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What is a Learning Healthcare System, and Where Does CERTAIN Fit In?

This article is the first in a series that examines what CERTAIN is doing to develop a true learning healthcare system in Washington State. Have a question about CERTAIN that you would like for us to cover in a future article? Let us know.

The United States spends more on healthcare than all other industrialized nations, but lags considerably behind in most measures of healthcare quality and efficiency. A 2012 Institute of Medicine report entitled, "Best Care at Lower Cost: The Path to Continuously Learning Health Care in America" cited multiple issues that contribute to US healthcare inadequacies. For example, the US spends over $100 billion each year on healthcare research, but most of this research does not help patients and doctors make better healthcare decisions. Furthermore, research evidence takes on average 12-17 years to be adopted into clinical practice, causing clinical care to lag far behind research-supported best practices. Even if research evidence was translated into clinical practice in a more timely manner, there is no performance surveillance system in place to monitor progress and outcomes of care. Finally, despite the billions of dollars being spent on research to improve healthcare, research studies are largely conducted by academic researchers who study questions that are important to them and their interests – questions that may not produce the information that patients and their doctors most need to make healthcare decisions.

What is needed is a system that tracks quality and cost, drives improvements in care by learning from the experiences of patients, is a mechanism for translating evidence into practice, and incorporates the voices of all healthcare stakeholders – patients, physicians, payers, and policymakers. These are the components of a learning healthcare system, and CERTAIN is the learning healthcare system developed in Washington State. CERTAIN is a suite of projects and programs, including:

  • A network of clinical practice partners, including hospitals and clinics (projects like the PAD Study and CINCO), doctor’s offices (PROs in Practice), and, in 2013, skilled nursing facilities, joined together to track quality and benchmark best practices.
  • Public health interventions to drive improvement (Strong for Surgery, 100% Checklist Campaign).
  • A mechanism for patients to “tell their story” related to healthcare (Patient Voices Project) so the system comes to understand the real impact of healthcare interventions and so researchers focus on the things that matter to patients.
  • Forums, advisory groups, and partnerships that allow all stakeholders in healthcare (patients, providers, policy makers, payers [including insurers and employers]) to be part of the learning network.

The work of CERTAIN is putting Washington State at the forefront of healthcare in America. We have accomplished a lot in our first 2 years, including creating a network of over 40 diverse healthcare organizations participating in continuous evaluation of healthcare delivery, outcomes, and interventions to improve care; developing focused performance surveillance activities across the continuum of care (pre-hospital, in-hospital, post-hospital, and long-term care), implementing system learning activities through comparative effectiveness research studies to provide evidence on effectiveness, benefits, and harms or different treatment options for different types of patients in real-world settings; engaging all stakeholder voices, and engaging partners in evidence translation into practice initiatives that get proven high-quality research evidence into clinical practice quickly and efficiently.

CERTAIN benefits all healthcare stakeholders. Patients and their doctors are able to get information needed to make better healthcare decisions. Clinicians, hospitals, and care networks are able to better integrate evidence into practice. Researchers are able to focus on issues that matter to patients and other healthcare stakeholders, and payers are able to recognize more value for healthcare dollars. CERTAIN could not function without the input and partnership of people like you – doctors, patients, payers, researchers, and policymakers – and your voice is needed to ensure CERTAIN is a continuing success. All healthcare stakeholders are invited to become involved in the work of CERTAIN. Are you a:

  • Patient? Participate in the Patient Advisory Network – tell your healthcare story and provide input on CERTAIN activities from the patient perspective.
  • Physician? Join a Research Advisory Group. Research Advisory Groups advise specifically on CERTAIN activities in relation to clinical practice sites – from development and implementation of research studies to development and implementation of initiatives to translate research evidence into clinical practice. Current groups exist in vascular, spine, cancer, and urologic care.
  • Researcher, payer, policymaker, physician, or patient? Join a Multi-Stakeholder Forum. These groups advise on broad issues relating to the clinical or project focus area and bring together multiple perspectives to tackle community-wide issues and develop and implement strategies for improving care. Current groups include the Spine Care Forum and the Strong for Surgery Stakeholder Advisory Group.

Contact us to learn more about any of the above opportunities or to explore other ways you can get involved in the work of CERTAIN.

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  • CERTAIN Medical Director Dr. David Flum on The Conversation with Ross Reynolds 4/11/12: listen here.