LeaRRn Podcast

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Season Three

In today’s episode, Dr. Cara Lewis presents, “Pragmatic Measurement of Implementation Outcomes: How to Operationalize Outcomes Important to Health Systems.” This talk will offer a roadmap to operationalizing a learning health system, with an emphasis on how to design pragmatic measures and outcomes that matter to stakeholders. We will explore ways to balance rigor and burden in the context of learning health system impact evaluations.
In today’s episode, Dr. Catherine Quatman-Yates presents, “Selecting Rehabilitation Metrics that Matter to Guide Transformative Improvements for Patients, Clinicians, Health Systems, and Society.” This presentation will cover theories, models, evidence, and case examples for selecting and leveraging meaningful metrics for monitoring and guiding and driving best practices and outcomes for rehabilitation settings and stakeholders.
In today’s episode, Dr. Elena Mendez-Escobar and John Goldie present, “Health Equity Accelerator – BMC’s Approach to Health Justice.” Boston Medical Center is committed to accelerating the path to achieve health justice and truly deliver on their mission. This talk will discuss BMC’s innovative approach and learnings to date, including how they are utilizing data and analytics to inform priorities, understand root causes, and propel change.
In today’s episode, Dr. Ericka Merriwether presents, “Confronting Racism in Pain and Rehabilitation Research: Reframing and Reimagining Study Designs.” Racism is a global determinant of health outcomes. Lack of awareness of or an unwillingness to examine the significant impact of racism on health underpins research questions and study design choices that often deepen inequities in pain and rehabilitation outcomes. This talk will highlight: 1) the roles of subjectivity and advocacy in research, 2) common study design factors that perpetuate harmful narratives about racialized groups, and 3) provide examples of ways to reframe and reimagine study designs, methodologies, and dissemination strategies through a health equity lens.
In today’s podcast, we share Dr. Julie Fritz’s presentation “Pragmatic and Embedded Trials – Strategies for Generating Real World Evidence.” Dr. Fritz will address the evidence-practice gaps that are well-established in rehabilitation. Pragmatic and embedded clinical trials provide an opportunity to generate evidence within health care systems that may help overcome these gaps and improve patient outcomes.
In today’s podcast, Dr. Elizabeth Skidmore presents, “Engaging Stakeholders and Health Systems to Optimize Pragmatic Trials.” This presentation will discuss strategies for collaborating with service recipients, providers, and health systems to inform the design and conduct of pragmatic trials in rehabilitation settings.
In today’s podcast, Dr. Michel Kahn presents, “Data Quality and Hidden Influencers in Electronic Medical Record Data.” He talks about how large scale data sharing networks are creating multi-institutional clinical data sets for comparative effectiveness studies at scale. Much attention has focused on handling systematic bias in non-randomized routine-care data collection. We focus here on issues with data quality and “hidden influencers” that can impact the use of electronic medical record data in obvious and not-so-obvious ways.
In today’s episode, Jacob Kean, PhD is an Associate Professor in Health System Innovation and Research, Department of Population Health Sciences, University of Utah, and Research Scientist, VA Informatics and Computing Infrastructure (VINCI) Salt Lake City VA Health Care System. Dr. Kean leads Analytics and Evaluation for Population Health, University of Utah Medical Group and focuses his research on the creation, implementation and operation of research networks and learning health systems to improve patient-centered outcomes, with a special focus on rehabilitation populations. Following the completion of his doctorate degree, Dr. Kean served as a Visiting Scientist at the Boston University Rehabilitation Outcomes Center, a Visiting Scholar at the Center for Rehabilitation Research Using Large Datasets at the University of Texas Medical Branch, an NIH Training Institute for Dissemination and Implementation Research in Health (TIDIRH) fellow, Research Scientist in Residence at Datavant, and completed a post-doctoral Master’s degree in Measurement, Evaluation, Statistics and Assessment (MESA) at the University of Illinois – Chicago.
In today’s episode, Rachel Richesson, presents, “Learning to Use EHR Data in Learning Health Systems: Focus on Computable Phenotypes.” Learning Health Systems thrive with use of real-world data from electronic health record (EHR) systems in both observational and interventional research to generate real-world evidence. Computable phenotypes are specified definitions that can be used to identify patients with particular clinical conditions through computerized queries to EHR systems or data repositories using defined data elements, codes, and logical expressions. Computable phenotypes can facilitate research and learning by supporting the identification of patient populations, the delivery of clinical interventions, and the assessment of outcomes. The sharing and re-use of computable phenotypes can enhance the efficiency of pragmatic research and the dissemination of evidence-based interventions into real-world settings. This talk will discuss current platforms for identifying existing computational phenotypes as well as challenges and strategies for their implementation and validation in learning health systems.
In today’s episode, Dr. Claire Kalpakjian, PhD, MS, presents, “Designing Data Inputs that Matter: Building an Infrastructure in a Real-World Learning Health System.” Meaningful and relevant data are essential for any learning health system. Learning communities benefit from support in selecting and implementing data inputs – clinical assessment and documentation, patient-reported measures – that align with their learning goals. This talk will describe the development of an infrastructure to support the design and practical application of data inputs in medical rehabilitation that power cycles of learning to improve care.
In today’s episode, Hadi Kharrazi, MD, PhD, presents, “Population Health Informatics: What, How, and Why?” In this presentation, we will discuss what is the rapidly growing field of Population Health Informatics (PHI), how PHI is leveraged to achieve the objectives of population health, and why PHI is critical for value-based care. We will also discuss the role of PHI in risk stratification efforts and the added value of new concepts in PHI such as social determinants of health, health disparities, frailty, and unique EHR data types.
In today’s episode, Megan Morris PhD, MPH, CCC-SLP presents “Advancing Healthcare Equity for Persons with Disabilities through Documentation in the Electronic Health Record.” Persons with disabilities experience significant barriers in accessing high quality, equitable health care services. The presentation will discuss research, policy, and advocacy efforts to advance systematic collection of disability status in the electronic health record, which is the first step to addressing these disparities.

