What can a learning healthcare system teach us about improving outcomes?

被引：10

作者：

Casey, Jonathan D. ^{[1
]}

Courtright, Katherine R. ^{[2
]}

Rice, Todd W. ^{[1
]}

Semler, Matthew W. ^{[1
]}

机构：

[1] Vanderbilt Univ, Med Ctr, Div Allergy Pulm & Crit Care Med, Nashville, TN USA

[2] Univ Penn, Perelman Sch Med, Palliat & Adv Illness Res PAIR Ctr, Div Pulm Allergy & Crit Care, Philadelphia, PA 19104 USA

来源：

CURRENT OPINION IN CRITICAL CARE | 2021年 / 27卷 / 05期

关键词：

clinical trials; comparative effectiveness research; learning healthcare system; CANCER CLINICAL-TRIALS; BALANCED CRYSTALLOIDS; RANDOMIZED-TRIAL; UNITED-STATES; HYDROXYCHLOROQUINE; SEPSIS; ADULTS; SALINE; WOMEN;

D O I：

10.1097/MCC.0000000000000857

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Purpose of review This review describes the learning healthcare system paradigm, recent examples, and future directions. Patients, clinicians, and health systems frequently encounter decisions between available treatments, technologies, and healthcare delivery methods with little or no evidence about the comparative effectiveness and safety of the available options. Learning healthcare systems endeavor to recognize such knowledge gaps, integrate comparative effectiveness research - including clinical trials - into clinical care to address the knowledge gaps, and seamlessly implement the results into practice to improve care and patient outcomes. Recent findings Recent studies comparing the effectiveness of diagnostic tests and treatments, using information technology to identify patients likely to experience an outcome or benefit from an intervention, and evaluating models of healthcare delivery have demonstrated how a learning healthcare system approach can reduce arbitrary variation in care, decrease cost, and improve patient outcomes. Learning healthcare systems have the potential to answer questions of importance to patients, clinicians, and health system leaders, improve efficiency of healthcare delivery, and improve patient outcomes. Achieving this goal will require realignment of the culture around clinical care, institutional and federal investment, expanded stakeholder engagement, tailored ethical and regulatory guidance, and methodologic advances in information technology and biostatistics.

引用

页码：527 / 536

页数：10

共 57 条

[1] Cluster-Randomized, Crossover Trial of Head Positioning in Acute Stroke [J].

Anderson, C. S. ;

Arima, H. ;

Lavados, P. ;

Billot, L. ;

Hackett, M. L. ;

Olavarria, V. V. ;

Munoz Venturelli, P. ;

Brunser, A. ;

Peng, B. ;

Cui, L. ;

Song, L. ;

Rogers, K. ;

Middleton, S. ;

Lim, J. Y. ;

Forshaw, D. ;

Lightbody, C. E. ;

Woodward, M. ;

Pontes-Neto, O. ;

De Silva, H. A. ;

Lin, R. -T. ;

Lee, T. -H. ;

Pandian, J. D. ;

Mead, G. E. ;

Robinson, T. ;

Watkins, C. .

NEW ENGLAND JOURNAL OF MEDICINE, 2017, 376 (25) :2437-2447

[2]

[Anonymous], 1948, Br Med J, V2, P769

[3] Minimal Impact of Implemented Early Warning Score and Best Practice Alert for Patient Deterioration [J].

Bedoya, Armando D. ;

Clement, Meredith E. ;

Phelan, Matthew ;

Steorts, Rebecca C. ;

O'Brien, Cara ;

Goldstein, Benjamin A. .

CRITICAL CARE MEDICINE, 2019, 47 (01) :49-55

[4] A Randomized Trial of a Multifactorial Strategy to Prevent Serious Fall Injuries [J].

Bhasin, Shalender ;

Gill, Thomas M. ;

Reuben, David B. ;

Latham, Nancy K. ;

Ganz, David A. ;

Greene, Erich J. ;

Dziura, James ;

Basaria, Shehzad ;

Gurwitz, Jerry H. ;

Dykes, Patricia C. ;

McMahon, Siobhan ;

Storer, Thomas W. ;

Gazarian, Priscilla ;

Miller, Michael E. ;

Travison, Thomas G. ;

Esserman, Denise ;

Carnie, Martha B. ;

Goehring, Lori ;

Fagan, Maureen ;

Greenspan, Susan L. ;

Alexander, Neil ;

Wiggins, Jocelyn ;

Ko, Fred ;

Siu, Albert L. ;

Volpi, Elena ;

Wu, Albert W. ;

Rich, Jeremy ;

Waring, Stephen C. ;

Wallace, Robert B. ;

Casteel, Carri ;

Resnick, Neil M. ;

Magaziner, Jay ;

Charpentier, Peter ;

Lu, Charles ;

Araujo, Katy ;

Rajeevan, Haseena ;

Meng, Can ;

Allore, Heather ;

Brawley, Brooke F. ;

Eder, Rich ;

McGloin, Joanne M. ;

Skokos, Eleni A. ;

Duncan, Pamela W. ;

Baker, Dorothy ;

Boult, Chad ;

Correa-de-Araujo, Rosaly ;

Peduzzi, Peter .

