It is obvious that COVID-19 has radically reshaped many aspects of our society and our lives over the last two years. But perhaps unnoticed by most, the pandemic has also accelerated a quiet but powerful transformation in the way we at UPMC approach how we care for patients. The result has been hundreds of lives saved and the promise that we can continue to improve care in the years to come.
Due to the urgent need to help patients facing a deadly virus, UPMC committed itself at the beginning of the crisis to truly becoming a “learning health system”, with near-real-time changes in how we handle patients based on the analysis of our own data, as well as the latest scientific findings and regulatory approvals.
For decades, clinicians and researchers across the country have known that our processes of digesting credible scientific knowledge and integrating it into patient care are too slow and cumbersome – sometimes taking years. That is why the National Academy of Medicine called for the development of a learning health system (LHS) in 2009 and set the goal that by 2020, “90 percent of clinical decisions will be supported by accurate, timely and up-to-date clinical information and will reflect the best available evidence.”
Others have defined LHS as an environment in which “Science, informatics, incentives and culture are adapted to continuous improvement and innovation, with best practices seamlessly embedded in the delivery process and new knowledge captured as an integrated by-product of the delivery experience.”
It is a mouthful and a heavy lift for any healthcare system. At UPMC, we have made some progress towards this goal in recent years, especially in science and informatics. Because we already had a robust data and analytics infrastructure, at the beginning of the pandemic, we were able to quickly turn our attention to the incentives, culture, and best practices embedded to take care of our patients.
It first involved the creation of an interdisciplinary COVID-19 Therapy Committee – composed of physicians, pharmacists, hospital managers and others – to evaluate possible treatment options and to quickly share updated guidelines with all facilities across our system.
In addition to continuously evaluating UPMC’s internal patient data and controlled clinical trials, the committee had to weigh a wave of COVID-19-related publications from around the globe – some peer-reviewed and many not. This put a premium on expertise in assessing the benefits of published information that emerged on an unprecedented scale – and our researchers led or were involved in many trials that quickly showed which treatments worked best for which patients. While our therapeutic committee recognized the benefits of and implemented some treatments – such as steroids, remdesivir and tocilizumab – it rejected the use of hydroxychloroquine, despite the government approving its emergency use early in the pandemic.
Information technology specialists at UPMC created warnings and orders in our electronic medical record systems to strengthen the guidelines. They also collaborated with our research team to integrate clinical practice with enrollment in clinical trials across our comprehensive system to ensure fair treatment, regardless of geography or hospital type. Instead of parting “research” and “care,” all care became an opportunity to quickly learn about improving patient outcomes.
In parallel with the Therapeutic Committee, a Real-Time Intensive Care Management Team made recommendations regarding respiratory support strategies and other critical, supportive care, while a system-wide infection prevention task force supervised testing, contact detection, isolation, and use of personal protective equipment.
The result of this joint effort was a significant improvement in care in an astonishingly short time and mostly before mass vaccination. Based on our data from more than 11,400 COVID-19 patients, the adjusted risk of hospital mortality decreased by an average of 5 percent from March 2020 to early June 2021.
At the same time, we saw no significant variation in the type or amount of drugs and therapies used for patients with COVID-19 across 22 hospitals, achieving our goal of fairness and access regardless of a patient’s zip code.
Although this pandemic is not over, we are already looking forward to what’s next for our learning health system. Although we can not determine the extent to which a single change improved the outcomes of our COVID patients, we know that our accelerated learning saved lives. Now we must continue to apply these experiences to the continuing hard work of the healthcare system long after this crisis is over. Our patients deserve nothing less.
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Dr. Marroquin is the Chief Health Care Data and Analytics Officer for UPMC.