Clinical Pathways. J Am Coll Surg 2024; 238:451-459. [PMID: 38180055 DOI: 10.1097/xcs.0000000000000944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
BACKGROUND We hypothesized that iterative revisions of our original 2016 risk-stratified pancreatectomy clinical pathways would be associated with decreased 90-day perioperative costs. STUDY DESIGN From a single-institution retrospective cohort study of consecutive patients with 3 iterations: "version 1" (V1) (October 2016 to January 2019), V2 (February 2019 to October 2020), and V3 (November 2020 to February 2022), institutional data were aggregated using revenue codes and adjusted to constant 2022-dollar value. Grand total perioperative costs (primary endpoint) were the sum of pancreatectomy, inpatient care, readmission, and 90-day global outpatient care. Proprietary hospital-based costs were converted to ratios using the mean cost of all hospital operations as the denominator. RESULTS Of 814 patients, pathway V1 included 363, V2 229, and V3 222 patients. Accordion Grade 3+ complications decreased with each iteration (V1: 28.4%, V2: 22.7%, and V3: 15.3%). Median length of stay decreased (V1: 6 days, interquartile range [IQR] 5 to 8; V2: 5 [IQR 4 to 6]; and V3: 5 [IQR 4 to 6]) without an increase in readmissions. Ninety-day global perioperative costs decreased by 32% (V1 cost ratio 12.6, V2 10.9, and V3 8.6). Reduction of the index hospitalization cost was associated with the greatest savings (-31%: 9.4, 8.3, and 6.5). Outpatient care costs decreased consistently (1.58, 1.41, and 1.04). When combining readmission and all outpatient costs, total "postdischarge" costs decreased (3.17, 2.59, and 2.13). Component costs of the index hospitalization that were associated with the greatest savings were room or board costs (-55%: 1.74, 1.14, and 0.79) and pharmacy costs (-61%: 2.20, 1.61, and 0.87; all p < 0.001). CONCLUSIONS Three iterative risk-stratified pancreatectomy clinical pathway refinements were associated with a 32% global period cost savings, driven by reduced index hospitalization costs. This successful learning health system model could be externally validated at other institutions performing abdominal cancer surgery.
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Affiliation(s)
- Ahad Azimuddin
- From the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Azimuddin, Tzeng, Prakash, Bruno, Arvide, Dewhurst, Newhook, Kim, Ikoma, Snyder, Lee, Perrier, Katz, Maxwell)
- Texas A&M School of Medicine, Houston, TX (Azimuddin)
| | - Ching-Wei D Tzeng
- From the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Azimuddin, Tzeng, Prakash, Bruno, Arvide, Dewhurst, Newhook, Kim, Ikoma, Snyder, Lee, Perrier, Katz, Maxwell)
| | - Laura R Prakash
- From the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Azimuddin, Tzeng, Prakash, Bruno, Arvide, Dewhurst, Newhook, Kim, Ikoma, Snyder, Lee, Perrier, Katz, Maxwell)
| | - Morgan L Bruno
- From the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Azimuddin, Tzeng, Prakash, Bruno, Arvide, Dewhurst, Newhook, Kim, Ikoma, Snyder, Lee, Perrier, Katz, Maxwell)
| | - Elsa M Arvide
- From the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Azimuddin, Tzeng, Prakash, Bruno, Arvide, Dewhurst, Newhook, Kim, Ikoma, Snyder, Lee, Perrier, Katz, Maxwell)
| | - Whitney L Dewhurst
- From the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Azimuddin, Tzeng, Prakash, Bruno, Arvide, Dewhurst, Newhook, Kim, Ikoma, Snyder, Lee, Perrier, Katz, Maxwell)
| | - Timothy E Newhook
- From the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Azimuddin, Tzeng, Prakash, Bruno, Arvide, Dewhurst, Newhook, Kim, Ikoma, Snyder, Lee, Perrier, Katz, Maxwell)
| | - Michael P Kim
- From the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Azimuddin, Tzeng, Prakash, Bruno, Arvide, Dewhurst, Newhook, Kim, Ikoma, Snyder, Lee, Perrier, Katz, Maxwell)
| | - Naruhiko Ikoma
- From the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Azimuddin, Tzeng, Prakash, Bruno, Arvide, Dewhurst, Newhook, Kim, Ikoma, Snyder, Lee, Perrier, Katz, Maxwell)
| | - Rebecca A Snyder
- From the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Azimuddin, Tzeng, Prakash, Bruno, Arvide, Dewhurst, Newhook, Kim, Ikoma, Snyder, Lee, Perrier, Katz, Maxwell)
| | - Jeffrey E Lee
- From the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Azimuddin, Tzeng, Prakash, Bruno, Arvide, Dewhurst, Newhook, Kim, Ikoma, Snyder, Lee, Perrier, Katz, Maxwell)
| | - Nancy D Perrier
- From the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Azimuddin, Tzeng, Prakash, Bruno, Arvide, Dewhurst, Newhook, Kim, Ikoma, Snyder, Lee, Perrier, Katz, Maxwell)
| | - Matthew Hg Katz
- From the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Azimuddin, Tzeng, Prakash, Bruno, Arvide, Dewhurst, Newhook, Kim, Ikoma, Snyder, Lee, Perrier, Katz, Maxwell)
| | - Jessica E Maxwell
- From the Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (Azimuddin, Tzeng, Prakash, Bruno, Arvide, Dewhurst, Newhook, Kim, Ikoma, Snyder, Lee, Perrier, Katz, Maxwell)
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Kashyap A, Callison-Burch C, Boland MR. A deep learning method to detect opioid prescription and opioid use disorder from electronic health records. Int J Med Inform 2023; 171:104979. [PMID: 36621078 PMCID: PMC9898169 DOI: 10.1016/j.ijmedinf.2022.104979] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 12/12/2022] [Accepted: 12/27/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE As the opioid epidemic continues across the United States, methods are needed to accurately and quickly identify patients at risk for opioid use disorder (OUD). The purpose of this study is to develop two predictive algorithms: one to predict opioid prescription and one to predict OUD. MATERIALS AND METHODS We developed an informatics algorithm that trains two deep learning models over patient Electronic Health Records (EHRs) using the MIMIC-III database. We utilize both the structured and unstructured parts of the EHR and show that it is possible to predict both challenging outcomes. RESULTS Our deep learning models incorporate elements from EHRs to predict opioid prescription with an F1-score of 0.88 ± 0.003 and an AUC-ROC of 0.93 ± 0.002. We also constructed a model to predict OUD diagnosis achieving an F1-score of 0.82 ± 0.05 and AUC-ROC of 0.94 ± 0.008. DISCUSSION Our model for OUD prediction outperformed prior algorithms for specificity, F1 score and AUC-ROC while achieving equivalent sensitivity. This demonstrates the importance of a) deep learning approaches in predicting OUD and b) incorporating both structured and unstructured data for this prediction task. No prediction models for opioid prescription as an outcome were found in the literature and therefore our model is the first to predict opioid prescribing behavior. CONCLUSION Algorithms such as those described in this paper will become increasingly important to understand the drivers underlying this national epidemic.
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Affiliation(s)
- Aditya Kashyap
- Department of Computer Science, University of Pennsylvania, United States of America
| | - Chris Callison-Burch
- Department of Computer Science, University of Pennsylvania, United States of America
| | - Mary Regina Boland
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, United States of America; Institute for Biomedical Informatics, University of Pennsylvania, United States of America; Center for Excellence in Environmental Toxicology, University of Pennsylvania, United States of America; Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, United States of America.
