Promoting learning health system feedback loops: Experience with a VA practice-based research network card study

Abstract Objectives The aim of this study is to determine the feasibility of conducting clinical research using electronic dental record (EDR) data from U.S. solo and small-group general dental practices in the National Dental Practice-Based Research Network (network) and evaluate the data completeness and correctness before performing survival analyses of root canal treatment (RCT) and posterior composite restorations (PCR). Methods Ninety-nine network general dentistry practices that used Dentrix or EagleSoft EDR shared de-identified data of patients who received PCR and/or RCT on permanent teeth through October 31, 2015. We evaluated the data completeness and correctness, summarized practice, and patient characteristics and summarized the two treatments by tooth type and arch location. Results Eighty-two percent of practitioners were male, with a mean age of 49 and 22.4 years of clinical experience. The final dataset comprised 217,887 patients and 11,289,594 observations, with the observation period ranging from 0 to 37 years. Most patients (73%) were 18 to 64 years old; 56% were female. The data were nearly 100% complete. Eight percent of observations had incorrect data, such as incorrect tooth number or surface, primary teeth, supernumerary teeth, and tooth ranges, indicating multitooth procedures instead of PCR or RCT. Seventy-three percent of patients had dental insurance information; 27% lacked any insurance information. While gender was documented for all patients, race/ethnicity was missing in the dataset. Conclusion This study established the feasibility of using EDR data integrated from multiple distinct solo and small-group network practices for longitudinal studies to assess treatment outcomes. The results laid the groundwork for a learning health system that enables practitioners to learn about their patients' outcomes by using data from their own practice.

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Patient-Centered Network of Learning Health Systems: Developing a resource for clinical translational research

Journal of Clinical and Translational Science ◽

10.1017/cts.2016.11 ◽

2017 ◽

Vol 1 (1) ◽

pp. 40-44 ◽

Cited By ~ 7

Author(s):

L. J. Finney Rutten ◽

A. Alexander ◽

P. J. Embi ◽

G. Flores ◽

C. Friedman ◽

...

Keyword(s):

Health System ◽

Translational Research ◽

Clinical Data ◽

Health Care Systems ◽

Research Network ◽

Research Networks ◽

Patient Centered ◽

Learning Health System ◽

Challenges And Opportunities ◽

Care Systems

IntroductionThe Learning Health System Network clinical data research network includes academic medical centers, health-care systems, public health departments, and health plans, and is designed to facilitate outcomes research, pragmatic trials, comparative effectiveness research, and evaluation of population health interventions.MethodsThe Learning Health System Network is 1 of 13 clinical data research networks assembled to create, in partnership with 20 patient-powered research networks, a National Patient-Centered Clinical Research Network.Results and ConclusionsHerein, we describe the Learning Health System Network as an emerging resource for translational research, providing details on the governance and organizational structure of the network, the key milestones of the current funding period, and challenges and opportunities for collaborative science leveraging the network.

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Transforming an Autism Pediatric Research Network into a Learning Health System

Pediatric Quality and Safety ◽

10.1097/pq9.0000000000000152 ◽

2019 ◽

Vol 4 (2) ◽

pp. e152 ◽

Cited By ~ 1

Author(s):

Donna S. Murray ◽

Julia S. Anixt ◽

Daniel L. Coury ◽

Karen A. Kuhlthau ◽

Janet Seide ◽

...

Keyword(s):

Health System ◽

Pediatric Research ◽

Research Network ◽

Learning Health System

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The University of Limerick Education and Research Network for General Practice (ULEARN-GP): practice characteristics and general practitioner perspectives

10.21203/rs.2.15185/v1 ◽

2019 ◽

Author(s):

Andrew O'Regan ◽

Peter Hayes ◽

Ray O'Connor ◽

Monica Casey ◽

Patrick O'Dwyer ◽

...