NEW ENGLAND JOURNAL OF MEDICINE, 2020, 383 (02) :129-140

[5] Detecting Sepsis: Are Two Opinions Better Than One? [J].

Bhattacharjee, Poushali ;

Churpek, Matthew M. ;

Snyder, Ashley ;

Howell, Michael D. ;

Edelson, Dana P. .

JOURNAL OF HOSPITAL MEDICINE, 2017, 12 (04) :256-258

[6] Randomized Clinical Trial of an ICU Recovery Pilot Program for Survivors of Critical Illness* [J].

Bloom, Sarah L. ;

Stollings, Joanna L. ;

Kirkpatrick, Olivia ;

Wang, Li ;

Byrne, Daniel W. ;

Sevin, Carla M. ;

Semler, Matthew W. .

CRITICAL CARE MEDICINE, 2019, 47 (10) :1337-1345

[7] Hydroxychloroquine and Chloroquine Prescribing Patterns by Provider Specialty Following Initial Reports of Potential Benefit for COVID-19 Treatment - United States, January-June 2020 [J].

Bull-Otterson, Lara ;

Gray, Elizabeth B. ;

Budnitz, Daniel S. ;

Strosnider, Heather M. ;

Schieber, Lyna Z. ;

Courtney, Joseph ;

Garcia, Macarena C. ;

Brooks, John T. ;

Mac Kenzie, William R. ;

Gundlapalli, Adi, V .

MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT, 2020, 69 (35) :1210-1215

[8] Transforming Evidence Generation to Support Health and Health Care Decisions [J].

Califf, Robert M. ;

Robb, Melissa A. ;

Bindman, Andrew B. ;

Briggs, Josephine P. ;

Collins, Francis S. ;

Conway, Patrick H. ;

Coster, Trinka S. ;

Cunningham, Francesca E. ;

De Lew, Nancy ;

DeSalvo, Karen B. ;

Dymek, Christine ;

Dzau, Victor J. ;

Fleurence, Rachael L. ;

Frank, Richard G. ;

Gaziano, Michael ;

Kaufmann, Petra ;

Lauer, Michael ;

Marks, Peter W. ;

McGinnis, J. Michael ;

Richards, Chesley ;

Selby, Joe V. ;

Shulkin, David J. ;

Shuren, Jeffrey ;

Slavitt, Andrew M. ;

Smith, Scott R. ;

Washington, B. Vindell ;

White, P. Jon ;

Woodcock, Janet ;

Woodson, Jonathan ;

Sherman, Rachel E. .

NEW ENGLAND JOURNAL OF MEDICINE, 2016, 375 (24) :2395-2400

[9]

Cameron ST, 2020, LANCET, V396, P1585, DOI 10.1016/S0140-6736(20)31785-2

[10] Rationale and Design of ORCHID: A Randomized Placebo-controlled Clinical Trial of Hydroxychloroquine for Adults Hospitalized with COVID-19 [J].

Casey, Jonathan D. ;

Johnson, Nicholas J. ;

Semler, Matthew W. ;

Collins, Sean P. ;

Aggarwal, Neil R. ;

Brower, Roy G. ;

Chang, Steven Y. ;

Eppensteiner, John ;

Filbin, Michael ;

Gibbs, Kevin W. ;

Ginde, Adit A. ;

Gong, Michelle N. ;

Harrell, Frank ;

Hayden, Douglas L. ;

Hough, Catherine L. ;

Khan, Akram ;

Leither, Lindsay M. ;

Moss, Marc ;

Oldmixon, Cathryn F. ;

Park, Pauline K. ;

Reineck, Lora A. ;

Ringwood, Nancy J. ;

Robinson, Bryce R. H. ;

Schoenfeld, David A. ;

Shapiro, Nathan, I ;

Steingrub, Jay S. ;

Torr, Donna K. ;

Weissman, Alexandra ;

Lindsell, Christopher J. ;

Rice, Todd W. ;

Thompson, B. Taylor ;

Brown, Samuel M. ;

Self, Wesley H. .

ANNALS OF THE AMERICAN THORACIC SOCIETY, 2020, 17 (09) :1144-1153

← 1 2 3 4 5 6 →