The Learning Healthcare System: Clinical Care and Research Working Hand in Hand
David Atkins, M.D., M.P.H., acting chief Research and Development Officer in the U.S. Department of Veteran Affairs (VA) will discuss the learning healthcare system at CTSI Grand Rounds on December 13. According to Atkins, the learning healthcare system blurs the lines between research done for the sake of discovery and research done with the goal of improving the quality of clinical care.
In the past, research was geared toward generating generalizable knowledge, but was less concerned with translating that knowledge into practice. At the same time, there were clinicians practicing medicine and conducting small studies aimed at improving care, but who were not concerned with contributing to scientific knowledge.
In a learning healthcare system, those lines dissolve. The realm of research takes more responsibility for translating discoveries to clinical care, and clinicians can use big data and apply more rigorous methods to produce knowledge that can benefit whole populations or whole healthcare systems.
The Institute of Medicine (now named National Academy of Medicine) is credited with developing the learning healthcare system concept. They describe it as a cycle of patient care providing information that generates research studies, which get applied to clinical care, which provides new information and generates new studies, and so on ad infinitum.
The VA mental health care system provides an excellent example of the learning healthcare system in action. The VA has a very a high burden of mental health issues and a rich supply of researchers dedicated to studying mental health care and how to improve it. Several research studies have recommended new treatment strategies, new models of care and modifications to the Electronic Health Record. Together these changes help identify people with mental health issues, aid in developing the best strategy for their care, and track whether optimal care was received. These changes have led to more effective treatments for PTSD and better delivery of care for patients with depression.
While new technologies like the Electronic Health Record have brought us closer to being able to fully implement the learning healthcare system, we still struggle to align incentives for clinicians and researchers so everyone is pursuing high value patient-centered care. Part of the problem is that academic researchers tend to get credit for grant funding and publishing study results, but not necessarily for following that research through to the bedside. With a dedicated research budget and global budget for healthcare, Atkins believes the VA has a better chance to align incentives: clinicians are motivate to provide high-value care rather than to generate practice income and researchers can be funded and rewarded for their impacts on patients rather than their publications.
On the other hand, it is still a challenge for someone to be equal parts researcher and clinician. You can either be a clinician investigator where your success is measured on your research and the money you bring in, or you can be clinician educator or administrator who does not get rewarded for contributing to, or participating in, research.
“We still have a world where the incentives are for you to declare yourself either a fish or a fowl,” says Atkins. “What we really need are people who can do both.”
To learn more about the learning healthcare system, join us for CTSI Grand Rounds on December 13th at noon in the Ryan Case Method Room (Medical Center room 1-9576). Lunch will be provided. Please bring your own beverage.
Susanne Pritchard Pallo |