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Coulter-Thompson EI, Matthews DD, Applegate J, Broder-Fingert S, Dubé K. Health Care Bias and Discrimination Experienced by Lesbian, Gay, Bisexual, Transgender, and Queer Parents of Children With Developmental Disabilities: A Qualitative Inquiry in the United States. J Pediatr Health Care 2023; 37:5-16. [PMID: 36184374 DOI: 10.1016/j.pedhc.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/03/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION This study explored the impact of health care (HC) bias and discrimination on lesbian, gay, bisexual, transgender, and queer (LGBTQ) parents and their children with disabilities in the United States, including the timing of developmental screening and diagnosis. METHOD We conducted semistructured interviews with 16 LGBTQ parents of children with developmental concerns or disabilities recruited through a prior national survey. Interviews were transcribed and analyzed using a combined inductive and deductive approach. RESULTS Discrimination types reported included noninclusive forms, disclosure challenges, and providers dismissing nongestational parents and diverse families. Few parents reported screening and diagnosis delays. Parents' recommendations included: avoiding assumptions, honoring family diversity, increasing LGBTQ family support, improving HC forms, increasing antibias training, and convening a learning community. DISCUSSION Our study advances the knowledge around HC bias and discrimination among LGBTQ parents of children with disabilities. Findings highlight the need for increased LGBTQ-affirming family support and research representing LGBTQ family diversity in U.S. health care.
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Affiliation(s)
- Emilee I Coulter-Thompson
- Emilee I. Coulter-Thompson, Manager, Research, Education, and Career Development, University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI.
| | - Derrick D Matthews
- Derrick D. Matthews, Assistant Professor, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC
| | - Julia Applegate
- Julia Applegate, Senior Lecturer, the Ohio State University, Columbus, OH
| | - Sarabeth Broder-Fingert
- Sarabeth Broder-Fingert, Associate Professor, University of Massachusetts Chan Medical School, Worcester, MA
| | - Karine Dubé
- Karine Dubé, Assistant Professor, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC
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Toward Population Health: Using a Learning Behavioral Health System and Measurement-Based Care to Improve Access, Care, Outcomes, and Disparities. Community Ment Health J 2022; 58:1428-1436. [PMID: 35352203 PMCID: PMC8964387 DOI: 10.1007/s10597-022-00957-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 03/01/2022] [Indexed: 01/27/2023]
Abstract
Achieving population behavioral health is urgently needed. The mental health system struggles with enormous challenges of providing access to mental health services, improving quality and equitability of care, and ensuring good health outcomes across subpopulations. Little data exists about increasing access within highly constrained resources, staging/sequencing treatment along care pathways, or personalizing treatments. The conceptual model of the learning healthcare system offers a potential paradigm shift for addressing these challenges. In this article we present an overview of how the three constructs of population health, learning health systems, and measurement-based care are inter-related, and we provide an example of how one academic, community-based, safety net health system is approaching integrating these paradigms into its service delivery system. Implementation outcomes will be described in a subsequent publication. We close by discussing how ultimately, to meaningfully improve population behavioral health, a learning healthcare system could expand into a learning health community in order to target critical points of prevention and intervention.
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Rasulić L, Socolovsky M, Heinen C, Demetriades A, Lepić M, Shlobin NA, Savić A, Grujić J, Mandić-Rajčević S, Lepić S, Samardžic M. Peripheral nerve surgery in Serbia: "Think global, act local" and the privilege of service. BRAIN & SPINE 2022; 2:101662. [PMID: 36506287 PMCID: PMC9729806 DOI: 10.1016/j.bas.2022.101662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/29/2022] [Accepted: 10/21/2022] [Indexed: 12/12/2022]
Abstract
Introduction The phrase "think globally, act locally", which has often been used to refer to conservation of the environment, highlights the importance of maintaining a holistic perspective and stipulates that each individual has a role to play in their community and larger world. Although peripheral nerve surgery has been largely unemphasized in global neurosurgical efforts, a wide disparity in peripheral nerve surgery is presumed to exist between high-income and low- and middle-income countries. Serbia is an upper middle-income country with a long history of peripheral nerve surgery. Research question How can understanding the development of peripheral nerve surgery in Serbia advance global education and improve peripheral nerve surgery worldwide? Material and methods An anecdotal and narrative review of recent advances in peripheral nerve surgery in Serbia was conducted. The World Federation of Neurosurgical Society (WFNS) Peripheral Nerve Surgery Committee discussions on improving peripheral nerve surgery education were summarized. Results In this manuscript, we describe the application of "think globally, act locally" to peripheral nerve surgery by providing an account of the development of peripheral nerve surgery in Serbia. Then, we report measures taken by the WFNS Peripheral Nerve Surgery Committee to improve education on peripheral nerve surgery in LMICs. Discussion and conclusion Viewing the development of peripheral nerve surgery in Serbia through the lens of "think globally, act locally" may guide the development of peripheral nerve surgery in LMICs.
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Affiliation(s)
- Lukas Rasulić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia,Department of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Clinic for Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia,Corresponding author. Department of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Clinic for Neurosurgery, Clinical Center of Serbia, Višegradska 26, Belgrade, Serbia.
| | - Mariano Socolovsky
- Peripheral Nerve and Plexus Program, Department of Neurosurgery, University of Buenos Aires School of Medicine, Buenos Aires, Argentina
| | - Christian Heinen
- Peripheral Nerve Unit Nord, Christliches Krankenhaus Quakenbrück GmbH, Quakenbrück, Germany
| | - Andreas Demetriades
- Department of Neurosurgery, Royal Infirmary of Edinburgh, Little France, Edinburgh, UK
| | - Milan Lepić
- Department of Neurosurgery, Military Medical Academy, Belgrade, Serbia
| | - Nathan A. Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Andrija Savić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia,Department of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Clinic for Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Jovan Grujić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia,Department of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Clinic for Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Stefan Mandić-Rajčević
- School of Public Health and Health Management and Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sanja Lepić
- Institute of Hygiene, Military Medical Academy, Belgrade, Serbia
| | - Miroslav Samardžic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia,Department of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Clinic for Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia
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Distributed learning for heterogeneous clinical data with application to integrating COVID-19 data across 230 sites. NPJ Digit Med 2022; 5:76. [PMID: 35701668 PMCID: PMC9198031 DOI: 10.1038/s41746-022-00615-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 05/19/2022] [Indexed: 11/09/2022] Open
Abstract
Integrating real-world data (RWD) from several clinical sites offers great opportunities to improve estimation with a more general population compared to analyses based on a single clinical site. However, sharing patient-level data across sites is practically challenging due to concerns about maintaining patient privacy. We develop a distributed algorithm to integrate heterogeneous RWD from multiple clinical sites without sharing patient-level data. The proposed distributed conditional logistic regression (dCLR) algorithm can effectively account for between-site heterogeneity and requires only one round of communication. Our simulation study and data application with the data of 14,215 COVID-19 patients from 230 clinical sites in the UnitedHealth Group Clinical Research Database demonstrate that the proposed distributed algorithm provides an estimator that is robust to heterogeneity in event rates when efficiently integrating data from multiple clinical sites. Our algorithm is therefore a practical alternative to both meta-analysis and existing distributed algorithms for modeling heterogeneous multi-site binary outcomes.
