Lowes Linda P, Noritz Garey H, Newmeyer Amy, Embi Peter J, Yin Han, Smoyer William E
Nationwide Children's Hospital, Columbus, OH, USA.
Department of Pediatrics, The Ohio State University, Columbus, OH, USA.
Dev Med Child Neurol. 2017 Feb;59(2):183-191. doi: 10.1111/dmcn.13227. Epub 2016 Aug 22.
The convergence of three major trends in medicine, namely conversion to electronic health records (EHRs), prioritization of translational research, and the need to control healthcare expenditures, has created unprecedented interest and opportunities to develop systems that improve care while reducing costs. However, operationalizing a 'learning health system' requires systematic changes that have not yet been widely demonstrated in clinical practice.
We developed, implemented, and evaluated a model of EHR-supported care in a cohort of 131 children with cerebral palsy that integrated clinical care, quality improvement, and research, entitled 'Learn From Every Patient' (LFEP).
Children treated in the LFEP Program for a 12-month period experienced a 43% reduction in total inpatient days (p=0.030 vs prior 12mo period), a 27% reduction in inpatient admissions, a 30% reduction in emergency department visits (p=0.001), and a 29% reduction in urgent care visits (p=0.046). LFEP Program implementation also resulted in reductions in healthcare costs of 210% (US$7014/child) versus a Time control group, and reductions of 176% ($6596/child) versus a Program Activities control group. Importantly, clinical implementation of the LFEP Program has also driven the continuous accumulation of robust research-quality data for both publication and implementation of evidence-based improvements in clinical care.
These results demonstrate that a learning health system can be developed and implemented in a cost-effective manner, and can integrate clinical care and research to systematically drive simultaneous clinical quality improvement and reduced healthcare costs.
医学领域三大主要趋势的融合，即向电子健康记录（EHR）的转变、转化医学研究的优先化以及控制医疗保健支出的需求，为开发既能改善护理又能降低成本的系统创造了前所未有的兴趣和机遇。然而，实施“学习型健康系统”需要系统性变革，而这在临床实践中尚未得到广泛验证。
我们在131名脑瘫儿童队列中开发、实施并评估了一种由电子健康记录支持的护理模式，该模式整合了临床护理、质量改进和研究，名为“向每位患者学习”（LFEP）。
在LFEP项目中接受治疗12个月的儿童，总住院天数减少了43%（与前12个月相比，p = 0.030），住院次数减少了27%，急诊就诊次数减少了30%（p = 0.001），紧急护理就诊次数减少了29%（p = 0.046）。与时间对照组相比，LFEP项目的实施还使医疗保健成本降低了210%（每位儿童7014美元），与项目活动对照组相比降低了176%（每位儿童6596美元）。重要的是，LFEP项目的临床实施还推动了高质量研究数据的持续积累，用于发表以及在临床护理中实施基于证据的改进。
这些结果表明，可以以具有成本效益的方式开发和实施学习型健康系统，并且该系统能够整合临床护理和研究，以系统性地推动临床质量的同时提高和医疗保健成本的降低。
