PMID- 33570841
OWN - NLM
STAT- MEDLINE
DCOM- 20210907
LR  - 20230717
IS  - 1938-808X (Electronic)
IS  - 1040-2446 (Print)
IS  - 1040-2446 (Linking)
VI  - 96
IP  - 9
DP  - 2021 Sep 1
TI  - Embedding Learning in a Learning Health Care System to Improve Clinical Practice.
PG  - 1311-1314
LID - 10.1097/ACM.0000000000003969 [doi]
AB  - PROBLEM: In an ideal learning health care system (LHS), clinicians learn from 
      what they do and do what they learn, closing the evidence-to-practice gap. In 
      operationalizing an LHS, great strides have been made in knowledge generation. 
      Yet, considerable challenges remain to the broad uptake of identified best 
      practices. To bridge the gap from generating actionable knowledge to applying 
      that knowledge in clinical practice, and ultimately to improving outcomes, new 
      information must be disseminated to and implemented by frontline clinicians. To 
      date, the dissemination of this knowledge through traditional avenues has not 
      achieved meaningful practice change quickly. APPROACH: Vanderbilt University 
      Medical Center (VUMC) developed QuizTime, a smartphone application learning 
      platform, to provide a mechanism for embedding workplace-based clinician learning 
      in the LHS. QuizTime leverages spaced education and retrieval-based practice to 
      facilitate practice change. Beginning in January 2020, clinician-researchers and 
      educators at VUMC designed a randomized, controlled trial to test whether the 
      QuizTime learning system influenced clinician behavior in the context of recent 
      evidence supporting the use of balanced crystalloids rather than saline for 
      intravenous fluid management and new regulations around opioid prescribing. 
      OUTCOMES: Whether spaced education and retrieval-based practice influence 
      clinician behavior and patient outcomes at the VUMC system level will be tested 
      using the data currently being collected. NEXT STEPS: These findings will inform 
      future directions for developing and deploying learning approaches at scale in an 
      LHS, with the goal of closing the evidence-to-practice gap.
CI  - Copyright (c) 2021 by the Association of American Medical Colleges.
FAU - McEvoy, Matthew D
AU  - McEvoy MD
AD  - M.D. McEvoy is professor of anesthesiology and surgery, vice chair for 
      educational affairs, program director of the perioperative medicine fellowship, 
      and director of the Center for Innovation in Perioperative Health, Education, and 
      Research, Department of Anesthesiology, Vanderbilt University Medical Center, 
      Nashville, Tennessee.
FAU - Dear, Mary Lynn
AU  - Dear ML
AD  - M.L. Dear is project manager, Learning Healthcare System Platform, Vanderbilt 
      Institute for Clinical and Translational Research, Vanderbilt University Medical 
      Center, Nashville, Tennessee.
FAU - Buie, Reagan
AU  - Buie R
AD  - R. Buie is health policy service analyst, Learning Healthcare System Platform, 
      Vanderbilt Institute for Clinical and Translational Research, Vanderbilt 
      University Medical Center, Nashville, Tennessee.
FAU - Fowler, Leslie C
AU  - Fowler LC
AD  - L.C. Fowler is director of the Educational Development and Research Office of 
      Educational Affairs, Department of Anesthesiology, Vanderbilt University Medical 
      Center, Nashville, Tennessee.
FAU - Miller, Bonnie
AU  - Miller B
AD  - B. Miller is professor of medical education and administration and vice president 
      for educational affairs, Vanderbilt University Medical Center, Nashville, 
      Tennessee.
FAU - Fleming, Geoffrey M
AU  - Fleming GM
AD  - G.M. Fleming was professor of pediatrics and associate director of the pediatric 
      critical care fellowship, Monroe Carell Jr. Children's Hospital, and vice 
      president, Continuous Professional Development, Office of Health Sciences 
      Education, Vanderbilt University Medical Center, Nashville, Tennessee.
FAU - Moore, Don
AU  - Moore D
AD  - D. Moore is professor of medical education and administration and director of the 
      Office for Continuing Professional Development, Vanderbilt University School of 
      Medicine, Nashville, Tennessee.
FAU - Rice, Todd W
AU  - Rice TW
AD  - T.W. Rice is associate professor of medicine, Department of Allergy, Pulmonary 
      and Critical Care Medicine, and medical director, Vanderbilt Human Research 
      Protection Program, Vanderbilt University Medical Center, Nashville, Tennessee.
FAU - Bernard, Gordon R
AU  - Bernard GR
AD  - G.R. Bernard is the Melinda Owen Bass Professor of Medicine, executive vice 
      president for research, senior associate dean for clinical sciences, and director 
      of the Vanderbilt Institute for Clinical and Translational Research, Vanderbilt 
      University Medical Center, Nashville, Tennessee.
FAU - Lindsell, Christopher J
AU  - Lindsell CJ
AD  - C.J. Lindsell is professor of biostatistics, associate director of the Center for 
      Clinical Quality and Implementation Research, director of the Vanderbilt 
      Institute for Clinical and Translational Research Methods Program, and director 
      of the Center for Health Data Science, Vanderbilt University Medical Center, 
      Nashville, Tennessee.
CN  - Vanderbilt Learning Healthcare System Investigators
LA  - eng
SI  - ClinicalTrials.gov/NCT03771482
GR  - UL1 TR002243/TR/NCATS NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PL  - United States
TA  - Acad Med
JT  - Academic medicine : journal of the Association of American Medical Colleges
JID - 8904605
RN  - 0 (Analgesics, Opioid)
SB  - IM
MH  - Academic Medical Centers/*organization & administration
MH  - Analgesics, Opioid/therapeutic use
MH  - Diffusion of Innovation
MH  - Female
MH  - Humans
MH  - Knowledge Management
MH  - Learning Health System/*methods
MH  - Male
MH  - *Mobile Applications
MH  - Outcome and Process Assessment, Health Care
MH  - Pain Management/methods
MH  - Practice Patterns, Physicians'
MH  - Problem-Based Learning/methods/*organization & administration
MH  - Quality Improvement
MH  - Randomized Controlled Trials as Topic
MH  - Tennessee
MH  - Translational Research, Biomedical/education/*methods
PMC - PMC8349926
MID - NIHMS1669809
EDAT- 2021/02/12 06:00
MHDA- 2021/09/08 06:00
PMCR- 2022/09/01
CRDT- 2021/02/11 14:19
PHST- 2021/02/12 06:00 [pubmed]
PHST- 2021/09/08 06:00 [medline]
PHST- 2021/02/11 14:19 [entrez]
PHST- 2022/09/01 00:00 [pmc-release]
AID - 00001888-202109000-00037 [pii]
AID - 10.1097/ACM.0000000000003969 [doi]
PST - ppublish
SO  - Acad Med. 2021 Sep 1;96(9):1311-1314. doi: 10.1097/ACM.0000000000003969.