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Dawson R, Saulnier T, Campbell A, Godambe SA. Leveraging a Safety Event Management System to Improve Organizational Learning and Safety Culture. Hosp Pediatr 2022; 12:407-417. [PMID: 35253052 DOI: 10.1542/hpeds.2021-006266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Safety event management systems (SEMS) are rich sources of patient safety information, which can be used to improve organizational safety culture. An ideal SEMS can accomplish this when the system is improved with the intention of increasing learning and engagement across the organization. To support a global aim of improving overall patient safety and becoming a highly reliable learning health system, focus was directed toward increasing event review and follow-up completion and using this information to drive resource allocation and improvement efforts. METHODS A new integrated SEMS was customized, tested, and implemented based on identified organizational need. Revised policies were developed to define expectations for event review and follow-up. The new SEMS incorporated a closed-loop communication process which ensured information from events was shared with the event submitters and facilitated shared learning. The expected impacts, improved event reporting, and follow-up were studied and guided ongoing improvements. RESULTS After transitioning to a new SEMS, we experienced increased overall reporting by 8.6% and improved event follow-up, demonstrated by documentation on specified system forms, by 53.7%. CONCLUSIONS By implementing a new, efficient, and standardized SEMS, which decentralized event management processes, the organization saw increased reporting and better engagement with patient safety event review and follow-up. Overall, these results demonstrated a stronger reporting culture, which allowed for local problem solving and improved learning from every event reported. A robust reporting culture positively impacted the overall organizational culture of safety.
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Affiliation(s)
| | | | - Adam Campbell
- Departments of Quality and Safety.,Department of Pediatrics, Eastern Virginia Medical School, Norfolk, Virginia
| | - Sandip A Godambe
- Departments of Quality and Safety.,Division of Pediatric Emergency Medicine, Children's Hospital of The King's Daughters, Norfolk, Virginia.,Department of Pediatrics, Eastern Virginia Medical School, Norfolk, Virginia
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Ferguson L, Rentes VC, McCarthy L, Vinson AH. Collaborative conversations during the time of COVID-19: Building a "meta"-learning community. Learn Health Syst 2022; 6:e10284. [PMID: 35036555 PMCID: PMC8753305 DOI: 10.1002/lrh2.10284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/19/2021] [Accepted: 06/22/2021] [Indexed: 11/26/2022] Open
Abstract
PROBLEM COVID-19 created new research, clinical, educational, and personal challenges, while simultaneously separating work teams who were under work-from-home restrictions. Addressing these challenges required new forms of collaborative groups. APPROACH To support the department community and the rapid sharing of new research, educational, clinical, and personal efforts, a Core Team from the Department of Learning Health Sciences at the University of Michigan developed a meeting series called the COVID Conversations. This Experience Report shares the organizational structure of the COVID Conversations, proposes a comparison to traditional Learning Communities, and reports the results of a questionnaire that gathered details about department members' COVID-related activities. OUTCOMES We identify and describe salient similarities and differences between the COVID Conversations and the characteristics of Learning Communities. We also developed and piloted a taxonomy for characterizing LHS research projects that may be further developed for use in Learning Community planning, in conjunction with other maturity grids and ontologies. We propose the term "Meta-Learning Community" to describe the structure and function of the COVID Conversations. NEXT STEPS In academic medicine, remote work, telemedicine, and virtual learning may be here to stay. The COVID Conversations constitute a distinct and innovative form of collaborative work in which separate teams addressing distinct goals, yet sharing a common passion to tackle the issues brought by the pandemic, are able to share experiences and learn from one other. The challenges of COVID-19 have made evident the need for multiple forms of organizing teamwork, and our study contributes the notion of a "Meta"-Learning Community as a new form of collaborative work.
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Affiliation(s)
- Lisa Ferguson
- Department of Learning Health SciencesUniversity of MichiganAnn ArborMichiganUSA
| | - Victor C. Rentes
- Department of Learning Health SciencesUniversity of MichiganAnn ArborMichiganUSA
| | - Lauren McCarthy
- Department of Learning Health SciencesUniversity of MichiganAnn ArborMichiganUSA
| | - Alexandra H. Vinson
- Department of Learning Health SciencesUniversity of MichiganAnn ArborMichiganUSA
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McEvoy MD, Dear ML, Buie R, Fowler LC, Miller B, Fleming GM, Moore D, Rice TW, Bernard GR, Lindsell CJ. Embedding Learning in a Learning Health Care System to Improve Clinical Practice. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1311-1314. [PMID: 33570841 PMCID: PMC8349926 DOI: 10.1097/acm.0000000000003969] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PROBLEM In an ideal learning health care system (LHS), clinicians learn from what they do and do what they learn, closing the evidence-to-practice gap. In operationalizing an LHS, great strides have been made in knowledge generation. Yet, considerable challenges remain to the broad uptake of identified best practices. To bridge the gap from generating actionable knowledge to applying that knowledge in clinical practice, and ultimately to improving outcomes, new information must be disseminated to and implemented by frontline clinicians. To date, the dissemination of this knowledge through traditional avenues has not achieved meaningful practice change quickly. APPROACH Vanderbilt University Medical Center (VUMC) developed QuizTime, a smartphone application learning platform, to provide a mechanism for embedding workplace-based clinician learning in the LHS. QuizTime leverages spaced education and retrieval-based practice to facilitate practice change. Beginning in January 2020, clinician-researchers and educators at VUMC designed a randomized, controlled trial to test whether the QuizTime learning system influenced clinician behavior in the context of recent evidence supporting the use of balanced crystalloids rather than saline for intravenous fluid management and new regulations around opioid prescribing. OUTCOMES Whether spaced education and retrieval-based practice influence clinician behavior and patient outcomes at the VUMC system level will be tested using the data currently being collected. NEXT STEPS These findings will inform future directions for developing and deploying learning approaches at scale in an LHS, with the goal of closing the evidence-to-practice gap.
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Affiliation(s)
- Matthew D McEvoy
- M.D. McEvoy is professor of anesthesiology and surgery, vice chair for educational affairs, program director of the perioperative medicine fellowship, and director of the Center for Innovation in Perioperative Health, Education, and Research, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mary Lynn Dear
- M.L. Dear is project manager, Learning Healthcare System Platform, Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Reagan Buie
- R. Buie is health policy service analyst, Learning Healthcare System Platform, Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Leslie C Fowler
- L.C. Fowler is director of the Educational Development and Research Office of Educational Affairs, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Bonnie Miller
- B. Miller is professor of medical education and administration and vice president for educational affairs, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Geoffrey M Fleming
- G.M. Fleming was professor of pediatrics and associate director of the pediatric critical care fellowship, Monroe Carell Jr. Children's Hospital, and vice president, Continuous Professional Development, Office of Health Sciences Education, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Don Moore
- D. Moore is professor of medical education and administration and director of the Office for Continuing Professional Development, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Todd W Rice
- T.W. Rice is associate professor of medicine, Department of Allergy, Pulmonary and Critical Care Medicine, and medical director, Vanderbilt Human Research Protection Program, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gordon R Bernard
- G.R. Bernard is the Melinda Owen Bass Professor of Medicine, executive vice president for research, senior associate dean for clinical sciences, and director of the Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christopher J Lindsell
- C.J. Lindsell is professor of biostatistics, associate director of the Center for Clinical Quality and Implementation Research, director of the Vanderbilt Institute for Clinical and Translational Research Methods Program, and director of the Center for Health Data Science, Vanderbilt University Medical Center, Nashville, Tennessee
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Aalsma MC, Aarons GA, Adams ZW, Alton MD, Boustani M, Dir AL, Embi PJ, Grannis S, Hulvershorn LA, Huntsinger D, Lewis CC, Monahan P, Saldana L, Schwartz K, Simon KI, Terry N, Wiehe SE, Zapolski TC. Alliances to disseminate addiction prevention and treatment (ADAPT): A statewide learning health system to reduce substance use among justice-involved youth in rural communities. J Subst Abuse Treat 2021; 128:108368. [PMID: 33867210 PMCID: PMC8883586 DOI: 10.1016/j.jsat.2021.108368] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/27/2021] [Accepted: 03/12/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Youth in the justice system (YJS) are more likely than youth who have never been arrested to have mental health and substance use problems. However, a low percentage of YJS receive SUD services during their justice system involvement. The SUD care cascade can identify potential missed opportunities for treatment for YJS. Steps along the continuum of the cascade include identification of treatment need, referral to services, and treatment engagement. To address gaps in care for YJS, we will (1) implement a learning health system (LHS) to develop, or improve upon, alliances between juvenile justice (JJ) agencies and community mental health centers (CMHC) and (2) present local cascade data during continuous quality improvement cycles within the LHS alliances. METHODS/DESIGN ADAPT is a hybrid Type II effectiveness implementation trial. We will collaborate with JJ and CMHCs in eight Indiana counties. Application of the EPIS (exploration, preparation, implementation, and sustainment) framework will guide the implementation of the LHS alliances. The study team will review local cascade data quarterly with the alliances to identify gaps along the continuum. The study will collect self-report survey measures longitudinally at each site regarding readiness for change, implementation climate, organizational leadership, and program sustainability. The study will use the Stages of Implementation Completion (SIC) tool to assess the process of implementation across interventions. Additionally, the study team will conduct focus groups and qualitative interviews with JJ and CMHC personnel across the intervention period to assess for impact. DISCUSSION Findings have the potential to increase SUD need identification, referral to services, and treatment for YJS.
