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Employing learning health system principles to advance research on severe neonatal and paediatric illness in Kenya

We have worked to develop a Clinical Information Network (CIN) in Kenya as an early form of learning health systems (LHS) focused on paediatric and neonatal care that now spans 22 hospitals. CIN’s aim was to examine important outcomes of hospitalisation at scale, identify and ultimately solve practi...

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Autores principales: English, Mike, Irimu, Grace, Akech, Samuel, Aluvaala, Jalemba, Ogero, Morris, Isaaka, Lynda, Malla, Lucas, Tuti, Timothy, Gathara, David, Oliwa, Jacquie, Agweyu, Ambrose
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7993294/
https://www.ncbi.nlm.nih.gov/pubmed/33758014
http://dx.doi.org/10.1136/bmjgh-2021-005300
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author English, Mike
Irimu, Grace
Akech, Samuel
Aluvaala, Jalemba
Ogero, Morris
Isaaka, Lynda
Malla, Lucas
Tuti, Timothy
Gathara, David
Oliwa, Jacquie
Agweyu, Ambrose
author_facet English, Mike
Irimu, Grace
Akech, Samuel
Aluvaala, Jalemba
Ogero, Morris
Isaaka, Lynda
Malla, Lucas
Tuti, Timothy
Gathara, David
Oliwa, Jacquie
Agweyu, Ambrose
author_sort English, Mike
collection PubMed
description We have worked to develop a Clinical Information Network (CIN) in Kenya as an early form of learning health systems (LHS) focused on paediatric and neonatal care that now spans 22 hospitals. CIN’s aim was to examine important outcomes of hospitalisation at scale, identify and ultimately solve practical problems of service delivery, drive improvements in quality and test interventions. By including multiple routine settings in research, we aimed to promote generalisability of findings and demonstrate potential efficiencies derived from LHS. We illustrate the nature and range of research CIN has supported over the past 7 years as a form of LHS. Clinically, this has largely focused on common, serious paediatric illnesses such as pneumonia, malaria and diarrhoea with dehydration with recent extensions to neonatal illnesses. CIN also enables examination of the quality of care, for example that provided to children with severe malnutrition and the challenges encountered in routine settings in adopting simple technologies (pulse oximetry) and more advanced diagnostics (eg, Xpert MTB/RIF). Although regular feedback to hospitals has been associated with some improvements in quality data continue to highlight system challenges that undermine provision of basic, quality care (eg, poor access to blood glucose testing and routine microbiology). These challenges include those associated with increased mortality risk (eg, delays in blood transfusion). Using the same data the CIN platform has enabled conduct of randomised trials and supports malaria vaccine and most recently COVID-19 surveillance. Employing LHS principles has meant engaging front-line workers, clinical managers and national stakeholders throughout. Our experience suggests LHS can be developed in low and middle-income countries that efficiently enable contextually appropriate research and contribute to strengthening of health services and research systems.
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spelling pubmed-79932942021-04-19 Employing learning health system principles to advance research on severe neonatal and paediatric illness in Kenya English, Mike Irimu, Grace Akech, Samuel Aluvaala, Jalemba Ogero, Morris Isaaka, Lynda Malla, Lucas Tuti, Timothy Gathara, David Oliwa, Jacquie Agweyu, Ambrose BMJ Glob Health Practice We have worked to develop a Clinical Information Network (CIN) in Kenya as an early form of learning health systems (LHS) focused on paediatric and neonatal care that now spans 22 hospitals. CIN’s aim was to examine important outcomes of hospitalisation at scale, identify and ultimately solve practical problems of service delivery, drive improvements in quality and test interventions. By including multiple routine settings in research, we aimed to promote generalisability of findings and demonstrate potential efficiencies derived from LHS. We illustrate the nature and range of research CIN has supported over the past 7 years as a form of LHS. Clinically, this has largely focused on common, serious paediatric illnesses such as pneumonia, malaria and diarrhoea with dehydration with recent extensions to neonatal illnesses. CIN also enables examination of the quality of care, for example that provided to children with severe malnutrition and the challenges encountered in routine settings in adopting simple technologies (pulse oximetry) and more advanced diagnostics (eg, Xpert MTB/RIF). Although regular feedback to hospitals has been associated with some improvements in quality data continue to highlight system challenges that undermine provision of basic, quality care (eg, poor access to blood glucose testing and routine microbiology). These challenges include those associated with increased mortality risk (eg, delays in blood transfusion). Using the same data the CIN platform has enabled conduct of randomised trials and supports malaria vaccine and most recently COVID-19 surveillance. Employing LHS principles has meant engaging front-line workers, clinical managers and national stakeholders throughout. Our experience suggests LHS can be developed in low and middle-income countries that efficiently enable contextually appropriate research and contribute to strengthening of health services and research systems. BMJ Publishing Group 2021-03-23 /pmc/articles/PMC7993294/ /pubmed/33758014 http://dx.doi.org/10.1136/bmjgh-2021-005300 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/ https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Practice
English, Mike
Irimu, Grace
Akech, Samuel
Aluvaala, Jalemba
Ogero, Morris
Isaaka, Lynda
Malla, Lucas
Tuti, Timothy
Gathara, David
Oliwa, Jacquie
Agweyu, Ambrose
Employing learning health system principles to advance research on severe neonatal and paediatric illness in Kenya
title Employing learning health system principles to advance research on severe neonatal and paediatric illness in Kenya
title_full Employing learning health system principles to advance research on severe neonatal and paediatric illness in Kenya
title_fullStr Employing learning health system principles to advance research on severe neonatal and paediatric illness in Kenya
title_full_unstemmed Employing learning health system principles to advance research on severe neonatal and paediatric illness in Kenya
title_short Employing learning health system principles to advance research on severe neonatal and paediatric illness in Kenya
title_sort employing learning health system principles to advance research on severe neonatal and paediatric illness in kenya
topic Practice
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7993294/
https://www.ncbi.nlm.nih.gov/pubmed/33758014
http://dx.doi.org/10.1136/bmjgh-2021-005300
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