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

[11] Bag-Mask Ventilation during Tracheal Intubation of Critically Ill Adults [J].

Casey, Jonathan D. ;

Janz, David R. ;

Russell, Derek W. ;

Vonderhaar, Derek J. ;

Joffe, Aaron M. ;

Dischert, Kevin M. ;

Brown, Ryan M. ;

Zouk, Aline N. ;

Gulati, Swati ;

Heideman, Brent E. ;

Lester, Michael G. ;

Toporek, Alexandra H. ;

Bentov, Itay ;

Self, Wesley H. ;

Rice, Todd W. ;

Semler, Matthew W. .

NEW ENGLAND JOURNAL OF MEDICINE, 2019, 380 (09) :811-821

[12] Disparities in participation in cancer clinical trials in the United States: A symptom of a healthcare system in crisis [J].

Colon-Otero, Gerardo ;

Smallridge, Robert C. ;

Solberg, Lawrence A., Jr. ;

Keith, Thomas D. ;

Woodward, Timothy A. ;

Willis, Floyd B. ;

Dunn, Ajani N. .

CANCER, 2008, 112 (03) :447-454

[13]

Committee on the Learning Healthcare System in America Institute of Medicine, 2013, BEST CARE LOWER COST

[14] The price of innovation: new estimates of drug development costs [J].

DiMasi, JA ;

Hansen, RW ;

Grabowski, HG .

JOURNAL OF HEALTH ECONOMICS, 2003, 22 (02) :151-185

[15] Trends in Intensive Care for Patients with COVID-19 in England, Wales, and Northern Ireland [J].

Doidge, James C. ;

Gould, Doug W. ;

Ferrando-Vivas, Paloma ;

Mouncey, Paul R. ;

Thomas, Karen ;

Shankar-Hari, Manu ;

Harrison, David A. ;

Rowan, Kathryn M. .

AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2021, 203 (05) :565-574

[16]

Dominus S., 2020, COVID DRUG WARS PITT

[17] Electronic health record-based clinical decision support alert for severe sepsis: a randomised evaluation [J].

Downing, Norman Lance ;

Rolnick, Joshua ;

Poole, Sarah F. ;

Hall, Evan ;

Wessels, Alexander J. ;

Heidenreich, Paul ;

Shieh, Lisa .

BMJ QUALITY & SAFETY, 2019, 28 (09) :762-768

[18] Automated Identification of Adults at Risk for In-Hospital Clinical Deterioration [J].

Escobar, Gabriel J. ;

Liu, Vincent X. ;

Schuler, Alejandro ;

Lawson, Brian ;

Greene, John D. ;

Kipnis, Patricia .

NEW ENGLAND JOURNAL OF MEDICINE, 2020, 383 (20) :1951-1960

[19] Early detection of impending physiologic deterioration among patients who are not in intensive care: Development of predictive models using data from an automated electronic medical record [J].

Escobar, Gabriel J. ;

LaGuardia, Juan Carlos ;

Turk, Benjamin J. ;

Ragins, Arona ;

Kipnis, Patricia ;

Draper, David .

JOURNAL OF HOSPITAL MEDICINE, 2012, 7 (05) :388-395

[20] An Ethics Framework for a Learning Health Care System: A Departure from Traditional Research Ethics and Clinical Ethics [J].

Faden, Ruth R. ;

Kass, Nancy E. ;

Goodman, Steven N. ;

Pronovost, Peter ;

Tunis, Sean ;

Beauchamp, Tom L. .

HASTINGS CENTER REPORT, 2013, 43 :S16-S27

← 1 2 3 4 5 6 →