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Affiliation(s)
- Matthew C. Aalsma
- Department of Pediatrics – Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Gregory A. Aarons
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States of America
| | - Zachary W. Adams
- Department of Psychiatry - Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Madison D. Alton
- Department of Pediatrics – Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Malaz Boustani
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Allyson L. Dir
- Department of Psychiatry - Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Peter J. Embi
- Department of Medicine, Indiana University School of Medicine, and Regenstrief Institute, Indianapolis, IN, United States of America
| | - Shaun Grannis
- Department of Medicine, Indiana University School of Medicine, and Regenstrief Institute, Indianapolis, IN, United States of America
| | - Leslie A. Hulvershorn
- Department of Psychiatry - Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | | | - Cara C. Lewis
- MacColl Center for Health Care Innovation, Kaiser Permanente Washington Health Research Institute – Seattle, Washington, United States of America
| | - Patrick Monahan
- Department of Biostatistics, Indiana University School of Medicine and School of Public Health, Indianapolis, IN, United States of America
| | - Lisa Saldana
- Oregon Social Learning Center, Eugene, OR, United States of America
| | - Katherine Schwartz
- Department of Pediatrics - Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, IN, United States of America.
| | - Kosali I. Simon
- School of Public and Environmental Affairs, Indiana University Bloomington, Bloomington, IN, United States of America
| | - Nicolas Terry
- McKinney School of Law, Indiana University – Purdue University Indianapolis, Indianapolis, IN, United States of America
| | - Sarah E. Wiehe
- Department of Pediatrics, Division of Children’s Health Services Research, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Tamika C.B. Zapolski
- Department of Psychology - Adolescent Behavioral Health Research Program, Indiana University – Purdue University Indianapolis, Indianapolis, IN, United States of America
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11
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Easterling D, Perry AC, Woodside R, Patel T, Gesell SB. Clarifying the concept of a learning health system for healthcare delivery organizations: Implications from a qualitative analysis of the scientific literature. Learn Health Syst 2021; 6:e10287. [PMID: 35434353 PMCID: PMC9006535 DOI: 10.1002/lrh2.10287] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 07/01/2021] [Accepted: 07/07/2021] [Indexed: 12/21/2022] Open
Abstract
The “learning health system” (LHS) concept has been defined in broad terms, which makes it challenging for health system leaders to determine exactly what is required to transform their organization into an LHS. This study provides a conceptual map of the LHS landscape by identifying the activities, principles, tools, and conditions that LHS researchers have associated with the concept. Through a multi‐step screening process, two researchers identified 79 publications from PubMed (published before January 2020) that contained information relevant to the question, “What work is required of a healthcare organization that is operating as an LHS?” Those publications were coded as to whether or not they referenced each of 94 LHS elements in the taxonomy developed by the study team. This taxonomy, named the Learning Health Systems Consolidated Framework (LHS‐CF), organizes the elements into five “bodies of work” (organizational learning, translation of evidence into practice, building knowledge, analyzing clinical data, and engaging stakeholders) and four “enabling conditions” (workforce skilled for LHS work, data systems and informatics technology in place, organization invests resources in LHS work, and supportive organizational culture). We report the frequency that each of the 94 elements was referenced across the 79 publications. The four most referenced elements were: “organization builds knowledge or evidence,” “quality improvement practices are standard practice,” “patients and family members are actively engaged,” and “organizational culture emphasizes and supports learning.” By dissecting the LHS construct into its component elements, the LHS‐CF taxonomy can serve as a useful tool for LHS researchers and practitioners in defining the aspects of LHS they are addressing. By assessing how often each element is referenced in the literature, the study provides guidance to health system leaders as to how their organization needs to evolve in order to become an LHS ‐ while also recognizing that each organization should emphasize elements that are most aligned with their mission and goals.
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Affiliation(s)
- Douglas Easterling
- Department of Social Sciences and Health Policy Wake Forest School of Medicine Winston‐Salem North Carolina USA
| | - Anna C. Perry
- Wake Forest Clinical and Translational Science Institute, Wake Forest School of Medicine Winston‐Salem North Carolina USA
| | - Rachel Woodside
- Wake Forest Clinical and Translational Science Institute, Wake Forest School of Medicine Winston‐Salem North Carolina USA
| | - Tanha Patel
- North Carolina Translational and Clinical Sciences Institute University of North Carolina School of Medicine Chapel Hill North Carolina USA
| | - Sabina B. Gesell
- Department of Social Sciences and Health Policy Wake Forest School of Medicine Winston‐Salem North Carolina USA
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12
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Sarakbi D, Mensah-Abrampah N, Kleine-Bingham M, Syed SB. Aiming for quality: a global compass for national learning systems. Health Res Policy Syst 2021; 19:102. [PMID: 34281534 PMCID: PMC8287697 DOI: 10.1186/s12961-021-00746-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 06/23/2021] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Transforming a health system into a learning one is increasingly recognized as necessary to support the implementation of a national strategic direction on quality with a focus on frontline experience. The approach to a learning system that bridges the gap between practice and policy requires active exploration. METHODS This scoping review adapted the methodological framework for scoping studies from Arksey and O'Malley. The central research question focused on common themes for learning to improve the quality of health services at all levels of the national health system, from government policy to point-of-care delivery. RESULTS A total of 3507 records were screened, resulting in 101 articles on strategic learning across the health system: health professional level (19%), health organizational level (15%), subnational/national level (26%), multiple levels (35%), and global level (6%). Thirty-five of these articles focused on learning systems at multiple levels of the health system. A national learning system requires attention at the organizational, subnational, and national levels guided by the needs of patients, families, and the community. The compass of the national learning system is centred on four cross-cutting themes across the health system: alignment of priorities, systemwide collaboration, transparency and accountability, and knowledge sharing of real-world evidence generated at the point of care. CONCLUSION This paper proposes an approach for building a national learning system to improve the quality of health services. Future research is needed to validate the application of these guiding principles and make improvements based on the findings.
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Affiliation(s)
- Diana Sarakbi
- Health Quality Programs, Queen's University, Kingston, Canada.
