Rapid, Bottom-Up Design of a Regional Learning Health System in Response to COVID-19

Abstract

eneath top-down national and state directives and recommendations, communities must respond to the many phases of coronavirus disease 2019 . The pandemic has unfolded differently across those communities with outcomes dependent on context, infrastructure, capacity, and how assets are organized, linked, and deployed. Achieving control requires real-time multisector data sharing, learning, and adaptation. Leaders from health care, public health, congregate care, elected offices, neighborhoods, schools, and businesses must work together to create systems that can respond to a pathogen that does not respect geographic, jurisdictional, or disciplinary boundaries. 1 Response capabilities have been compromised by limited cross-sector coordination and decades-long disinvestment in public health. [2][3][4] The Pandemic All-Hazards Preparedness Act of 2006 was passed to overcome these limitations by establishing an "electronic nationwide public health situational awareness capability through an interoperable network of systems to share data and information." 5 This goal has not been achieved, 6 and communities continue to rely on insights pieced together, often manually, from multiple isolated sources. 7 Data are often at too large a scale (ie, national or state) or too incomplete (ie, single sector or jurisdiction) to be useful for decision-making.As severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) found its way

A Learning Health System Approach to the COVID-19 Pandemic: System-Wide Changes in Clinical Practice and 30-Day Mortality Among Hospitalized Patients

“…Other institutions have qualitatively described their respective LHS processes employed in response to the COVID-19 pandemic, 33,34 with limited quantitative temporal assessment of clinical outcomes. 35 We believe our analysis and description is the first to empirically document how COVID-specific processes employed within an LHS were actually implemented to achieve timely changes in clinical practice on a system level, which likely in turn favorably influenced clinical outcomes as evidenced by lower mortality over time.…”

A COVID-19 primer for primary care clinicians

“…The role of pediatrician advocacy has been highlighted in numerous communities throughout the United States where collaboration with data collection and sharing, testing, treatment, and policy have been prioritized. 90 , 91 , 92 Exemplar communities have established pediatric collaboratives, with subsequent creation of listservs, accumulation of robust data sets, and crafting of local protocols designed to help inform local best practices and ultimately aid school groups in decision-making regarding safe school protocols. 90 Pediatricians have established learning networks across sectors and have built community partnerships with infrastructure designed to outlast the COVID-19 pandemic and ideally address public health needs in the years to come.…”

“… 90 Pediatricians have established learning networks across sectors and have built community partnerships with infrastructure designed to outlast the COVID-19 pandemic and ideally address public health needs in the years to come. 92 …”

Collaborative conversations during the time of COVID‐19: Building a “meta”‐learning community

“…Beck et al 1 have recently described using a Learning Health Network approach to address the pandemic by rapidly building public health infrastructure for regional COVID-19 response. Our approach to building a Learning Community draws from the same conceptual foundations as their approach but has a different goal, namely to support an existing community as it rapidly shifted its research, clinical and educational activities, daily operations, and personal lives.…”

“…This was intended to build a deeper understanding of the interdependent components between our mode of organizing the community and the specific projects underway: community connection and knowledge sharing. 1 We pursued both of these objectives and the resulting mini-studies are presented below.…”