Keyword(s):

General Practice ◽

Health System ◽

Research Process ◽

Research Network ◽

Research Engagement ◽

Practice Characteristics ◽

Current Trends ◽

Practice Based Research ◽

The University ◽

National Profile

Abstract Background A well-functioning General Practice sector that has a strong research component is recognised as a key foundation of any modern health system. General practitioners (GPs) are more likely to collaborate in research if they are part of an established research network. The primary aims of this study are to describe Ireland’s newest general practice-based research network and to analyse the perspectives of the network’s members on research engagement. Method A survey was sent to all GPs participating in the network in order to document practice characteristics so that this research network’s profile could be compared to other national profiles of Irish general practice. In depth interviews were then conducted and analysed thematically to explore the experiences and views of a selection of these GPs on research engagement. Results All 134 GPs responded to the survey. Practices have similar characteristics to the national profile in terms of location, size, computerisation, type of premises and out of hours arrangements. Twenty-two GPs were interviewed and the resulting data was categorised into subthemes and four related overarching themes: GPs described catalysts for research in their practices, the need for coherence in how research is understood in this context, systems failures, whereby the current health system design is prohibitive of GP participation and aspirations for a better future. Conclusion This study has demonstrated that the research network under examination is representative of current trends in Irish general practice. It has elucidated a better understanding of factors that need to be addressed in order to encourage more GPs to engage in the research process.

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The University of Limerick Education and Research Network for General Practice (ULEARN-GP): practice characteristics and general practitioner perspectives

10.21203/rs.2.15185/v2 ◽

2020 ◽

Author(s):

Andrew O'Regan ◽

Peter Hayes ◽

Ray O'Connor ◽

Monica Casey ◽

Patrick O'Dwyer ◽

...

Keyword(s):

General Practice ◽

Health System ◽

Research Process ◽

Research Network ◽

Research Engagement ◽

Practice Characteristics ◽

Current Trends ◽

Practice Based Research ◽

The University ◽

National Profile

Abstract Background A well-functioning general practice sector that has a strong research component is recognised as a key foundation of any modern health system. General practitioners (GPs) are more likely to collaborate in research if they are part of an established research network. The primary aims of this study are to describe Ireland’s newest general practice-based research network and to analyse the perspectives of the network’s members on research engagement. Method A survey was sent to all GPs participating in the network in order to document practice characteristics so that this research network’s profile could be compared to other national profiles of Irish general practice. In depth interviews were then conducted and analysed thematically to explore the experiences and views of a selection of these GPs on research engagement. Results All 134 GPs responded to the survey. Practices have similar characteristics to the national profile in terms of location, size, computerisation, type of premises and out of hours arrangements. Twenty-two GPs were interviewed and the resulting data was categorised into subthemes and four related overarching themes: GPs described catalysts for research in their practices, the need for coherence in how research is understood in this context, systems failures, whereby the current health system design is prohibitive of GP participation and aspirations for a better future. Conclusion This study has demonstrated that the research network under examination is representative of current trends in Irish general practice. It has elucidated a better understanding of factors that need to be addressed in order to encourage more GPs to engage in the research process.

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Generating Knowledge from Best Care: Advancing the Continuously Learning Health System

NAM Perspectives ◽

10.31478/201609b ◽

2016 ◽

Vol 6 (9) ◽

Cited By ~ 3

Author(s):

Edward Abraham ◽

◽

Carlos Blanco ◽

Celeste Castillo Lee ◽

Jennifer B. Christian ◽

...

Keyword(s):

Health System ◽

Learning Health System

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Sustainable generation of patient‐led resources in a learning health system

Learning Health Systems ◽

10.1002/lrh2.10260 ◽

2021 ◽

Author(s):

Jennie David ◽

Catalina Berenblum Tobi ◽

Samantha Kennedy ◽

Alexander Jofriet ◽

Madeleine Huwe ◽

...

Keyword(s):

Health System ◽

Learning Health System

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Health system responsiveness: a systematic evidence mapping review of the global literature

International Journal for Equity in Health ◽

10.1186/s12939-021-01447-w ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Gadija Khan ◽

Nancy Kagwanja ◽

Eleanor Whyle ◽

Lucy Gilson ◽

Sassy Molyneux ◽

...

