Exploring Learning Health Systems’ Needs

Identify Persons Who Are Frail

Frailty increases a person’s risk for functional impairment and cognitive decline, and poor health outcomes such as hospitalizations and institutionalization. Identifying frailty and functional disability plays an important role in informing clinical care, risk-adjustment in patient-centered outcomes research, and evaluating performance and payments in value-based care programs. Multiple claims-based frailty indexes (CFIs) have been developed and validated over the past few years; however, healthcare providers often do not have access to the insurance claims records of their entire population of patients, thus necessitating the development of reliable EHR-based frailty indexes (EFI).

AHRQ conducted a study to address the operational gap between CFIs and EFIs. This project focused on validating an established CFI using linked claims-EHR databases of multiple large health systems. The project provides a systematic approach that health systems can use to examine the quality of the EHR data and prepare it for the application of EFI measures.

The findings demonstrated that structured EHR data can be used by healthcare providers to identify frail patients using validated EFIs; however, claims data can identify additional frailty cases compared to EHR data. EFIs can also be used to improve the prediction of various healthcare utilization outcomes. Risk stratification developers may integrate EFI in their model development process, and population health managers may incorporate EFI in disease management efforts.

• Developing and Assessing the Validity of Claims-based Indicators of Frailty & Functional Disabilities in Electronic Health Records: Final Report (PDF, 1 MB).
• Code used for the project.

Research Summit

AHRQ hosted a AHRQ Research Summit on Learning Health Systems  in September 2017 for a variety of external stakeholders to learn what AHRQ can do to address their needs. These stakeholders included representatives from large and small delivery systems, research organizations, Federal and State Government agencies, and others. 

Through a series of co-creation exercises, attendees developed and prioritized ideas regarding research, tools, training, and data that AHRQ could produce to advance learning health care organizations. Participants brainstormed ideas and were asked to develop further the higher rated ideas. For each idea, participants worked in small groups to develop/describe future AHRQ initiatives that might address it or support it. The descriptions addressed the following aspects: (1) A problem statement/need, (2) AHRQ actions, (3) Audience/stakeholders, (4) Partners with AHRQ, and (5) Evaluation. Once these descriptions were developed, Summit attendees again voted to identify the most critical ideas.

The top five ideas as voted on by Summit participants included:

1. Develop a business case for investing in LHS and disseminate to delivery system chief executive officers.
2. Catalyze the development of a public commons in the form of a common data platform that accelerates sharing of data, tools, and resources.
3. Curate a guide to becoming a LHS with practical guidance and tools for health care delivery organizations.
4. Accelerate the spread of evidence-based best practices across learning health systems.
5. Advance patient-reported outcomes and patient experience measures to support the ability of learning health systems to pursue meaningful patient-centered improvement.

Watch videos with highlights of the summit  and perspectives on learning health systems offered by key participants. 

An Executive Summary of the meeting is also available.

How Learning Health Systems Learn: Lessons from the Field

AHRQ conducted site visits at a few leading organizations to learn about the steps they have taken to move evidence to the frontlines of care. How Learning Health Systems Learn: Lessons from the Field gathered information that could be shared with other organizations involved in the journey toward becoming a learning health system and to identify ways in which AHRQ could support this process.

Learning Health Systems Case Studies

AHRQ developed a series of case studies to help health system chief executive officers and other C-suite leaders better understand the concept of a learning health system and the value of making investments in transformation. Building this understanding is part of the Agency’s ongoing effort to accelerate learning and innovation in healthcare delivery in order to ensure that people across America receive the highest quality, safest, most up-to-date care.

• Case studies Overview—Learning Health Systems: Making the Case Against Business as Usual (PDF, 105.5 KB).
• Baylor Scott & White Health: Building a Foundation for Continuous Improvement (PDF, 246.6 KB).
• Denver Health: How a Safety Net System Maximizes Its Value (PDF, 162.15 KB).
• HCA Healthcare: How a Large Healthcare System Is Looking Beyond the Electronic Health Record (PDF, 195.4 KB).
• University of Utah Health: Creating a Formula for Value-Based Care (PDF, 263.5 KB).