学习型医疗保健系统能教我们如何改善结果？
What can a learning healthcare system teach us about improving outcomes?
机构信息
Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
Division of Pulmonary, Allergy, and Critical Care, Palliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
出版信息
Curr Opin Crit Care. 2021 Oct 1;27(5):527-536. doi: 10.1097/MCC.0000000000000857.
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.
SUMMARY
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.
目的综述
本文描述了学习型医疗保健系统范例、近期范例以及未来方向。患者、临床医生和医疗体系在面对现有治疗方法、技术和医疗服务方式的选择时，经常会遇到各种决策，而这些选择在比较有效性和安全性方面的证据很少或几乎没有。学习型医疗保健系统努力发现这些知识空白，将包括临床试验在内的比较有效性研究纳入临床护理，以解决这些知识空白，并将研究结果无缝地应用于实践，以改善护理和患者的预后。
最近的发现
最近的研究比较了诊断测试和治疗方法的有效性，利用信息技术来识别可能经历某种结果或从干预中获益的患者，并评估了医疗服务提供模式，这些研究都证明了学习型医疗保健系统方法如何能够减少护理中的任意差异，降低成本，并改善患者预后。
总结
学习型医疗保健系统有可能回答患者、临床医生和医疗体系领导者关心的问题，提高医疗保健的效率，并改善患者的预后。要实现这一目标，需要调整围绕临床护理的文化、机构和联邦投资、扩大利益攸关方的参与、定制适合的伦理和监管指导，以及在信息技术和生物统计学方面的方法学进展。
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