M.D. McEvoy is professor of anesthesiology and surgery, vice chair for educational affairs, program director of the perioperative medicine fellowship, and director of the Center for Innovation in Perioperative Health, Education, and Research, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee.
M.L. Dear is project manager, Learning Healthcare System Platform, Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee.
Acad Med. 2021 Sep 1;96(9):1311-1314. doi: 10.1097/ACM.0000000000003969.
In an ideal learning health care system (LHS), clinicians learn from what they do and do what they learn, closing the evidence-to-practice gap. In operationalizing an LHS, great strides have been made in knowledge generation. Yet, considerable challenges remain to the broad uptake of identified best practices. To bridge the gap from generating actionable knowledge to applying that knowledge in clinical practice, and ultimately to improving outcomes, new information must be disseminated to and implemented by frontline clinicians. To date, the dissemination of this knowledge through traditional avenues has not achieved meaningful practice change quickly.
Vanderbilt University Medical Center (VUMC) developed QuizTime, a smartphone application learning platform, to provide a mechanism for embedding workplace-based clinician learning in the LHS. QuizTime leverages spaced education and retrieval-based practice to facilitate practice change. Beginning in January 2020, clinician-researchers and educators at VUMC designed a randomized, controlled trial to test whether the QuizTime learning system influenced clinician behavior in the context of recent evidence supporting the use of balanced crystalloids rather than saline for intravenous fluid management and new regulations around opioid prescribing.
Whether spaced education and retrieval-based practice influence clinician behavior and patient outcomes at the VUMC system level will be tested using the data currently being collected.
These findings will inform future directions for developing and deploying learning approaches at scale in an LHS, with the goal of closing the evidence-to-practice gap.
在理想的学习型医疗保健系统（LHS）中，临床医生从他们所做的事情中学习，并将所学应用于实践，从而缩小证据与实践之间的差距。在实施 LHS 方面，在知识生成方面已经取得了巨大进展。然而，要广泛采用已确定的最佳实践，仍然存在相当大的挑战。为了弥合从生成可操作知识到将该知识应用于临床实践并最终改善结果的差距，必须将新信息传播给一线临床医生并由其实施。迄今为止，通过传统途径传播这些知识并没有迅速实现有意义的实践改变。
范德比尔特大学医学中心（VUMC）开发了 QuizTime，这是一种智能手机应用学习平台，旨在为将基于工作场所的临床医生学习纳入 LHS 提供一种机制。QuizTime 利用间隔教育和基于检索的实践来促进实践的改变。从 2020 年 1 月开始，VUMC 的临床医生研究人员和教育工作者设计了一项随机对照试验，以测试 QuizTime 学习系统是否会影响临床医生在最近支持使用平衡晶体液而不是生理盐水进行静脉输液管理的证据以及有关阿片类药物处方新规定的背景下的行为。
目前正在收集的数据将用于测试间隔教育和基于检索的实践是否会影响 VUMC 系统层面的临床医生行为和患者结果。
这些发现将为在 LHS 中大规模开发和部署学习方法提供未来方向，目标是缩小证据与实践之间的差距。
