We’re committed to learning health systems at KPWHRI

In his first post since the Kaiser Permanente transition, Dr. Eric B. Larson outlines a bold new strategy for a long-time goal

by Eric B. Larson, MD, MPH, Kaiser Permanente Washington Health Research Institute executive director, and Kaiser Foundation Health Plan of Washington vice president for research and health care innovation

I’m excited to bring you my first post since Group Health Research Institute officially became Kaiser Permanente Washington Health Research Institute — or KPWHRI. I’m still the Institute’s executive director, and now have leadership responsibilities with Kaiser Foundation Health Plan of Washington in research and health care innovation. I’ve been giving a lot of thought to these responsibilities.

Coincidentally, local and national events recently converged to infuse one of our long-standing innovation efforts with new energy. We had a visit from Kaiser Permanente executives, where KPWHRI leaders including Paula Lozano, MD, MPH, and Katie Coleman, MSPH, presented our bold vision for working with our Kaiser Permanente clinical partners. Also this month, we answered a call from the Agency for Healthcare Research and Quality (AHRQ) and others for information about the learning health system (LHS) model. Our message was the same to our Kaiser Permanente colleagues and to AHRQ — KPWHRI is fully committed to this innovation.

New vigor for LHS

In an LHS, clinical research and patient care are integrated in a cycle of continuous improvement. Questions about how to advance care are discussed among health care providers, leaders, and researchers. Working with clinical partners, researchers can help to define questions and then design studies that measure key outcomes to answer them. The idea is to focus on ways to achieve care that is more efficient and effective and aligned with the health care system’s regional and national strategic plans. As the model says, research influences practice, and practice influences research.

Our report to AHRQ relied on our extensive experience as an LHS. We described how we’ve met the challenges of keeping medical data private and secure, yet available for research. We told of our efforts to incorporate patient-generated information from fitness trackers and community data on environmental and social factors important to personal and public health into our research. These data tell us what affects people’s health every day, not just during clinic visits. We explained how to be good research partners with a delivery system. We’ve learned not to impose on our clinical collaborators, but to work with them to address issues aligned with their challenges and opportunities.

We were proud to describe our work on stakeholder engagement — making sure people affected by our research, from patients to health care professionals who care for them — are involved in every step of a study. These efforts are aligned with our region’s overall strategic plan and are the key to implementation, which means making sure that what we learn will work in diverse clinical practices.

Real-life examples

In both our response to AHRQ questions and our conversations with Kaiser Permanente leaders, we gave specific examples of an LHS in action. Here is just some of the work that we highlighted:

• Our opioid safety initiative that has standardized opioid prescribing for chronic noncancer pain. We have been at the forefront of responding to the national epidemic of opioid misuse and deaths.
• Our low-dose computed tomography screening program for people at high risk of lung cancer. This initiative is serving as an example for health care organizations across the country.
• The pragmatic clinical trials we’re conducting that make research part of everyday care, so the results reflect how practice improvements might work in the real world.
• Innovations such as the patient-centered medical home model, where we learned that the program had value but had difficulty sustaining the model after the initial implementation. An LHS like ours evaluates these types of findings and applies what we learn to improve future collaborations with our delivery system.

Thinking about our visit with Kaiser Permanente leaders and the collective wisdom that we passed along to AHRQ, I’m enthusiastic about the commitment I hear, regionally and nationally, about the LHS model. Our arrival at this point as an institution and as a country has been a bumpy road but we’re now poised to mature the LHS model. With our Kaiser Permanente partners, we have identified bold steps that we are uniquely positioned to take to advance our goal of achieving affordable, high quality health care for all Americans. Our Kaiser Permanente Washington Region president, Susan Mullaney, wants a strong research partnership and KPWHRI is prepared to be that partner.

To learn more about the LHS model, please see our 2012 Annals of Internal Medicine report (abstract here). To see an LHS in action, watch for bold actions from KPWHRI at our new home with Kaiser Permanente.

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