Embedding Learning in a Learning Health Care System to Improve Clinical Practice

Abstract

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.

Effect of Smartphone App–Based Education on Clinician Prescribing Habits in a Learning Health Care System

“…An idealized learning health care system is designed to learn from what it does and then do what it learns, thereby closing the evidence-to-practice gap. 3 , 39 Great strides have been made in knowledge generation, yet considerable challenges remain in the dissemination and uptake of that new knowledge into routine practice. 40 We evaluated whether the provision of spaced education with retrieval practice to frontline clinicians could change prescribing practices.…”

“…An idealized learning health care system is designed to learn from what it does and then do what it learns, thereby closing the evidence-to-practice gap. 3,39 Great strides have been made in knowledge…”

“…1 Effective approaches for rapid dissemination and education on the latest evidence may help bridge this implementation gap. 2,3 However, the best method for engaging clinicians in ongoing education for practice-based learning and improvement remains unknown. [4][5][6][7][8][9][10][11] Research has demonstrated that passive learning is insufficient to produce practice change, 12 yet most continuing education offerings in health care rely on passive learning models through lecture-style presentations.…”

“…Timely implementation of new evidence remains suboptimal in health care . Effective approaches for rapid dissemination and education on the latest evidence may help bridge this implementation gap . However, the best method for engaging clinicians in ongoing education for practice-based learning and improvement remains unknown .…”

“…To disseminate learning at scale using spaced education with retrieval practice, Vanderbilt University School of Medicine created QuizTime, a web-based smartphone app (eAppendix 2 in Supplement 2). This study evaluated the effect of using QuizTime on clinician prescribing patterns for intravenous fluids and for pain medications. Fluid prescribing patterns were selected because a large pragmatic clinical trial performed at our institution demonstrated a 0.9% mortality benefit of balanced crystalloids (lactated Ringer’s solution or Plasma-Lyte A [Normosol]) compared with saline (0.9% NaCl) when used as the routine fluid choice in the intensive care unit environment .…”