A Foundation for Evidence-Driven Practice A Rapid Learning System for Cancer Care: Workshop Summary (2010) / Chapter Skim
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2 Overview
2 Overview
Pages 5-12
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From page 5... ...
RLHS is both patient centered and system centered, a point underscored by both Etheredge and Abernethy. Data collected at the individual patient level not only inform care for that person, but also contribute to evidence development and systemic improvements, along with other data collected system-wide using the experience of all cancer patients, as well as results of clinical trials, systematic reviews, and other relevant aggregated information.
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From page 6... ...
Dr. Abernethy views the critical elements of a RLHS as being linked information, motivated individuals, and systems that are engaged to provide reliable integrated information.
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That information would be added to such point-of-care data collected on other patients throughout the country, or even globally, as well as to data collected from clinical trials and other sources, and the aggregate information would be used for real-time analyses to determine the best treatment for her individual patients at the time care
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From page 8... ...
are the gold standard for the development of clinical guidelines and are an essential component in expanding the knowledge base in oncology, in a RLHS the results of RCTs would be complemented by data collected internally within the healthcare system as well as external linked information, such as genomic and molecular data. Enabling RLHS are advances in in silico research, which Etheredge defined as research on computerized databases.
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From page 9... ...
Clancy expanded on some of these goals and added other challenges that a RLHS might help address, including concerns about healthcare spending, pervasive problems with quality of care, and uncertainty about best practices. Data collected by her agency and the Dartmouth Atlas of Health Care revealed that the quality of health care delivered in this country varied considerably by region, literally all over the map, with some regions outperforming others, and that furthermore there was a lack of correlation between the amount of Medicare spending and the quality of care received (Fisher et al., 2003a, 2003b; Hossain, 2009)
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Dr. Clancy suspects that much of the variability in care stems from clinical uncertainty about best practices and treatments -- knowledge gaps on the comparative effectiveness of various options that could be ameliorated by gathering more information from patients.
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OVERVIEW Information-rich, patient-focused enterprises Information and Evidence is evidence transform 21st-Century continually refined interactions from as a byproduct of reactive to Health Care proactive (benefits care delivery and harms) Actionable information available -- to clinicians AND patients -- "just in time" FIGURE 2-3 A vision for twenty-first century health care.
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