- Health Quality Programs, Queen's University, Cataraqui Building, 92 Barrie Street, Kingston, ON, K7L 3N6, Canada.
| | | | | | - Shams B Syed
- Integrated Health Services, World Health Organization, Geneva, Switzerland
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13
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Schleyer T, Williams L, Gottlieb J, Weaver C, Saysana M, Azar J, Sadowski J, Frederick C, Hui S, Kara A, Ruppert L, Zappone S, Bushey M, Grout R, Embi PJ. The Indiana Learning Health System Initiative: Early experience developing a collaborative, regional learning health system. Learn Health Syst 2021; 5:e10281. [PMID: 34277946 PMCID: PMC8278436 DOI: 10.1002/lrh2.10281] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/30/2021] [Accepted: 06/03/2021] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Learning health systems (LHSs) are usually created and maintained by single institutions or healthcare systems. The Indiana Learning Health System Initiative (ILHSI) is a new multi-institutional, collaborative regional LHS initiative led by the Regenstrief Institute (RI) and developed in partnership with five additional organizations: two Indiana-based health systems, two schools at Indiana University, and our state-wide health information exchange. We report our experiences and lessons learned during the initial 2-year phase of developing and implementing the ILHSI. METHODS The initial goals of the ILHSI were to instantiate the concept, establish partnerships, and perform LHS pilot projects to inform expansion. We established shared governance and technical capabilities, conducted a literature review-based and regional environmental scan, and convened key stakeholders to iteratively identify focus areas, and select and implement six initial joint projects. RESULTS The ILHSI successfully collaborated with its partner organizations to establish a foundational governance structure, set goals and strategies, and prioritize projects and training activities. We developed and deployed strategies to effectively use health system and regional HIE infrastructure and minimize information silos, a frequent challenge for multi-organizational LHSs. Successful projects were diverse and included deploying a Fast Healthcare Interoperability Standards (FHIR)-based tool across emergency departments state-wide, analyzing free-text elements of cross-hospital surveys, and developing models to provide clinical decision support based on clinical and social determinants of health. We also experienced organizational challenges, including changes in key leadership personnel and varying levels of engagement with health system partners, which impacted initial ILHSI efforts and structures. Reflecting on these early experiences, we identified lessons learned and next steps. CONCLUSIONS Multi-organizational LHSs can be challenging to develop but present the opportunity to leverage learning across multiple organizations and systems to benefit the general population. Attention to governance decisions, shared goal setting and monitoring, and careful selection of projects are important for early success.
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Affiliation(s)
- Titus Schleyer
- Center for Biomedical InformaticsRegenstrief Institute, IncIndianapolisIndianaUSA
- Department of MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Linda Williams
- Center for Health Services ResearchRegenstrief Institute, IncIndianapolisIndianaUSA
- Department of NeurologyIndiana University School of MedicineIndianapolisIndianaUSA
- VA HSR&D EXTEND QUERIRichard L. Roudebush VA Medical CenterIndianapolisIndianaUSA
| | - Jonathan Gottlieb
- Department of Health AdministrationUniversity of ProvidenceGreat FallsMontanaUSA
| | - Christopher Weaver
- Department of Emergency MedicineIndiana University School of MedicineIndianapolisIndianaUSA
- Physician AdministrationIndiana University HealthIndianapolisIndianaUSA
| | - Michele Saysana
- Physician AdministrationIndiana University HealthIndianapolisIndianaUSA
- Department of PediatricsIndiana University School of MedicineIndianapolisIndianaUSA
| | - Jose Azar
- Department of MedicineIndiana University School of MedicineIndianapolisIndianaUSA
- Division of Quality and Patient SafetyIndiana University HealthIndianapolisIndianaUSA
| | - Josh Sadowski
- Department of Infection PreventionIndiana University HealthIndianapolisIndianaUSA
| | - Chris Frederick
- AdministrationRegenstrief Institute, IncIndianapolisIndianaUSA
| | - Siu Hui
- Center for Biomedical InformaticsRegenstrief Institute, IncIndianapolisIndianaUSA
- Department of Biostatistics & Health Data ScienceIndiana University School of MedicineIndianapolisIndianaUSA
| | - Areeba Kara
- Department of MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Laura Ruppert
- Center for Biomedical InformaticsRegenstrief Institute, IncIndianapolisIndianaUSA
| | - Sarah Zappone
- Center for Biomedical InformaticsRegenstrief Institute, IncIndianapolisIndianaUSA
| | - Michael Bushey
- Department of PsychiatryIndiana University School of MedicineIndianapolisIndianaUSA
- Department of PsychiatryIndiana University HealthIndianapolisIndianaUSA
| | - Randall Grout
- Center for Biomedical InformaticsRegenstrief Institute, IncIndianapolisIndianaUSA
- Department of PediatricsIndiana University School of MedicineIndianapolisIndianaUSA
- InformaticsEskenazi HealthIndianapolisIndianaUSA
| | - Peter J. Embi
- Department of MedicineIndiana University School of MedicineIndianapolisIndianaUSA
- AdministrationRegenstrief Institute, IncIndianapolisIndianaUSA
- AdministrationIndiana University HealthIndianapolisIndianaUSA
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14
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Taylor YJ, Kowalkowski M, Spencer MD, Evans SM, Hall MN, Rissmiller S, Shrestha R, McWilliams A. Realizing a learning health system through process, rigor and culture change. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2021; 8 Suppl 1:100478. [PMID: 34175095 DOI: 10.1016/j.hjdsi.2020.100478] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 07/28/2020] [Accepted: 09/18/2020] [Indexed: 12/19/2022]
Abstract
While many healthcare organizations strive to achieve the patient care benefits of being a learning health system (LHS), myriad challenges stand in the way of successful implementation. The reality of creating a true LHS requires top-to-bottom commitment to culture change with the necessary vision, leadership, and investment. The Center for Outcomes Research and Evaluation (CORE) is a multidisciplinary research unit embedded within a large, vertically integrated healthcare system in the southeastern United States. We used a two-pronged approach to: a) methodically recruit a team of experts, while generating early wins that demonstrated real success; and b) build relationships and buy-in across organizational leadership. Building out a team with diverse expertise created the ability to deploy pragmatic, data-driven research designs that fit seamlessly into real-world care delivery, resulting in agile study execution that aligns with health system timelines. Case study examples from hospital readmissions and antibiotic stewardship illustrate how our LHS operationalizes practice-informed research and research-informed practice. Lessons from this experience can serve as a blueprint for other healthcare systems or networks seeking to expand the promise of the LHS framework to improve health for patients and communities.
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Affiliation(s)
| | - Marc Kowalkowski
- Center for Outcomes Research and Evaluation, Atrium Health, USA.
| | | | - Susan M Evans
- Center for Outcomes Research and Evaluation, Atrium Health, USA.
| | - Mary N Hall
- Division of Medical Education and Research, Atrium Health, USA; Medical Group Division, Atrium Health, USA.
| | | | | | - Andrew McWilliams
- Center for Outcomes Research and Evaluation, Atrium Health, USA; Medical Group Division, Atrium Health, USA; Department of Internal Medicine, Hospital Medicine, Atrium Health, USA.
