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"learning health system"

James F Burgess, Nir Menachemi, Matthew L Maciejewski
OBJECTIVE: To present revised core competencies for doctoral programs in health services research (HSR), modalities to deliver these competencies, and suggested methods for assessing mastery of these competencies. DATA SOURCES AND DATA COLLECTION: Core competencies were originally developed in 2005, updated (but unpublished) in 2008, modestly updated for a 2016 HSR workforce conference, and revised based on feedback from attendees. Additional feedback was obtained from doctoral program directors, employer/workforce experts and attendees of presentation on these competencies at the AcademyHealth's June 2017 Annual Research Meeting...
March 13, 2018: Health Services Research
Grace Irimu, Morris Ogero, George Mbevi, Ambrose Agweyu, Samuel Akech, Thomas Julius, Rachel Nyamai, David Githang'a, Philip Ayieko, Mike English
No abstract text is available yet for this article.
March 7, 2018: Archives of Disease in Childhood
M Fung-Kee-Fung, D E Maziak, J R Pantarotto, J Smylie, L Taylor, T Timlin, T Cacciotti, P J Villeneuve, C Dennie, C Bornais, S Madore, J Aquino, P Wheatley-Price, R S Ozer, D J Stewart
Background: The Ottawa Hospital (toh) defined delay to timely lung cancer care as a system design problem. Recognizing the patient need for an integrated journey and the need for dynamic alignment of providers, toh used a learning health system (lhs) vision to redesign regional diagnostic processes. A lhs is driven by feedback utilizing operational and clinical information to drive system optimization and innovation. An essential component of a lhs is a collaborative platform that provides connectivity across silos, organizations, and professions...
February 2018: Current Oncology
Kayte Spector-Bagdady, Andrew G Shuman
Clinical data registries are perhaps one of the most powerful outcomes of electronic medical records, and their benefits are projected to redound to patients and clinicians across the nation. The American Academy of Otolaryngology-Head and Neck Surgery Foundation's Reg-ent fits within the conceptual framework of a learning health system. Because the data within this system are deidentified, research informed consent is not legally required. But ethical concerns remain regarding whether and how to best notify, and whether to obtain consent from, patients whose data are included...
March 2018: Otolaryngology—Head and Neck Surgery
Michael Seid, George Dellal, Laura E Peterson, Lloyd Provost, Peter A Gloor, David Livingstone Fore, Peter A Margolis
BACKGROUND: Our health care system fails to deliver necessary results, and incremental system improvements will not deliver needed change. Learning health systems (LHSs) are seen as a means to accelerate outcomes, improve care delivery, and further clinical research; yet, few such systems exist. We describe the process of codesigning, with all relevant stakeholders, an approach for creating a collaborative chronic care network (C3N), a peer-produced networked LHS. OBJECTIVE: The objective of this study was to report the methods used, with a diverse group of stakeholders, to translate the idea of a C3N to a set of actionable next steps...
February 22, 2018: JMIR Human Factors
Katherine D Blizinsky, Vence L Bonham
To fully achieve the goals of a genomics-enabled learning health care system, purposeful efforts to understand and reduce health disparities and improve equity of care are essential. This paper highlights three major challenges facing genomics-enabled learning health care systems, as they pertain to ancestrally diverse populations: inequality in the utility of genomic medicine; lack of access to pharmacogenomics in clinical care; and inadequate incorporation of social and environmental data into the electronic health care record (EHR)...
January 2018: Learning Health Systems
Todd R McNutt, Michael Bowers, Sierra Cheng, Peijin Han, Xuan Hui, Joseph Moore, Scott Robertson, Charles Mayo, Ranh Voong, Harry Quon
The capture of high quality treatment and outcomes data is necessary in order to learn from our clinical experiences with big data analytics. In radiotherapy, there are several practical challenges to overcome. Practical aspects of data collection are discussed pointing to a need for a culture change in clinical practice to one that captures structured patient related data in routine care in a prospective manner. Radiation dosimetry and the contoured anatomy must also be captured routinely to represent the best estimate of delivered radiation...
February 15, 2018: Medical Physics
Sameer K Berry, Gil Y Melmed
Inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis, is a chronic, debilitating, and expensive condition affecting millions of people globally. There is significant variation in the quality of care for patients with IBD across North America, Europe, and Asia; this variation suggests poor quality of care due to overuse, underuse, or misuse of health services and disparity of outcomes. Several initiatives have been developed to reduce variation in care delivery and improve processes of care, patient outcomes, and reduced healthcare costs...
January 2018: Intestinal Research
Harry Hemingway, Folkert W Asselbergs, John Danesh, Richard Dobson, Nikolaos Maniadakis, Aldo Maggioni, Ghislaine Jm van Thiel, Maureen Cronin, Gunnar Brobert, Panos Vardas, Stefan D Anker, Diederick E Grobbee, Spiros Denaxas
Aims: Cohorts of millions of people's health records, whole genome sequencing, imaging, sensor, societal and publicly available data present a rapidly expanding digital trace of health. We aimed to critically review, for the first time, the challenges and potential of big data across early and late stages of translational cardiovascular disease research. Methods and results: We sought exemplars based on literature reviews and expertise across the BigData@Heart Consortium...
August 29, 2017: European Heart Journal
Sabine E M de Hoon, Karin Hek, Liset van Dijk, Robert A Verheij
BACKGROUND: Adequate record keeping of medication adverse events in electronic health records systems is important for patient safety. Events that remain unrecorded cannot be communicated from one health professional to another. In the absence of a gold standard, we investigate the variation between Dutch general practices in the extent to which they record medication adverse events. METHODS: Data were derived from electronic health records (EHR) of Dutch general practices participating in NIVEL Primary Care Database (NIVEL-PCD) in 2014, including 308 general practices with a total practice population of 1,256,049 listed patients...
