Vanderbilt University Medical Center has established a first-of-its-kind Center for Learning Healthcare that will bring together clinicians, health system operations leaders and researchers to generate evidence in the course of health care delivery to continuously improve the quality, value and safety of health care offered to patients.
The center, which is part of the Vanderbilt Institute for Clinical and Translational Research (VICTR), will partner with personnel from across the Vanderbilt Health system to rigorously compare available treatments and approaches to health care delivery, understand which work best, and implement the findings into practice to improve outcomes for patients.
The center will also support researchers across the Vanderbilt community who are interested in conducting comparative effectiveness research and pragmatic trials, helping them obtain grants and share the findings through high-impact publications.
The Center for Learning Healthcare will be led by Matthew Semler, MD, MSc, assistant professor of Medicine in the Division of Allergy, Pulmonary and Critical Care Medicine, and Cheryl Gatto, PhD, research assistant professor of Biostatistics and VICTR associate director.
The new center builds on work led over the past five years by the VICTR Learning Healthcare System Platform. Sponsored by VUMC’s Clinical and Translational Science Award (CTSA), the platform has brought together experts in clinical trials, biostatistics, regulatory affairs, project management, data science, health care administration and operations, and community engagement to complete more than 25 randomized trials addressing common uncertainties in routine practice.
“A good example of the type of research that will be done in this center is our recent research on IV fluids. For more than a century, one of the most common treatments that patients receive in the hospital has been IV fluids,” Semler said. “There were two types: saline and balanced crystalloid solutions. The two types had never been compared. Some clinicians used saline; some used balanced crystalloids, and no one knew which was better. Vanderbilt’s Learning Healthcare System identified that variation as an opportunity to improve care,” he said.
So, the Vanderbilt Learning Healthcare System embedded a large clinical trial inside routine practice and determined that balanced crystalloids were better for patients in terms of survival and preventing damage to the kidneys. Because of that research, the Vanderbilt Health system switched to using primarily balanced crystalloids.
“That’s an example of a treatment that patients were receiving globally, all day every day for about 100 years. The Vanderbilt Health system, by applying rigorous scientific methods, figured out what was best for patients and improved outcomes for patients by putting that knowledge into practice,” Semler said.
Gatto emphasizes that learning health care means continuous improvement. “Our charge through this center is to empower a culture that expects continuous learning around how to best provide care to our patients.
“As a learning health care system, we should always be learning by virtue of the fact that we are always seeing patients. The center will support the infrastructure, collaboration, and investigative processes required to facilitate this learning,” Gatto said.
“I’m inspired to do this work because it addresses a profound challenge for us as health care providers and health systems,” Semler said. “The history of health care is littered with treatments that were viewed as promising and widely given to patients that, when rigorously tested, were proven ineffective. The learning health care culture seeks to rectify that. We aim to continuously examine our care, figure out what works best, and then make sure we’re always delivering the best care for patients. To us, that’s what ‘learning health care’ means.”