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15
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Davis FD, Williams MS, Stametz RA. Geisinger's effort to realize its potential as a learning health system: A progress report. Learn Health Syst 2021; 5:e10221. [PMID: 33889731 PMCID: PMC8051344 DOI: 10.1002/lrh2.10221] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 01/20/2020] [Accepted: 01/22/2020] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES In the last two decades, several organizational initiatives have moved Geisinger into closer alignment with the key characteristics of the learning health system (LHS) model. The intent of this experience report is to provide a firsthand view of the potential of the model and of the complex, multifaceted nature of any endeavor designed and implemented to realize that potential. METHODS After describing Geisinger, we offer a critical self-assessment of our progress toward the goal of becoming an LHS, followed by an account of the challenges. RESULTS Geisinger has made incremental but measurable progress in implementing the LHS model, especially in two key domains: in patient-clinician engagement and science and informatics. Other challenges, however, present significant opportunities for additional forward movement, especially with respect to incentives, culture, and leadership. CONCLUSION Becoming a fully realized LHS is and will be a long-term challenge for any organization that embraces this aspiration.
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Affiliation(s)
- F. Daniel Davis
- Center for Translational Bioethics and Healthcare PolicyDanvillePennsylvaniaUSA
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16
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Miake-Lye I, Mak S, Lam CA, Lambert-Kerzner AC, Delevan D, Olmos-Ochoa T, Shekelle P. Scaling Beyond Early Adopters: a Content Analysis of Literature and Key Informant Perspectives. J Gen Intern Med 2021; 36:383-395. [PMID: 33111242 PMCID: PMC7878615 DOI: 10.1007/s11606-020-06142-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 08/12/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Innovations and improvements in care delivery are often not spread across all settings that would benefit from their uptake. Scale-up and spread efforts are deliberate efforts to increase the impact of innovations successfully tested in pilot projects so as to benefit more people. The final stages of scale-up and spread initiatives must contend with reaching hard-to-engage sites. OBJECTIVE To describe the process of scale-up and spread initiatives, with a focus on hard-to-engage sites and strategies to approach them. DESIGN Qualitative content analysis of systematically identified literature and key informant interviews. PARTICIPANTS Leads from large magnitude scale-up and spread projects. APPROACH We conducted a systematic literature search on large magnitude scale-up and spread and interviews with eight project leads, who shared their perspectives on strategies to scale-up and spread clinical and administrative practices across healthcare systems, focusing on hard-to-engage sites. We synthesized these data using content analysis. KEY RESULTS Searches identified 1919 titles, of which 52 articles were included. Thirty-four discussed general scale-up and spread strategies, 11 described hard-to-engage sites, and 7 discussed strategies for hard-to-engage sites. These included publications were combined with interview findings to describe a fourth phase of the national scale-up and spread process, common challenges for spreading to hard-to-engage sites, and potential benefits of working with hard-to-engage sites, as well as useful strategies for working with hard-to-engage sites. CONCLUSIONS We identified scant published evidence that describes strategies for reaching hard-to-engage sites. The sparse data we identified aligned with key informant accounts. Future work could focus on better documentation of the later stages of spread efforts, including specific tailoring of approaches and strategies used with hard-to-engage sites. Spread efforts should include a "flexible, tailored approach" for this highly variable group, especially as implementation science is looking to expand its impact in routine care settings.
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Affiliation(s)
- Isomi Miake-Lye
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. .,Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA.
| | - Selene Mak
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Christine A Lam
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Deborah Delevan
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | | | - Paul Shekelle
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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17
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Krapohl GL, Hemmila MR, Hendren S, Bishop K, Rogers R, Rocker C, Fasbinder L, Englesbe MJ, Vu JV, Campbell DA. Building, scaling, and sustaining a learning health system for surgical quality improvement: A toolkit. Learn Health Syst 2020; 4:e10215. [PMID: 32685683 PMCID: PMC7362672 DOI: 10.1002/lrh2.10215] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 12/12/2019] [Accepted: 12/18/2019] [Indexed: 12/25/2022] Open
Abstract
This article describes how to start, replicate, scale, and sustain a learning health system for quality improvement, based on the experience of the Michigan Surgical Quality Collaborative (MSQC). The key components to operationalize a successful collaborative improvement infrastructure and the features of a learning health system are explained. This information is designed to guide others who desire to implement quality improvement interventions across a regional network of hospitals using a collaborative approach. A toolkit is provided (under Supporting Information) with practical information for implementation.
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Affiliation(s)
- Greta L. Krapohl
- Michigan Surgical Quality CollaborativeAnn ArborMichigan
- Department of SurgeryUniversity of MichiganAnn ArborMichigan
| | - Mark R. Hemmila
- Department of SurgeryUniversity of MichiganAnn ArborMichigan
| | | | - Kathy Bishop
- Michigan Surgical Quality CollaborativeAnn ArborMichigan
| | - Rhonda Rogers
- Michigan Surgical Quality CollaborativeAnn ArborMichigan
| | - Cheryl Rocker
- Michigan Surgical Quality CollaborativeAnn ArborMichigan
| | | | - Michael J. Englesbe
- Michigan Surgical Quality CollaborativeAnn ArborMichigan
- Department of SurgeryUniversity of MichiganAnn ArborMichigan
| | - Joceline V. Vu
- Department of SurgeryUniversity of MichiganAnn ArborMichigan
| | - Darrell A. Campbell
- Michigan Surgical Quality CollaborativeAnn ArborMichigan
- Department of SurgeryUniversity of MichiganAnn ArborMichigan
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18
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Abstract
Many communities in the United States are struggling to deal with the negative consequences of illicit opioid use. Effectively addressing this epidemic requires the coordination and support of community stakeholders in a change process with common goals and objectives, continuous engagement with individuals with opioid use disorder (OUD) through their treatment and recovery journeys, application of systems engineering principles to drive process change and sustain it, and use of a formal evaluation process to support a learning community that continuously adapts. This review presents strategies to improve OUD treatment and recovery with a focus on engineering approaches grounded in systems thinking.
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Affiliation(s)
- Paul M Griffin
- Regenstrief Center for Healthcare Engineering and Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana 47907, USA;
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19
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Fanaroff AC, Vora AN, Chen AY, Mathews R, Udell JA, Roe MT, Thomas LE, Wang TY. Hospital participation in clinical trials for patients with acute myocardial infarction: Results from the National Cardiovascular Data Registry. Am Heart J 2019; 214:184-193. [PMID: 31234037 DOI: 10.1016/j.ahj.2019.05.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 05/21/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Little is known about the proportion of hospitals in the United States that offer clinical trial enrollment opportunities and how patient outcomes differ between hospitals that do and do not participate in clinical trials. METHODS In the nationwide Chest Pain-MI registry, we described the proportion of hospitals that enrolled patients with acute myocardial infarction (MI) in clinical trials from 2009 to 2014. Hospital-level adherence to every eligible MI performance measure was compared between hospitals that did and did not enroll patients in clinical trials. Using linked Medicare data, we also compared 1-year major adverse cardiovascular events (MACE: death, MI, heart failure, or stroke) among patients ≥65 years old treated at trial versus nontrial hospitals. RESULTS Among 766 hospitals, 430 (56.1%) enrolled ≥1 MI patient in a clinical trial during the study period, but the proportion of hospitals enrolling patients in clinical trials declined from 36.8% in 2009 to 26.6% in 2014. Complete adherence to performance measures was delivered to a greater proportion of patients at trial hospitals than nontrial hospitals (72.6% vs 64.9%, P < .001; adjusted OR 1.07, 95% CI 1.03-1.12). One-year MACE rates were also lower for trial hospitals (adjusted HR 0.96, 95% CI 0.93-0.99). CONCLUSIONS Hospitals are becoming less likely to engage in clinical trials for patients with MI. Patients admitted to hospitals that participated in clinical trials more often received guideline-adherent care and had better long-term outcomes.
