Learning Health Systems (LHS) require a workforce with specific knowledge and skills to identify and address healthcare quality issues, develop solutions to address those issues, and sustain and spread improvements within and outside the organization. Educational programs are tasked with designing learning opportunities that can meet these organizational needs. This manuscript explores different mechanisms for addressing challenges to creating educational programs to prepare individuals who can work in and lead LHS. Strategies and recommendations for educational programs to support the LHS include the creation of a new program, collaborating across existing programs, and producing a set of instructional materials.
(CAHPS) survey questions, were collected at each on-treatment visit. Additionally, physicians completed the NCI CTCAE v4.0 toxicity score and collected UTEs from the patients' medical records. Propensity score weighting and regression methods were used to quantify associations between PNREs and patient experience. Results: 20/24 patients (pts) who enrolled with 2 months f/u during RT comprise our study cohort. Mean age was 64.5AE2.1 year (SEM); 60% male. Overall, 80 encounters occurred, median of 4 (range: 3-5). In 39% of encounters, at least one PNRE was reported yielding 40 total PNREs from 75% of the pts. 32.5% of PNREs were safety related while the remaining were related to pts' care experience. In encounters when pts did not report PNREs, the GHS and DT measurements were 70.8AE3.0 and 2.5AE0.4, respectively. In cases where pts reported at least one PNRE, GHS decreased to 63.9AE4.4 (pZ0.182) and distress increased to 3.7AE0.6 (pZ0.088). The GHS was even lower (56.4AE6.9) and distress higher (4.6AE0.9) in pts who experienced safety-related PNREs. Three study pts each had one UTE (15% of participants), including a hospital readmission for surgical complications. 15.4% of the adult safety-related PNREs related to these UTEs. The 5 pts who never reported a PNRE experienced no UTEs. Encounters in which PNREs were reported were associated with lower CAHPS composite scores e no PNRE: 58% top-box ratings; !1 PNRE: 19% top-box ratings (p<0.001). Conclusion: This pilot study demonstrates the feasibility of collecting PNREs to identify potential systems safety risks in a radiation oncology clinic. Future efforts will include a large phase II trial to validate these findings, and to assess the value of PNREs in improving cancer care processes and patients' outcomes.
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