December 6, 2017: BMC Medical Informatics and Decision Making
Vidhi Thakkar, Terrence Sullivan
Health services and policy research (HSPR) represent a multidisciplinary field which integrates knowledge from health economics, health policy, health technology assessment, epidemiology, political science among other fields, to evaluate decisions in health service delivery. Health service decisions are informed by evidence at the clinical, organizational, and policy level, levels with distinct, managerial drivers. HSPR has an evolving discourse spanning knowledge translation, linkage and exchange between research and decision-maker partners and more recently, implementation science and learning health systems...
April 10, 2017: International Journal of Health Policy and Management
Alex John London
To give substance to the rhetoric of 'learning health systems', a variety of novel trial designs are being explored to more seamlessly integrate research with medical practice, reduce study duration and reduce the number of participants allocated to ineffective interventions. Many of these designs rely on response adaptive randomisation (RAR). However, critics charge that RAR is unethical on the grounds that it violates the principle of equipoise. In this paper, I reconstruct critiques of RAR as holding that it is inconsistent with five important ethical principles...
November 24, 2017: Journal of Medical Ethics
Zachary Pruitt, Rahul Mhaskar, Bryan G Kane, Robert D Barraco, Deborah J DeWaay, Alex M Rosenau, Kristin A Bresnan, Marna Rayl Greenberg
Background: There is currently no gold standard for delivery of systems-based practice in medical education, and it is challenging to incorporate into medical education. Health systems competence requires physicians to understand patient care within the broader health care system and is vital to improving the quality of care clinicians provide. We describe a health systems curriculum that utilizes problem-based learning across 4 years of systems-based practice medical education at a single institution...
2017: Advances in Medical Education and Practice
Kamila B Mistry, Christopher B Forrest
No abstract text is available yet for this article.
December 2017: Pediatrics
Ankur Kalra, Srinath Adusumalli, Shashank S Sinha
No abstract text is available yet for this article.
November 7, 2017: Journal of the American College of Cardiology
Arif H Kamal, Kathryn B Kirkland, Diane E Meier, Tamara S Morgan, Eugene C Nelson, Steven Z Pantilat
BACKGROUND: Palliative care offers an approach to the care of people with serious illness that focuses on quality of life and aligning care with individual and family goals, and values in the context of what is medically achievable. OBJECTIVE: Measurement of the impact of palliative care is critical for determining what works for which patients in what settings, to learn, improve care, and ensure access to high value care for people with serious illness. METHODS: A learning health system that includes patients and families partnering with clinicians and care teams, is directly linked to a registry to support networks for improvement and research, and offers an ideal framework for measuring what matters to a range of stakeholders interested in improving care for this population...
March 2018: Journal of Palliative Medicine
B Séroussi, L F Soualmia, J H Holmes
Objectives: To provide an introduction to the 2017 IMIA Yearbook of Medical Informatics by the editors. Methods: We present a brief overview of the 2017 special topic "Learning from experience: Secondary use of patient data". We review our choice of special topic section editors, present the new section "Health Information Management", and discuss transitions in the editorial team. Results: In this edition of the Yearbook, we focused on one of the most important issues for the medical informatics community: The secondary use of clinical data...
August 2017: Yearbook of Medical Informatics
Bright I Nwaru, Charles Friedman, John Halamka, Aziz Sheikh
There is increasing international policy and clinical interest in developing learning health systems and delivering precision medicine, which it is hoped will help reduce variation in the quality and safety of care, improve efficiency, and lead to increasing the personalisation of healthcare. Although reliant on similar policies, informatics tools, and data science and implementation research capabilities, these two major initiatives have thus far largely progressed in parallel. In this opinion piece, we argue that they should be considered as complementary, synergistic initiatives whereby the creation of learning health systems infrastructure can support and catalyse the delivery of precision medicine that maximises the benefits and minimises the risks associated with treatments for individual patients...
October 2, 2017: BMC Medicine
Jean-Francois Ethier, Vasa Curcin, Mark M McGilchrist, Sarah N Lim Choi Keung, Lei Zhao, Anna Andreasson, Piotr Bródka, Radoslaw Michalski, Theodoros N Arvanitis, Nikolaos Mastellos, Anita Burgun, Brendan C Delaney
OBJECTIVE: The Learning Health System (LHS) requires integration of research into routine practice. 'eSource' or embedding clinical trial functionalities into routine electronic health record (EHR) systems has long been put forward as a solution to the rising costs of research. We aimed to create and validate an eSource solution that would be readily extensible as part of a LHS. MATERIALS AND METHODS: The EU FP7 TRANSFoRm project's approach is based on dual modelling, using the Clinical Research Information Model (CRIM) and the Clinical Data Integration Model of meaning (CDIM) to bridge the gap between clinical and research data structures, using the CDISC Operational Data Model (ODM) standard...
October 2017: International Journal of Medical Informatics
Kavishwar B Wagholikar, Rahul Jain, Eliel Oliveira, Joshua Mandel, Jeffery Klann, Ricardo Colas, Prasad Patil, Kuladip Yadav, Kenneth D Mandl, Thomas Carton, Shawn N Murphy
Research networks for data sharing are growing into a large platform for pragmatic clinical trials to generate quality evidence for shared medical decision-making. Institutions partnering in the networks have made large investments in developing the infrastructure for sharing data. We investigate whether institutions partnering on Patient-Centered Outcomes Research Institute's (PCORI) network can share clinical apps. At two different sites, we imported patient data in PCORI's clinical data model (CDM) format into i2b2 repositories, and adapted the SMART-on-FHIR cell to perform CDM-to-FHIR translation, serving demographics, laboratory results and diagnoses...
2017: AMIA Summits on Translational Science Proceedings
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