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2017 Roadmap for Innovation-ACC Health Policy Statement on Healthcare Transformation in the Era of Digital Health, Big Data, and Precision Health: A Report of the American College of Cardiology Task Force on Health Policy Statements and Systems of Care. J Am Coll Cardiol 2019; 70:2696-2718. [PMID: 29169478 DOI: 10.1016/j.jacc.2017.10.018] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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21
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Tognoni G, Franzosi MG, Garattini S. Embedding patient- and public health-oriented research in a national health service: the GISSI experience. J R Soc Med 2019; 112:200-204. [PMID: 31074337 PMCID: PMC6512170 DOI: 10.1177/0141076819844934] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Gianni Tognoni
- IRCCS Istituto di Ricerche Farmacologiche, ‘Mario
Negri’, Milan 20156, Italy
| | | | - Silvio Garattini
- IRCCS Istituto di Ricerche Farmacologiche, ‘Mario
Negri’, Milan 20156, Italy
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22
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Embi PJ, Richesson R, Tenenbaum J, Kannry J, Friedman C, Sarkar IN, Smith J. Reimagining the research-practice relationship: policy recommendations for informatics-enabled evidence-generation across the US health system. JAMIA Open 2019; 2:2-9. [PMID: 31984339 PMCID: PMC6951885 DOI: 10.1093/jamiaopen/ooy056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 10/16/2018] [Accepted: 11/21/2018] [Indexed: 01/08/2023] Open
Abstract
The widespread adoption and use of electronic health records and their use to enable learning health systems (LHS) holds great promise to accelerate both evidence-generating medicine (EGM) and evidence-based medicine (EBM), thereby enabling a LHS. In 2016, AMIA convened its 10th annual Policy Invitational to discuss issues key to facilitating the EGM-EBM paradigm at points-of-care (nodes), across organizations (networks), and to ensure viability of this model at scale (sustainability). In this article, we synthesize discussions from the conference and supplements those deliberations with relevant context to inform ongoing policy development. Specifically, we explore and suggest public policies needed to facilitate EGM-EBM activities on a national scale, particularly those policies that can enable and improve clinical and health services research at the point-of-care, accelerate biomedical discovery, and facilitate translation of findings to improve the health of individuals and populations.
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Affiliation(s)
- Peter J Embi
- Regenstrief Institute, 1101 West 10th Street, Indianapolis, Indiana 46202, USA
| | - Rachel Richesson
- Duke University School of Nursing, 307 Trent Drive, Durham, North Carolina 27710, USA
| | - Jessica Tenenbaum
- Duke University School of Medicine, 2424 Erwin Road, Durham, North Carolina 27705, USA
| | - Joseph Kannry
- Icahn School of Medicine at Mount Sinai, Box 187, New York, New York 10029, USA
| | - Charles Friedman
- Department of Learning Health Sciences, University Michigan Medical School, 1111 E. Catherine, St. Ann Arbor, Michigan 48109-2054, USA
| | - Indra Neil Sarkar
- Center for Biomedical Informatics, Brown University, Box G-R, Providence, Rhode Island 02912, USA
| | - Jeff Smith
- American Medical Informatics Association, 4720 Montgomery Ln., Suite 500, Bethesda, Maryland 20814, USA
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23
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Jackson GP, Moffatt-Bruce SD, Melton GB. Leveraging Health Information Technologies to Support Surgical Practice. JAMA Surg 2018; 153:981-982. [DOI: 10.1001/jamasurg.2018.1978] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Gretchen P. Jackson
- Department of Surgery, Vanderbilt University Medical Center and Vanderbilt University, Nashville, Tennessee
- Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee
| | - Susan D. Moffatt-Bruce
- Department of Surgery, University Hospital, The Ohio State University Wexner Medical Center, Columbus
- Department of Biomedical Informatics, University Hospital, The Ohio State University Wexner Medical Center, Columbus
| | - Genevieve B. Melton
- Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis
- Institute for Health Informatics, University of Minnesota, Minneapolis
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Knosp BM, Barnett WK, Anderson NR, Embi PJ. Research IT maturity models for academic health centers: Early development and initial evaluation. J Clin Transl Sci 2018; 2:289-294. [PMID: 30828469 PMCID: PMC6390403 DOI: 10.1017/cts.2018.339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/26/2018] [Accepted: 10/30/2018] [Indexed: 11/07/2022] Open
Abstract
This paper proposes the creation and application of maturity models to guide institutional strategic investment in research informatics and information technology (research IT) and to provide the ability to measure readiness for clinical and research infrastructure as well as sustainability of expertise. Conducting effective and efficient research in health science increasingly relies upon robust research IT systems and capabilities. Academic health centers are increasing investments in health IT systems to address operational pressures, including rapidly growing data, technological advances, and increasing security and regulatory challenges associated with data access requirements. Current approaches for planning and investment in research IT infrastructure vary across institutions and lack comparable guidance for evaluating investments, resulting in inconsistent approaches to research IT implementation across peer academic health centers as well as uncertainty in linking research IT investments to institutional goals. Maturity models address these issues through coupling the assessment of current organizational state with readiness for deployment of potential research IT investment, which can inform leadership strategy. Pilot work in maturity model development has ranged from using them as a catalyst for engaging medical school IT leaders in planning at a single institution to developing initial maturity indices that have been applied and refined across peer medical schools.
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Affiliation(s)
- Boyd M. Knosp
- Roy J. and Lucille A. Carver College of Medicine and the Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA, USA
| | - William K. Barnett
- Regenstrief InstituteInc., Indiana, CTSI, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Nicholas R. Anderson
- Clinical Translational Science Center and Department of Public Health Sciences, UC Davis Health System, University of California, Davis, Davis, CA, USA
| | - Peter J. Embi
- Regenstrief InstituteInc., Indiana, CTSI, Indiana University School of Medicine, Indianapolis, IN, USA
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25
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"Learn From Every Patient": How a Learning Health System Can Improve Patient Care. Pediatr Qual Saf 2018; 3:e100. [PMID: 30584627 PMCID: PMC6221586 DOI: 10.1097/pq9.0000000000000100] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 07/26/2018] [Indexed: 11/26/2022] Open
Abstract
Aim: We created a Learning Health System, the “Learn From Every Patient” program, embedded in our cerebral palsy team clinic. This program was designed to simultaneously provide clinical care while systematically collecting data for quality improvement and research projects on all patients. Method: Clinicians created tools within the Electronic Health Record to discretely capture data for clinical use which was also available for quality improvement/research efforts. At baseline, all patients in our clinic received annual hip x-rays to screen for hip displacement. Using our “Learn From Every Patient” database, we reviewed the outcomes for the most mildly affected patients, Level I on the Gross Motor Functional Classification System. Results: One hundred thirty-two patients were classified as Gross Motor Functional Classification System Level I. During the study period, these patients received 212 pelvis x-rays, viewing 424 hips, of which 419 (98.8%) were normal. Five hips (1.2%) had < 30% displacement. None had any hip-related symptoms nor required any procedures during the period. We used these data to create an evidence-based change in our standardized hip screening procedure by eliminating annual screening x-rays for this population. Interpretation: This implementation of a local learning health system approach to systematically collect research data simultaneously with routine clinical care enabled us to implement an evidence-based improvement in clinical practice. This complete integration of research into clinical care improved care by reducing radiation exposure, while simultaneously reducing health care costs.
