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A learning health system approach to the COVID‐19 pandemic: System‐wide changes in clinical practice and 30‐day mortality among hospitalized patients

INTRODUCTION: Rapid, continuous implementation of credible scientific findings and regulatory approvals is often slow in large, diverse health systems. The coronavirus disease 2019 (COVID‐19) pandemic created a new threat to this common “slow to learn and adapt” model in healthcare. We describe how...

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Autores principales: McCreary, Erin K., Kip, Kevin E., Bariola, J. Ryan, Schmidhofer, Mark, Minnier, Tami, Mayak, Katelyn, Albin, Debbie, Daley, Jessica, Linstrum, Kelsey, Hernandez, Erik, Sackrowitz, Rachel, Hughes, Kailey, Horvat, Christopher, Snyder, Graham M., McVerry, Bryan J., Yealy, Donald M., Huang, David T., Angus, Derek C., Marroquin, Oscar C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9284933/
https://www.ncbi.nlm.nih.gov/pubmed/35860323
http://dx.doi.org/10.1002/lrh2.10304
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author McCreary, Erin K.
Kip, Kevin E.
Bariola, J. Ryan
Schmidhofer, Mark
Minnier, Tami
Mayak, Katelyn
Albin, Debbie
Daley, Jessica
Linstrum, Kelsey
Hernandez, Erik
Sackrowitz, Rachel
Hughes, Kailey
Horvat, Christopher
Snyder, Graham M.
McVerry, Bryan J.
Yealy, Donald M.
Huang, David T.
Angus, Derek C.
Marroquin, Oscar C.
author_facet McCreary, Erin K.
Kip, Kevin E.
Bariola, J. Ryan
Schmidhofer, Mark
Minnier, Tami
Mayak, Katelyn
Albin, Debbie
Daley, Jessica
Linstrum, Kelsey
Hernandez, Erik
Sackrowitz, Rachel
Hughes, Kailey
Horvat, Christopher
Snyder, Graham M.
McVerry, Bryan J.
Yealy, Donald M.
Huang, David T.
Angus, Derek C.
Marroquin, Oscar C.
author_sort McCreary, Erin K.
collection PubMed
description INTRODUCTION: Rapid, continuous implementation of credible scientific findings and regulatory approvals is often slow in large, diverse health systems. The coronavirus disease 2019 (COVID‐19) pandemic created a new threat to this common “slow to learn and adapt” model in healthcare. We describe how the University of Pittsburgh Medical Center (UPMC) committed to a rapid learning health system (LHS) model to respond to the COVID‐19 pandemic. METHODS: A treatment cohort study was conducted among 11 429 hospitalized patients (pediatric/adult) from 22 hospitals (PA, NY) with a primary diagnosis of COVID‐19 infection (March 19, 2020 ‐ June 6, 2021). Sociodemographic and clinical data were captured from UPMC electronic medical record (EMR) systems. Patients were grouped into four time‐defined patient “waves” based on nadir of daily hospital admissions, with wave 3 (September 20, 2020 ‐ March 10, 2021) split at its zenith due to high volume with steep acceleration and deceleration. Outcomes included changes in clinical practice (eg, use of corticosteroids, antivirals, and other therapies) in relation to timing of internal system analyses, scientific publications, and regulatory approvals, along with 30‐day rate of mortality over time. RESULTS: The mean (SD) daily number of admissions across hospitals was 26 (29) with a maximum 7‐day moving average of 107 patients. System‐wide implementation of the use of dexamethasone, remdesivir, and tocilizumab occurred within days of release of corresponding seminal publications and regulatory actions. After adjustment for differences in patient clinical profiles over time, each month of hospital admission was associated with an estimated 5% lower odds of 30‐day mortality (adjusted odds ratio [OR] = 0.95, 95% confidence interval: 0.93‐0.97, P < .001). CONCLUSIONS: In our large LHS, near real‐time changes in clinical management of COVID‐19 patients happened promptly as scientific publications and regulatory approvals occurred throughout the pandemic. Alongside these changes, patients with COVID‐19 experienced lower adjusted 30‐day mortality following hospital admission over time.
