“Learn From Every Patient”: How a Learning Health System Can Improve Patient Care

AIM: We created a Learning Health System, the “Learn From Every Patient” program, embedded in our cerebral palsy team clinic. This program was designed to simultaneously provide clinical care while systematically collecting data for quality improvement and research projects on all patients. METHOD: Clinicians created tools within the Electronic Health Record to discretely capture data for clinical use which was also available for quality improvement/research efforts. At baseline, all patients in our clinic received annual hip x-rays to screen for hip displacement. Using our “Learn From Every Patient” database, we reviewed the outcomes for the most mildly affected patients, Level I on the Gross Motor Functional Classification System. RESULTS: One hundred thirty-two patients were classified as Gross Motor Functional Classification System Level I. During the study period, these patients received 212 pelvis x-rays, viewing 424 hips, of which 419 (98.8%) were normal. Five hips (1.2%) had < 30% displacement. None had any hip-related symptoms nor required any procedures during the period. We used these data to create an evidence-based change in our standardized hip screening procedure by eliminating annual screening x-rays for this population. INTERPRETATION: This implementation of a local learning health system approach to systematically collect research data simultaneously with routine clinical care enabled us to implement an evidence-based improvement in clinical practice. This complete integration of research into clinical care improved care by reducing radiation exposure, while simultaneously reducing health care costs.