scholarly journals Swiss Learning Health System: A national initiative to establish learning cycles for continuous health system improvement

2018 ◽  
Vol 2 (3) ◽  
pp. e10059 ◽  
Author(s):  
Stefan Boes ◽  
Sarah Mantwill ◽  
Cornel Kaufmann ◽  
Mirjam Brach ◽  
Jerome Bickenbach ◽  
...  
Keyword(s):  
Health System ◽  
System A ◽  
Learning Health System ◽  
Health System Improvement ◽  
Learning Cycles ◽  
National Initiative ◽  
System Improvement

Novel tools for a learning health system: a combined difference-in-difference/regression discontinuity approach to evaluate effectiveness of a readmission reduction initiative

2019 ◽  
Vol 29 (2) ◽  
pp. 161-167 ◽  
Author(s):  
Allan J Walkey ◽  
Jacob Bor ◽  
Nicholas J Cordella
Keyword(s):  
Health System ◽  
Regression Discontinuity ◽  
Continuous Measure ◽  
Difference In Difference ◽  
System A ◽  
Learning Health System ◽  
Healthcare Improvement ◽  
Improvement Interventions ◽  
System Improvement

Current methods used to evaluate the effects of healthcare improvement efforts have limitations. Designs with strong causal inference—such as individual patient or cluster randomisation—can be inappropriate and infeasible to use in single-centre settings. Simpler designs—such as prepost studies—are unable to infer causal relationships between improvement interventions and outcomes of interest, often leading to spurious conclusions regarding programme success. Other designs, such as regression discontinuity or difference-in-difference (DD) approaches alone, require multiple assumptions that are often unable to be met in real world improvement settings. We present a case study of a novel design in improvement and implementation research—a hybrid regression discontinuity/DD design—that leverages risk-targeted improvement interventions within a hospital readmission reduction programme. We demonstrate how the hybrid regression discontinuity-DD approach addresses many of the limitations of either method alone, and represents a useful method to evaluate the effects of multiple, simultaneous heath system improvement activities—a necessary capacity of a learning health system. Finally, we discuss some of the limitations of the hybrid regression discontinuity-DD approach, including the need to assign patients to interventions based upon a continuous measure, the need for large sample sizes, and potential susceptibility of risk-based intervention assignment to gaming.

scholarly journals Geisinger's effort to realize its potential as a learning health system: A progress report

2020 ◽  
Author(s):  
F. Daniel Davis ◽  
Marc S. Williams ◽  
Rebecca A. Stametz
Keyword(s):  
Health System ◽  
Progress Report ◽  
System A ◽  
Learning Health System

scholarly journals Training for Health System Improvement: Emerging Lessons from Canadian and US Approaches to Embedded Fellowships

2019 ◽  
Vol 15 (SP) ◽  
pp. 34-48
Author(s):  
Meghan McMahon ◽  
Stephen Bornstein ◽  
Adalsteinn Brown ◽  
Lisa Simpson ◽  
Lucy Savitz ◽  
...  
Keyword(s):  
Health System ◽  
Health System Improvement ◽  
System Improvement

Fellowship Program in Health System Improvement: A novel approach integrating leadership development and patient-centred health system transformation

2018 ◽  
Vol 31 (2) ◽  
pp. 62-65 ◽  
Author(s):  
Donald J. Philippon ◽  
Stephanie Montesanti ◽  
Tania Stafinski
Keyword(s):  
Leadership Development ◽  
Health System ◽  
System Transformation ◽  
Fellowship Program ◽  
Early Assessment ◽  
University Of Alberta ◽  
Health System Improvement ◽  
Novel Approach ◽  
System Improvement ◽  
The University

This article highlights a novel approach to professional development, integrating leadership, development and patient-centred health system transformation in the new Fellowship Program in Health System Improvement offered by the School of Public Health at the University of Alberta. Early assessment of the program is also provided.

scholarly journals Hypertension in Russia: Changes Observed After 4 Years of a Comprehensive Health System Improvement Program in the Yaroslavl Region

2016 ◽  
Vol 19 (2) ◽  
pp. 198-204 ◽  
Author(s):  
Maria Mozheyko ◽  
Sergey Eregin ◽  
Natalia Danilenko ◽  
Alexey Vigdorchik ◽  
Sheldon W. Tobe ◽  
...  
Keyword(s):  
Health System ◽  
Improvement Program ◽  
Health System Improvement ◽  
Comprehensive Health ◽  
System Improvement

“Hybrid” medical leadership emergency medicine training for international medical graduates

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Prakash Subedi ◽  
Jill Aylott ◽  
Naushad Khan ◽  
Niki Shrestha ◽  
Dayaram Lamsal ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Health System ◽  
International Medical Graduates ◽  
Content Type ◽  
Medical Graduates ◽  
Health System Improvement ◽  
New Learning ◽  
System Improvement ◽  
The Uk ◽  
Medical Leadership

Purpose The purpose of this paper is to outline the “Hybrid” “International” Emergency Medicine (HIEM) programme, which is an ethical pathway for the recruitment, employment and training of Emergency Medicine doctors; with a rotation through the NHS on a two-year medical training initiative with a Tier 5 visa, “earn, learn and return” programme. The HIEM programme offers an advantage to the Tier 2 visa by combining training, education and employment resulting in new learning to help improve the health system in Nepal and provide continued cultural support, clinical and leadership development experience in the UK NHS. Finally, this programme also provides a Return on Investment to the NHS. Design/methodology/approach A shortage of doctors in the UK, combined with a need to develop Emergency Medicine doctors in Nepal, led to a UK Emergency Medicine Physician (PS) to facilitate collaboration between UK/Nepal partners. A mapping exercise of the Royal College of Emergency Medicine curriculum with the competencies for the health system and quality improvement leaders and partners with patients produced a “HIEM programme”. The HIEM programme aims to develop first-class doctors to study in Emergency Departments in the UK NHS while also building trainee capability to improve the health system in Nepal with a research thesis. Findings The HIEM programme has 12 doctors on its programme across years one and two, with the first six doctors working in the UK NHS and progressing well. There are reports of high levels of satisfaction with the trainees in their transition from Nepal to the UK and the hospital is due to save £720,000 (after costs) over two years. Each trainee will earn £79,200 over two years which is enough to pay back the £16,000 cost for the course fees. Nepal as a country will benefit from the HIEM programme as each trainee will submit a health system improvement Thesis. Research limitations/implications The HIEM programme is in its infancy as it is two years through a four-year programme. Further evaluation data are required to assess the full impact of this programme. In addition, the HIEM programme has only focussed on the development of one medical speciality which is Emergency Medicine. Further research is required to evaluate the impact of this model across other medical and surgical specialties. Practical implications The HIEM programme has exciting potential to support International Medical Graduates undertake a planned programme of development while they study in the UK with a Tier 5 visa. IMGs require continuous support while in the UK and are required to demonstrate continued learning through continuous professional development (CPD). The HIEM programme offers an opportunity for this CPD learning to be structured, meaningful and progressive to enable new learning. There is also specific support to develop academic and research skills to undertake a thesis in an area that requires health system improvement in Nepal. Originality/value This is the first time an integrated clinical, leadership, quality improvement and patient partnership model curriculum has been developed. The integrated nature of the curriculum saves precious time, money and resources. The integrated nature of this “hybrid” curriculum supports the development of an evidence-based approach to generating attitudes of collaboration, partnership and facilitation and team building in medical leadership with patient engagement. This “hybrid” model gives hope for the increased added value of the programme at a time of global austerity and challenges in healthcare.

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