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Reck-Burneo CA, Vilanova-Sanchez A, Gasior AC, Dingemans AJM, Lane VA, Dyckes R, Nash O, Weaver L, Maloof T, Wood RJ, Zobell S, Rollins MD, Levitt MA. A structured bowel management program for patients with severe functional constipation can help decrease emergency department visits, hospital admissions, and healthcare costs. J Pediatr Surg 2018; 53:1737-1741. [PMID: 29773453 DOI: 10.1016/j.jpedsurg.2018.03.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 02/20/2018] [Accepted: 03/18/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Published health-care costs related to constipation in children in the USA are estimated at $3.9 billion/year. We sought to assess the effect of a bowel management program (BMP) on health-care utilization and costs. METHODS At two collaborating centers, BMP involves an outpatient week during which a treatment plan is implemented and objective assessment of stool burden is performed with daily radiography. We reviewed all patients with severe functional constipation who participated in the program from March 2011 to June 2015 in center 1 and from April 2014 to April 2016 in center 2. ED visits, hospital admissions, and constipation-related morbidities (abdominal pain, fecal impaction, urinary retention, urinary tract infections) 12 months before and 12 months after completion of the BMP were recorded. RESULTS One hundred eighty-four patients were included (center 1 = 96, center 2 = 88). Sixty-three (34.2%) patients had at least one unplanned visit to the ED before treatment. ED visits decreased to 23 (12.5%) or by 64% (p < 0.0005). Unplanned hospital admissions decreased from 65 to 28, i.e., a 56.9% reduction (p < 0.0005). CONCLUSION In children with severe functional constipation, a structured BMP decreases unplanned visits to the ED, hospital admissions, and costs for constipation-related health care. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Carlos A Reck-Burneo
- Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
| | - Alejandra Vilanova-Sanchez
- Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Alessandra C Gasior
- Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Alexander J M Dingemans
- Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Victoria A Lane
- Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Robert Dyckes
- Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Onnalisa Nash
- Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Laura Weaver
- Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Tassiana Maloof
- Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Richard J Wood
- Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Sarah Zobell
- Primary Children's Hospital, 100 N Mario Capecchi Drive, Division of Pediatric Surgery, Suite 2600, Salt Lake City, UT 84113, USA
| | - Michael D Rollins
- Primary Children's Hospital, 100 N Mario Capecchi Drive, Division of Pediatric Surgery, Suite 2600, Salt Lake City, UT 84113, USA
| | - Marc A Levitt
- Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
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Affiliation(s)
- Paul T Rosenau
- Department of Pediatrics, Larner College of Medicine, University of Vermont and The University of Vermont Children's Hospital, Burlington, Vermont;
| | - Brian K Alverson
- Department of Pediatrics, Warren Alpert Medical School, Brown University, Providence, Rhode Island; and.,Division of Hospital Medicine, Hasbro Children's Hospital, Providence Rhode Island
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Moffatt-Bruce S, Huerta T, Gaughan A, McAlearney AS. IDEA4PS: The Development of a Research-Oriented Learning Healthcare System. Am J Med Qual 2018; 33:420-425. [PMID: 29310442 DOI: 10.1177/1062860617751044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Leveraging opportunities to learn and then improve the delivery of care using experiences throughout the health care system is essential in efforts to transform health care delivery. The authors present the approach of one academic medical center in becoming a research-oriented Learning Healthcare System (ro-LHS). By reframing the role of research in improving outcomes, the organization was able to move beyond its focus on quality improvement to foster a culture in which feedback informs practice and research drives improvement. The patient safety learning laboratory, the Institute for the Design of Environments Aligned for Patient Safety, funded by the Agency for Healthcare Research and Quality, has provided foundational infrastructure to connect stakeholders across the medical center and university and conduct rigorous research in the context of practice. With this new focus, research now informs operations in a cycle of continuous improvement across the authors' ro-LHS.
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Asi YM, Williams C. The role of digital health in making progress toward Sustainable Development Goal (SDG) 3 in conflict-affected populations. Int J Med Inform 2017; 114:114-120. [PMID: 29126701 DOI: 10.1016/j.ijmedinf.2017.11.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 10/30/2017] [Accepted: 11/04/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE The progress of the Millennium Development Goals (MDGs) shows that sustained global action can achieve success. Despite the unprecedented achievements in health and education, more than one billion people, many of them in conflict-affected areas, were unable to reap the benefits of the MDG gains. The recently developed Sustainable Development Goals (SDGs) are even more ambitious then their predecessor. SDG 3 prioritizes health and well-being for all ages in specific areas such as maternal mortality, communicable diseases, mental health, and healthcare workforce. However, without a shift in the approach used for conflict-affected areas, the world's most vulnerable people risk being left behind in global development yet again. We must engage in meaningful discussions about employing innovative strategies to address health challenges fragile, low-resource, and often remote settings. In this paper, we will argue that to meet the ambitious health goals of SDG 3, digital health can help to bridge healthcare gaps in conflict-affected areas. METHODS First, we describe the health needs of populations in conflict-affected environments, and how they overlap with the SDG 3 targets. Secondly, we discuss how digital health can address the unique needs of conflict-affected areas. Finally, we evaluate the various challenges in deploying digital technologies in fragile environments, and discuss potential policy solutions. DISCUSSION Persons in conflict-affected areas may benefit from the diffusive nature of digital health tools. Innovations using cellular technology or cloud-based solutions overcome physical barriers. Additionally, many of the targets of SDG 3 could see significant progress if efficacious education and outreach efforts were supported, and digital health in the form of mHealth and telehealth offers a relatively low-resource platform for these initiatives. Lastly, lack of data collection, especially in conflict-affected or otherwise fragile states, was one of the primary limitations of the MDGs. Greater investment in data collection efforts, supported by digital health technologies, is necessary if SDG 3 targets are to be measured and progress assessed. Standardized EMR systems as well as context-specific data warehousing efforts will assist in collecting and managing accurate data. Stakeholders such as patients, providers, and NGOs, must be proactive and collaborative in their efforts for continuous progress toward SDG 3. Digital health can assist in these inter-organizational communication efforts. CONCLUSION The SDGS are complex, ambitious, and comprehensive; even in the most stable environments, achieving full completion towards every goal will be difficult, and in conflict-affected environments, this challenge is much greater. By engaging in a collaborative framework and using the appropriate digital health tools, we can support humanitarian efforts to realize sustained progress in SDG 3 outcomes.
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Affiliation(s)
- Yara M Asi
- Department of Health Management and Informatics, College of Health and Public Affairs, University of Central Florida, Orlando, FL, United States.
| | - Cynthia Williams
- Department of Public Health, Brooks College of Health, University of North Florida, Jacksonville, FL, United States.
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Deliberato RO, Celi LA, Stone DJ. Clinical Note Creation, Binning, and Artificial Intelligence. JMIR Med Inform 2017; 5:e24. [PMID: 28778845 PMCID: PMC5561387 DOI: 10.2196/medinform.7627] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 06/09/2017] [Accepted: 06/30/2017] [Indexed: 11/26/2022] Open
Abstract
The creation of medical notes in software applications poses an intrinsic problem in workflow as the technology inherently intervenes in the processes of collecting and assembling information, as well as the production of a data-driven note that meets both individual and healthcare system requirements. In addition, the note writing applications in currently available electronic health records (EHRs) do not function to support decision making to any substantial degree. We suggest that artificial intelligence (AI) could be utilized to facilitate the workflows of the data collection and assembly processes, as well as to support the development of personalized, yet data-driven assessments and plans.
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Affiliation(s)
- Rodrigo Octávio Deliberato
- Big Data Analytics Department, Hospital Israelita Albert Einstein, São Paulo, Brazil.,Harvard - MIT, Division of Health Science and Technology, Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Leo Anthony Celi
- Harvard - MIT, Division of Health Science and Technology, Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States.,Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - David J Stone
- Harvard - MIT, Division of Health Science and Technology, Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States.,Departments of Anesthesiology and Neurosurgery, University of Virgina School of Medicine, Charlottesville, VA, United States
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