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spelling pubmed-92849332022-07-19 A learning health system approach to the COVID‐19 pandemic: System‐wide changes in clinical practice and 30‐day mortality among hospitalized patients McCreary, Erin K. Kip, Kevin E. Bariola, J. Ryan Schmidhofer, Mark Minnier, Tami Mayak, Katelyn Albin, Debbie Daley, Jessica Linstrum, Kelsey Hernandez, Erik Sackrowitz, Rachel Hughes, Kailey Horvat, Christopher Snyder, Graham M. McVerry, Bryan J. Yealy, Donald M. Huang, David T. Angus, Derek C. Marroquin, Oscar C. Learn Health Syst Research Reports INTRODUCTION: Rapid, continuous implementation of credible scientific findings and regulatory approvals is often slow in large, diverse health systems. The coronavirus disease 2019 (COVID‐19) pandemic created a new threat to this common “slow to learn and adapt” model in healthcare. We describe how the University of Pittsburgh Medical Center (UPMC) committed to a rapid learning health system (LHS) model to respond to the COVID‐19 pandemic. METHODS: A treatment cohort study was conducted among 11 429 hospitalized patients (pediatric/adult) from 22 hospitals (PA, NY) with a primary diagnosis of COVID‐19 infection (March 19, 2020 ‐ June 6, 2021). Sociodemographic and clinical data were captured from UPMC electronic medical record (EMR) systems. Patients were grouped into four time‐defined patient “waves” based on nadir of daily hospital admissions, with wave 3 (September 20, 2020 ‐ March 10, 2021) split at its zenith due to high volume with steep acceleration and deceleration. Outcomes included changes in clinical practice (eg, use of corticosteroids, antivirals, and other therapies) in relation to timing of internal system analyses, scientific publications, and regulatory approvals, along with 30‐day rate of mortality over time. RESULTS: The mean (SD) daily number of admissions across hospitals was 26 (29) with a maximum 7‐day moving average of 107 patients. System‐wide implementation of the use of dexamethasone, remdesivir, and tocilizumab occurred within days of release of corresponding seminal publications and regulatory actions. After adjustment for differences in patient clinical profiles over time, each month of hospital admission was associated with an estimated 5% lower odds of 30‐day mortality (adjusted odds ratio [OR] = 0.95, 95% confidence interval: 0.93‐0.97, P < .001). CONCLUSIONS: In our large LHS, near real‐time changes in clinical management of COVID‐19 patients happened promptly as scientific publications and regulatory approvals occurred throughout the pandemic. Alongside these changes, patients with COVID‐19 experienced lower adjusted 30‐day mortality following hospital admission over time. John Wiley and Sons Inc. 2022-01-27 /pmc/articles/PMC9284933/ /pubmed/35860323 http://dx.doi.org/10.1002/lrh2.10304 Text en © 2022 The Authors. Learning Health Systems published by Wiley Periodicals LLC on behalf of University of Michigan. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Reports
McCreary, Erin K.
Kip, Kevin E.
Bariola, J. Ryan
Schmidhofer, Mark
Minnier, Tami
Mayak, Katelyn
Albin, Debbie
Daley, Jessica
Linstrum, Kelsey
Hernandez, Erik
Sackrowitz, Rachel
Hughes, Kailey
Horvat, Christopher
Snyder, Graham M.
McVerry, Bryan J.
Yealy, Donald M.
Huang, David T.
Angus, Derek C.
Marroquin, Oscar C.
A learning health system approach to the COVID‐19 pandemic: System‐wide changes in clinical practice and 30‐day mortality among hospitalized patients
title A learning health system approach to the COVID‐19 pandemic: System‐wide changes in clinical practice and 30‐day mortality among hospitalized patients
title_full A learning health system approach to the COVID‐19 pandemic: System‐wide changes in clinical practice and 30‐day mortality among hospitalized patients
title_fullStr A learning health system approach to the COVID‐19 pandemic: System‐wide changes in clinical practice and 30‐day mortality among hospitalized patients
title_full_unstemmed A learning health system approach to the COVID‐19 pandemic: System‐wide changes in clinical practice and 30‐day mortality among hospitalized patients
title_short A learning health system approach to the COVID‐19 pandemic: System‐wide changes in clinical practice and 30‐day mortality among hospitalized patients
title_sort learning health system approach to the covid‐19 pandemic: system‐wide changes in clinical practice and 30‐day mortality among hospitalized patients
topic Research Reports
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9284933/
https://www.ncbi.nlm.nih.gov/pubmed/35860323
http://dx.doi.org/10.1002/lrh2.10304
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