Using a network organisational architecture to support the development of Learning Healthcare Systems
Using a network organisational architecture to support the development of Learning Healthcare Systems
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DOI：
10.1136/bmjqs-2017-007219
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发表时间：
2018-11-01
影响因子：
5.4
通讯作者：
Seid, Michael
中科院分区：
文献类型：
--
作者：
Britto, Maria T.;Fuller, Sandra C.;Seid, Michael
美国国家科学院呼吁建立一个学习型医疗保健系统，让患者和临床医生共同努力，根据最佳证据选择护理，并将发现作为每次临床治疗的自然结果，以确保护理点的创新，质量和价值。然而，学习型医疗保健系统的愿景在很大程度上仍然是理想的。在过去的13年里，研究人员，临床医生和家庭，从我们的儿科医疗中心的支持下，设计，开发和实施了一个网络组织模式，以实现学习医疗保健系统的愿景。该网络框架使参与者围绕着一个共同的目标，即改善健康成果、成果措施的透明度以及灵活和适应性强的协作学习系统。通过使用标准化的流程、协议和政策，包括通信政策、数据共享、隐私保护和合规性，促进团队协作。学习方法包括使用改进的突破系列方法和统计过程控制方法进行协作质量改进。参与者观察自己的成果，并从他人的经验中学习。公共存储库（commons）用于共享由参与者创建的资源。标准化的技术方法减轻了数据输入的负担，促进了护理，并产生了对研究和学习有用的数据。我们描述了这个组织框架是如何在四种条件下复制的，从而在各种条件下大规模地改善了结果。
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.