Background: The vision of learning healthcare systems (LHSs) is attractive as a more effective model for health care services, but achieving the vision is complex. There is limited literature describing the processes needed to construct such multicomponent systems or to assess development. Methods:We used the concept of a capability maturity matrix to describe the maturation of necessary infrastructure and processes to create learning networks (LNs), multisite collaborative LHSs that use an actor-oriented network organizational architecture. We developed a network maturity grid (NMG) assessment tool by incorporating information from literature review, content theory from existing networks, and expert opinion to establish domains and components. We refined the maturity grid in response to feedback from network leadership teams. We followed NMG scores over time for nine LNs and plotted scores for each domain component with respect to SD for one participating network. We sought subjective feedback on the experience of applying the NMG to individual networks.Results: LN leaders evaluated the scope, depth, and applicability of the NMG to their networks. Qualitative feedback from network leaders indicated that changes in NMG scores over time aligned with leaders' reports about growth in specific domains; changes in scores were consistent with network efforts to improve in various areas.Scores over time showed differences in maturation in the individual domains of each network. Scoring patterns, and SD for domain component scores, indicated consistency among LN leaders in some but not all aspects of network maturity. A case

Objective: Multihospital collaboration for safety improvements is increasingly common, but strategies for developing bundles when effective evidence-based practices are not well described are limited. The Children's Hospitals' Solutions for Patient Safety (SPS) Network sought to further reduce patient harm by developing improvement bundles when preliminary evidence was limited.Methods: As part of the novel Pioneer process, cohorts of volunteer SPS hospitals collaborated to identify a harm reduction bundle for carefully selected hospital-acquired harm categories where evidence-based practices were limited. For each harm type, a leadership team selected interventions (factors) for testing and guided the work throughout the Pioneer process. Using fundamental quality improvement techniques and a planned experimentation design, each participating hospital submitted outcome and process compliance data for the factor implemented. Data from all hospitals implementing that factor were analyzed together using Shewhart charts, response plots, and analysis of covariance to identify whether reliable implementation of the factor influenced outcomes. Factors were categorized based on strength of evidence and other clinical or evidentiary support. Factors with strong support were included in a final bundle and disseminated to all SPS hospitals. Results:The SPS began the bundle identification process for nine harm types and three have completed the process. The analytic approach resulted in four scenarios that along with clinical input guided the inclusion or rejection of the factor in the final bundle. Conclusions:In this multihospital collaborative, quality improvement methods and planned experimentation were effective at developing evidence-based harm reduction bundles in situations where limited data for interventions exist.

networks supported by the US Centers for Medicare & Medicaid Services Partnership for Patients program have reported significant reductions in hospital-acquired harm, but methodological limitations and lack of peer review have led to persistent questions about the effectiveness of this approach.OBJECTIVE To evaluate associations between membership in Children's Hospitals' Solutions for Patient Safety (SPS), a federally funded hospital engagement network, and hospital-acquired harm using standardized definitions and secular trend adjustment. DESIGN, SETTING, AND PARTICIPANTSThis prospective hospital cohort study included 99 children's hospitals. Using interrupted time series analyses with staggered intervention introduction, immediate and postimplementation changes in hospital-acquired harm rates were analyzed, with adjustment for preexisting secular trends. Outcomes were further evaluated by early-adopting (n = 73) and late-adopting (n = 26) cohorts.EXPOSURES Hospitals implemented harm prevention bundles, reported outcomes and bundle compliance using standard definitions to the network monthly, participated in learning events, and implemented a broad safety culture program. Hospitals received regular reports on their comparative performance. MAIN OUTCOMES AND MEASURESOutcomes for 8 hospital-acquired conditions were evaluated over 1 year before and 3 years after intervention. RESULTSIn total, 99 hospitals met the inclusion criteria and were included in the analysis. A total of 73 were considered part of the early-adopting cohort (joined between 2012-2013) and 26 were considered part of the late-adopting cohort (joined between 2014-2016). A total of 42 hospitals were freestanding children's hospitals, and 57 were children's hospitals within hospital or health systems. The implementation of SPS was associated with an improvement in hospital-acquired condition rates in 3 of the 8 conditions after accounting for secular trends. Membership in the SPS was associated with an immediate reduction in central catheter-associated bloodstream infections (coefficient = −0.152; 95% CI, −0.213 to −0.019) and falls of moderate or greater severity (coefficient = −0.331; 95% CI, −0.594 to −0.069). The implementation of the SPS was associated with a reduction in the monthly rate of adverse drug events (coefficient = −0.021; 95% CI, −0.034 to −0.008) in the post-SPS period. The study team observed larger decreases for the early-adopting cohort compared with the late-adopting cohort.CONCLUSIONS AND RELEVANCE Through the application of rigorous methods (standard definitions and longitudinal time series analysis with adjustment for secular trends), this study provides a more thorough analysis of the association between the Partnership for Patients hospital engagement network model and reductions in hospital-acquired conditions. These findings strengthen previous claims of an association between this model and improvement. However, inconsistent observations across hospital-acquired conditions when adjusted for secular trends suggests that...

Rakuten Ichiba uses a taxonomy to organize the items it sells. Currently, the taxonomy classes that are relevant in terms of profit generation and difficulty of exploration are being manually extended with data properties deemed helpful to create pages that improve the user search experience and ultimately the conversion rate. In this paper we present a scalable approach that aims to automate this process, automatically selecting the relevant and semantically homogenous subtrees in the taxonomy, extracting from semi-structured text in items descriptions a core set of properties and a popular subset of their ranges, then extending the covered range using relational similarities in free text. Additionally, our process automatically tags the items with the new semantic information and exposes them as RDF triples. We present a set of experiments showing the effectiveness of our approach in this business context.