Season Two

In today’s episode, we share two presentations on the subject of guideline implementation. First, Dr. Kelly Tanner and Dr. Victoria Baker present, “Implementing Occupational Therapy Clinical Practice Guidelines in an Outpatient Pediatric Hospital-based Setting.” This presentation will highlight how one pediatric hospital institution has developed an evolving system to implement rehabilitation clinical guidelines into practice. Then, Dr. Susan Whitney presents “Guideline Implementation: Moving Evidence into Clinical Practice.” This talk highlights methods utilized to create guidelines and discuss guideline implementation; and discusses whether they have been effective in changing practice.

In today’s episode, Dr. Mark Helfand presents “Systematic Review Approaches to Optimize Learning Health Systems.” This presentation will describe how an embedded evidence synthesis program evolved to incorporate the core components of a Learning Health System through understanding the culture clashes between health system leaders and systematic reviewers; and adapting methods to address real-time problems and identify areas for future research in the VA.

In today’s episode, Dr. Miriam Rafferty presents “Application of Sustainability Frameworks and Assessments in Rehabilitation – A 4 Year Implementation Project.” This talk contrasts different sustainability models and assessment tools for clinical implementation projects and provides a framework for creating lasting clinical improvements.

In today’s episode, Dr. David Chambers presents “A Dynamic Approach to Sustainability: Implications for Planning and Strategies for Long-term Use of Interventions.” This presentation will discuss: the benefits of taking a dynamic approach to efforts to sustain health interventions; considering the impact of the approach on planning for sustainability; opportunities to learn over time; as well as tactics to improve the likelihood of sustainability.

In today’s episode, Dr. Susan Stark presents “Designing Complex Behavioral Interventions for Implementation.” This talk discusses the pragmatic strategies used to design a community-based fall prevention intervention for older adults, with the goal of facilitating future implementation.

In today’s episode, Dr. Byron Powell presents “Designing and Evaluating Implementation Strategies: Ongoing Challenges and Emerging Directions.” This talk provides an overview of methods and tools that can be used to improve the design and evaluation of implementation strategies.

In today’s episode, Dr. Anne Sales presents “Selecting Frameworks for Use in Implementing Evidence into Practice.” This talk discusses different types of frameworks, and where each fits into the systematic processes of implementing evidence based practices.

In today’s episode, Dr. Lisa Juckett presents “Identifying Contextual Determinants and Implementation Strategies: Stakeholder-Engaged Initiatives to Improve Rehabilitation Research and Practice.” This talk reviews two national-level initiatives, both guided by the Consolidated Framework for Implementation Research, or CFIR, that aim to advance the use of evidence in rehabilitation practice. 

In today’s episode, Laura Damschroder presents “Learning from the Dynamic Role of Context: Conceptual Frameworks for Guiding Implementation Projects.” This talk highlights the value of conceptual frameworks for guiding implementation projects, using a case illustration based on a published study to highlight application of the Consolidated Framework for Implementation Research (or CFIR), which helps to identify determinants of implementation outcomes. Ms. Damschroder presents next steps for how to use contextual assessments to help guide selection and tailoring of implementation strategies, and provides a sneak peek at planned updates for CFIR Version 2.

