Building a Learning Healthcare Network:The transition of the Vascular Interventional Surgical Care Outcomes Assessment Program to the Comparative Effectiveness Research Translation Network

Abstract

Building a Learning Healthcare Network:The transition of the Vascular Interventional Surgical Care Outcomes Assessment Program to the Comparative Effectiveness Research Translation Network The purpose of the thesis: "Building a Learning Healthcare Network: The transition of the Vascular Interventional Surgical Care Outcomes Assessment Program to (VI SCOAP) the the Comparative Effectiveness Research Translation Network (CERTAIN)" is to describe the creation of a learning healthcare network. In "The Learning Health System and its Innovation Collaboratives Update Report" that was published in 20111, the Institute of Medicine (IOM) describes a learning network as one that harnesses the sum of individual clinical data to answer a clinical question. It does this by applying rigorous research methodology to deliver a best practice, evidence based recommendation for how to address the clinical problem. In addition, it incorporates the patient experience into this process with the final sum being a network that delivers the right therapy to the right patient at the right time in a way that is patient centered. Critical to this network is the ability to translate the best practice recommendation directly into the physicians practice so that the improvement in quality and/or appropriateness occurs immediately. In effect, this system learns from itself and incorporates that learning into its implementation with the goal of reducing variation in care delivery and overall costs to the system. In 2009, data from VI SCOAP revealed variation in the approach among vascular surgeons, interventional radiologists, and cardiologists, to treating mild and moderate claudication. Furthermore, there remained clinical debate as to the best form of intervention for this population - open surgery, endovascular stenting, or usual care (walking program, smoking cessation counseling, medication). This variation in approach to intervention and appropriateness of intervention has implications for both large healthsystem delivery costs and patient safety and lends itself to comparative effectivness research. This is the story of what the Washington State medical community has undertaken to be part of the nationwide transformation in the United States healthcare system. Not only have the clinicians been willing to embrace change, they have orchestrated it. Washington State physicians have been bold in their openness to question the status quo, work together to build a better health system, and remain single minded in their care and concern for the patients they serve.