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Using a network organisational architecture to support the development of Learning Healthcare Systems
  1. Maria T Britto1,
  2. Sandra C Fuller1,
  3. Heather C Kaplan1,2,
  4. Uma Kotagal1,
  5. Carole Lannon1,3,
  6. Peter A Margolis1,
  7. Stephen E Muething1,
  8. Pamela J Schoettker1,
  9. Michael Seid1,4
  1. 1 James M Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
  2. 2 Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
  3. 3 Senior Quality Advisor, American Board of Pediatrics, Chapel Hill, NC, USA
  4. 4 Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
  1. Correspondence to Pamela J Schoettker, James M Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA; Pam.Schoettker{at}cchmc.org

Abstract

The US National Academy of Sciences has called for the development of a Learning Healthcare System in which patients and clinicians work together to choose care, based on best evidence, and to drive discovery as a natural outgrowth of every clinical encounter to ensure innovation, quality and value at the point of care. However, the vision of a Learning Healthcare System has remained largely aspirational. Over the last 13 years, researchers, clinicians and families, with support from our paediatric medical centre, have designed, developed and implemented a network organisational model to achieve the Learning Healthcare System vision. The network framework aligns participants around a common goal of improving health outcomes, transparency of outcome measures and a flexible and adaptive collaborative learning system. Team collaboration is promoted by using standardised processes, protocols and policies, including communication policies, data sharing, privacy protection and regulatory compliance. Learning methods include collaborative quality improvement using a modified Breakthrough Series approach and statistical process control methods. Participants observe their own results and learn from the experience of others. A common repository (a ‘commons’) is used to share resources that are created by participants. Standardised technology approaches reduce the burden of data entry, facilitate care and result in data useful for research and learning. We describe how this organisational framework has been replicated in four conditions, resulting in substantial improvements in outcomes, at scale across a variety of conditions.

  • communication
  • continuous quality improvement
  • control charts, run charts
  • healthcare quality improvement
  • teams

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors MTB, PAM and MS participated in the development and implementation of the Learning Networks, helped draft the original manuscript and contributed to its critical revision. SCF, HCK, UK, CL and SEM participated in the development and implementation of the Learning Networks and helped draft the original manuscript. PJS helped draft the original manuscript and contributed to its critical revision.

  • Funding Sponsor/ funding agency: Patient-Centered Outcomes Research Institute (Grant/contract number: PCS-1406-18643. Title: Anti-TNF monotherapy versus combination therapy with low dose methotrexate in pediatric Crohn’s disease); Patient-Centered Outcomes Research Institute (Grant/contract number: PPRND-1507-31321. Title: PCORI PPRN N-of-1 demonstration project); Patient-Centered Outcomes Research Institute (Grant/contract number: CDRN-1306-01556. Title: A national pediatric learning health system); ImproveCareNow (Title: ImproveCareNow Contract—Abbvie—Effectiveness of adalimumab); ImproveCareNow (Title: ImproveCareNow Contract—Celgene—Delayed growth); David R Clare and Margaret C Clare Foundation (Title: Building a collaborative community to improve the health); Agency for Healthcare Research and Quality (Grant/contract number: R18 HS023763. Title: Reduction of nephrotoxic medication-associated acute kidney injury in children); Patient-Centered Outcomes Research Institute (Grant/contract number: RI-PCC-2017. Title: Advancement of PCORnet infrastructure: development of pilot people-centered communities project); Ohio Children’s Hospital Solutions for Patient Safety; Cystic Fibrosis Foundation Therapeutics (Grant/contract number: SEID14A0. Title: A C3N for CF: design and development of a peer-produced); Cystic Fibrosis Foundation Therapeutics (Title: A CF C3N care model of the future: proposal for piloting); Agency for Healthcare Research and Quality (Grant/contract number: R01 HS020024. Title: Building modular pediatric chronic disease registries for QI and CE research); Agency for Healthcare Research and Quality (Grant/contract number: R01HS022974. Title: Enhancing the sustainability of a pediatric learning health system); National Institute of Diabetes and Digestive and Kidney Disease (Grant/contract number: R01DK085719. Title: Open source science: transforming chronic illness care); Agency for Healthcare Research and Quality (Grant/contract number: U19HS021114. Title: Pursuing perfection in pediatric therapeutics).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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