Creating a provincial post COVID‐19 interdisciplinary clinical care network as a learning health system during the pandemic: Integrating clinical care and research

Abstract

Introduction Coronavirus Disease‐2019 (COVID‐19) affects multiple organ systems in the acute phase and also has long‐term sequelae. Research on the long‐term impacts of COVID‐19 is limited. The Post COVID‐19 Interdisciplinary Clinical Care Network (PC‐ICCN), conceived in July 2020, is a provincially funded resource that is modelled as a Learning Health System (LHS), focused on those people with persistent symptoms post COVID‐19 infection. Methods The PC‐ICCN emerged through collaboration among over 60 clinical specialists, researchers, patients, and health administrators. At the core of the network are the post COVID‐19 Recovery Clinics (PCRCs), which provide direct patient care that includes standardized testing and education at regular follow‐up intervals for a minimum of 12 months post enrolment. The PC‐ICCN patient registry captures data on all COVID‐19 patients with confirmed infection, by laboratory testing or epi‐linkage, who have been referred to one of five post COVID‐19 Recovery Clinics at the time of referral, with data stored in a fully encrypted Oracle‐based provincial database. The PC‐ICCN has centralized administrative and operational oversight, multi‐stakeholder governance, purpose built data collection supported through clinical operations geographically dispersed across the province, and research operations including data analytics. Results To date, 5364 patients have been referred, with an increasing number and capacity of these clinics, and 2354 people have had at least one clinic visit. Since inception, the PC‐ICCN has received over 30 research proposal requests. This is aligned with the goal of creating infrastructure to support a wide variety of research to improve care and outcomes for patients experiencing long‐term symptoms following COVID‐19 infection. Conclusions The PC‐ICCN is a first‐in‐kind initiative in British Columbia to enhance knowledge and understanding of the sequelae of COVID‐19 infection over time. This provincial initiative serves as a model for other national and international endeavors to enable care as research and research as care.

Proteomic Evolution from Acute to Post-COVID-19 Conditions

“…Apolipoprotein L1 (apoL1) that was decreased in patients with reduced FVC, %, predicted, is a minor component of HDL and circulates with HDL3, and both interferon-γ and TNF-α increase apolipoprotein L1. ApoL1 is associated with focal glomerulosclerosis and HIV-associated nephropathy, and renal dysfunction also frequently complicates acute and post-COVID-19 conditions . Abundances of coagulation factors XII and XIIIB (F12, F13B) were also differentiated; F12 increases the generation of angiotensin and bradykinin, both of which are central to the pathogenesis of acute COVID-19. − Complement activation is also fundamental to the pathogenesis of acute COVID-19 .…”

“…Patients who were discharged from the hospital after acute COVID-19 were referred to a British Columbia provincial network of five Post-COVID-19 condition clinics . For the current study, patients were evaluated at St. Paul’s Hospital and Vancouver General Hospital post-COVID-19 condition clinics.…”

“…Several functions and pathways were associated with FVC, %, predicted, including apolipoprotein-related pathways, coagu- 74 and renal dysfunction also frequently complicates acute 75 and post-COVID-19 conditions. 33 Abundances of coagulation factors XII and XIIIB (F12, F13B) were also differentiated; F12 increases the generation of angiotensin and bradykinin, both of which are central to the pathogenesis of acute COVID-19. 76−78 Complement activation is also fundamental to the pathogenesis of acute COVID-19.…”

Evaluating fatigue in patients recovering from COVID-19: validation of the fatigue severity scale and single item screening questions

“…The study was conducted through the Post-COVID-19 Interdisciplinary Clinical Care Network (PC-ICCN) which was designed as a learning health system to facilitate both clinical care and research throughout BC, a Canadian province of approximately 5 million people [ 22 , 23 ]. At the time of this study, the PC-ICCN comprised of 4 PCRCs which were physically located in the outpatient departments at St. Paul’s Hospital, Vancouver General Hospital, Surrey Memorial Hospital and Abbotsford Regional Hospital.…”

Expanding the Learning Health Care System Beyond the Academic Health Center

“…For example, in British Columbia, we developed the Post-COVID-19 Interdisciplinary Clinical Care Network (PC-ICCN), a province-wide learning health care system to support the recovery of patients following COVID-19. 2 The PC-ICCN comprises several clinics with standardized referral criteria, laboratory testing, questionnaires, and follow-up protocols. Most clinics are based at academic health centers, but 50% to 60% of the patients are assessed through telehealth appointments, and patients can also participate in virtual group education sessions.…”