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Learning Networks for Improvement and Research. Carole Lannon MD MPH Director, Learning Networks Core Anderson Center for Health Systems Excellence Cincinnati Children’s Hospital Medical Center Principal Investigator, pediatric Center for Education and Research on Therapeutics (AHRQ)

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learning networks for improvement and research

Learning Networks for Improvement and Research

Carole Lannon MD MPH

Director, Learning Networks Core

Anderson Center for Health Systems Excellence

Cincinnati Children’s Hospital Medical Center

Principal Investigator, pediatric Center for Education and Research on Therapeutics (AHRQ)

Senior Quality Advisor, American Board of Pediatrics

aim integrate new knowledge into health care delivery system
Aim: Integrate new knowledge into health care delivery system

Improving Child Health

Health care delivery

Outcomes Research

Clinical Trials

Translational Research

Basic research

John Bucuvalas, MD

Cincinnati Children’s

learning networks
Learning Networks

Multi-site clinical networks

Registries/shared data for improvement and research

Quality improvement methods (e.g. data over time, small tests of change)

Collaborations among multidisciplinary teams of clinicians and staff

Engaged patients/ families

Serve as laboratories for research

Translating research into practice

Innovation and discovery

Comparative effectiveness

teams

Teams

Participate in face-to-face learning sessions (~2x/year)

Provide process and outcome data monthly

Receive individual and aggregate performance feedback report

Use monthly webinars & listserv to review data, share challenges & successful strategies

“All teach, all learn”

learning networks in which cchmc provides qi data project management support
Learning Networks in which CCHMC provides QI/data/project management support

Regional

Ohio Perinatal Quality Collaborative

Ohio Solutions for Patient Safety

National

ImproveCareNow: pediatric inflammatory bowel disease

National Pediatric Cardiology Quality Improvement Collaborative

Pediatric Rheumatology Care and Outcomes Improvement Network

slide8

Key Driver Diagram

OUTCOMES

KEY DRIVERS

INTERVENTIONS

Global AIM

Build sustainable collaborative network where all pediatric gastroenterologists can work together in a compelling process of continuous quality improvement and acquisition of new knowledge that will over the next decade dramatically reduce the morbidity and improve the health and well being of children with IBD.

Registry/ Population Management

-Consistent, reliable data entry process with population

management tool used to manage entire population

Accurate diagnosis and

disease classification

Appropriate drug

selection

Pre-visit Planning

-Clear process and tools for pre-visit planning

implemented across clinic with ongoing monitoring

for consistency

  • By December 30, 2012
  • Patients in remission >70%
  • Patients not on prednisone >92%
  • Appropriate drug dosage >90%
  • Consistent, reliable care (complete
  • diagnosis and evaluation bundle) > 90%

Appropriate drug

dosage

Protocols

-Protocols for excellent care spread throughout practice

with reliability of 90%+.

Appropriate

drug levels maintained

Auditing Delivery of Appropriate Care

-Regular use of audit tool with results shared across

practice on a daily basis to inform practice changes.

Adequate nutritional

intake

Self Management Support

-Self management consistently offered with goals

documented for all patients with reliable follow-up

Appropriate growth

monitoring

remission rate improved
Remission rate improved

% of patients (Crohn’s disease + ulcerative colitis)

Remission

Mild disease

activity

Moderate or severe disease activity

Data from first 15 centers

slide10

The Ohio Perinatal Quality Collaborative (since 2007)

24 Neonatal Intensive Care Units (96% preemies)

20 Maternity Hospitals (50% all births)

infants 22 29 wks discharged with at least one nosocomial infection von
Infants 22-29 wks discharged with at least one nosocomial infection (VON)

14.3%

18.2%

In 15 months, 20% reduction in neonatal infections

40 fewer infections, 7 fewer deaths and 1.1 million dollars in savings

quality transformation network 90 children s hospitals growing
Quality Transformation Network90 Children’s Hospitals & Growing

The Quality Transformation Network (QTN) is a large and growing group of children’s hospitals combining forces to improve care and outcomes for high-impact clinical issues. Participating hospitals are achieving improvements at lower cost, more efficiently, and faster than any single hospital can achieve working independently.

Current focus on healthcare associated infections

large volume of outcome process data enables rigorous analyses to understand what works
Large Volume of Outcome & Process Data Enables Rigorous Analyses to Understand What Works
  • Impact of line maintenance practices unknown at outset.
  • Process compliance data collected to understand effect on infection rates.
  • Aggregating data on practices standardized across many sites yields critical mass of data to analyze.
  • As line maintenance compliance increases, infection rates decline.

Line maintenance compliance increases

Infection rate decreases

Reducing PICU Central Line–Associated Bloodstream Infections: 3-Year Results; Miller, M et al, Pediatrics, October 2011

impact of learning networks
Impact of Learning Networks
  • Improved health outcomes for children
  • New knowledge and spread
  • Translate research into practice
    • Real-time learning about what works
    • Databases for comparative effectiveness research
    • Opportunities for collaboration and innovation
interested to learn more
Interested to learn more?
  • National Meeting on Collaborative Improvement Networks
    • November 2011
    • Sponsored by American Board of Pediatrics, NACHRI, and CCHMC
    • Presentations at https://www.abp.org/abpwebsite/moc/collabimp.htm
    • Pediatrics supplement planned
  • CCHMC Learning Networks webpage
    • http://www.cincinnatichildrens.org/19055/learning-networks/
    • Contact me at carole.lannon@cchmc.org