Keyword(s):

Health System ◽

Grey Literature ◽

Feedback Loops ◽

Theoretical Development ◽

World Health ◽

Evidence Map ◽

Evidence Mapping ◽

Mapping Review ◽

System Responsiveness ◽

Health System Responsiveness

Abstract Background The World Health Organisation framed responsiveness, fair financing and equity as intrinsic goals of health systems. However, of the three, responsiveness received significantly less attention. Responsiveness is essential to strengthen systems’ functioning; provide equitable and accountable services; and to protect the rights of citizens. There is an urgency to make systems more responsive, but our understanding of responsiveness is limited. We therefore sought to map existing evidence on health system responsiveness. Methods A mixed method systemized evidence mapping review was conducted. We searched PubMed, EbscoHost, and Google Scholar. Published and grey literature; conceptual and empirical publications; published between 2000 and 2020 and English language texts were included. We screened titles and abstracts of 1119 publications and 870 full texts. Results Six hundred twenty-one publications were included in the review. Evidence mapping shows substantially more publications between 2011 and 2020 (n = 462/621) than earlier periods. Most of the publications were from Europe (n = 139), with more publications relating to High Income Countries (n = 241) than Low-to-Middle Income Countries (n = 217). Most were empirical studies (n = 424/621) utilized quantitative methodologies (n = 232), while qualitative (n = 127) and mixed methods (n = 63) were more rare. Thematic analysis revealed eight primary conceptualizations of ‘health system responsiveness’, which can be fitted into three dominant categorizations: 1) unidirectional user-service interface; 2) responsiveness as feedback loops between users and the health system; and 3) responsiveness as accountability between public and the system. Conclusions This evidence map shows a substantial body of available literature on health system responsiveness, but also reveals evidential gaps requiring further development, including: a clear definition and body of theory of responsiveness; the implementation and effectiveness of feedback loops; the systems responses to this feedback; context-specific mechanism-implementation experiences, particularly, of LMIC and fragile-and conflict affected states; and responsiveness as it relates to health equity, minority and vulnerable populations. Theoretical development is required, we suggest separating ideas of services and systems responsiveness, applying a stronger systems lens in future work. Further agenda-setting and resourcing of bridging work on health system responsiveness is suggested.

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Antibiotic Use in Periodontal Therapy among French Dentists and Factors Which Influence Prescribing Practices

Antibiotics ◽

10.3390/antibiotics10030303 ◽

2021 ◽

Vol 10 (3) ◽

pp. 303

Author(s):

Kevimy Agossa ◽

Kadiatou Sy ◽

Théo Mainville ◽

Marjolaine Gosset ◽

Sylvie Jeanne ◽

...

Keyword(s):

Antibiotic Use ◽

Aggressive Periodontitis ◽

Periodontal Therapy ◽

Research Network ◽

Prescribing Practices ◽

French Society ◽

Private Practitioners ◽

First Line Therapy ◽

Practice Based Research ◽

Systemic Antibiotics

The aim of the present survey is to investigate the use of antibiotics during periodontal therapy among French dentists with a focus on exploring potential differences between various groups of practitioners. A self-administered questionnaire was distributed to different groups of practitioners including members of (i) the French Society of Periodontology and Implantology; (ii) the College of University Teachers in Periodontology and, (iii) private practitioners participating in the French general dental practice-based research network. 272 questionnaires were included in the analysis. Prescription patterns were globally in line with the current recommendations. Systemic antibiotics are most frequently used as a first-line therapy in necrotizing periodontitis (92%) and aggressive periodontitis (53.3% to 66.1%). However, malpractice still exists, including in the management of periodontal abscesses. Antibiotics are prescribed (i) less frequently for periodontal abscesses and (ii) more frequently for generalized aggressive periodontitis by members of the periodontal society and University college (p < 0.05). Amoxicillin (59.9%) and the amoxicillin + metronidazole (59.6%) combination were the most frequently prescribed molecules. Providing a high number of periodontal treatments per week, being more recently graduated, having a post-graduate certificate in periodontology and holding or having held an academic position/hospital practice were all factors associated with a better knowledge of and/or more adequate antibiotic use.

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