Today’s minisode provides an overview of the LeaRRn Pilot Studies Program and reviews the application process. You can also view the LeaRRn Pilot Studies webpage:
https://sites.brown.edu/learrn/home-2/opportunities/pilot-grants/

Today’s minisode features audio from the informational webinar about the learning health systems scholars program released on September 28, 2022. Topics covered include application instructions, targeted research priorities for each health system, and deadlines for letters of intent and the interview process for inclusion in this program.  

You can learn more about what kind of research learning health system scholars do in rehabilitative research by listening to the scholars themselves in our LHS Scholar Spotlight minisodes.

For those interested in the pilot study program, please stay tuned for an upcoming minisode that promotes LeaRRn’s Request for Applications for Pilot Study applicants

Dr. Shweta Gore presents on her work as an LHS scholar and LeaRRn pilot study awardee. Shweta is an Associate Professor in the Department of Physical Therapy at MGH Institute of Health Professions. She was an LHS Scholar at Johns Hopkins/ Boston Medical Center (BMC) during the 2021-2022 academic year. In this podcast, she discusses how she took the work from her scholar year, expanding on it this year as a LeaRRn pilot study awardee. Her work focuses on the measurement of physical activity and its relationship with health outcomes in individuals with chronic cardiovascular and pulmonary conditions using complex survey data and electronic health records. To discover more, go to https://sites.brown.edu/learrn

In today’s minisode, we hear from Learning Health System Scholars Dr. Joshua Johnson and Dr. MJ Lee. Dr. Johnson is a Learning Health System Scholar from the first year of the program, who has just been awarded LeaRRn Pilot funding to continue his work with Cleveland Clinic. Dr. Lee is a Learning Health System Scholar from the second year of the program, also sited at Cleveland Clinic. They discuss how they collaborated as LeaRRn Scholars, leveraging each other’s experiences and building off of each other’s work; as well as how their time as Scholars will impact their future research and benefit the health system.

Season One

In this pilot, LeaRRn program manager Maggie Whitten will explain the purpose of the podcast as well as some of the goals of LeaRRn. To visit the LeaRRn website please click on the following link: https://sites.brown.edu/learrn/.

Date: December 15th, 2021

In today’s episode, Dr. Charles Friedman presents “Essence of the Learning Health System,” an introduction to the concept of learning health systems, how they work, and what such an approach offers those seeking to improve health care.

Dr. Friedman is the Chair of the Department of Learning Health Sciences and the Josiah Macy Jr. Professor of Medical Education at the University of Michigan Medical School, as well as a professor of information and of public health. Dr. Friedman first explored the concept of Learning Health Systems in 2010 through the Institute of Medicine while at the Office of the National Coordinator for Health IT (ONC), and now serves as the Editor-in-Chief of the journal Learning Health Systems. Dr. Friedman’s research emphasizes large-scale information infrastructures and resources to improve health, how individuals and groups interact with information resources, and methods for studying the outcomes of these interactions.

In today’s episode, Dr. Alan Jette presents “Challenges in Adopting Systematic Outcome Measurement in the Learning Health System.” 

Dr. Jette is a former Professor of Interprofessional Studies in the “PhD in Rehabilitation Sciences” program and in the Department of Physical Therapy at the MGH Institute. He is also Professor Emeritus in the Department of Physical Therapy & Athletic Training at Boston University. As a physical therapist, and an internationally recognized expert in the measurement of function and disability, he has developed numerous instruments that assess function and disability, and has published numerous articles on these topics in the rehabilitation, geriatrics, and public health literature.

In today’s episode, Dr. Christopher Forrest presents “The Learning Health System Science Competencies.” 

Dr. Forrest is Director of the Center for Applied Clinical Research, at the Children’s Hospital of Philadelphia Research Institute; and Professor of Pediatrics at the Children’s Hospital of Philadelphia and the University of Pennsylvania. He serves as the Principal Investigator for PedsNet, a consortium of children’s hospitals that conducts patient-centered outcomes research among children and youth. Dr. Forrest is also the author of the seminal manuscript titled Development of the Learning Health System Researcher Core Competencies.

In today’s episode, Dr. Margo Edmunds presents “Consumer Informatics and Digital Inclusion: Implications for Research on Engagement.” 

Dr. Edmunds is Vice President of Evidence Generation and Translation at AcademyHealth, and Director of the Center on Diversity, Inclusion, and Minority Engagement. She specializes in health information and communications technology and has expertise in consumer engagement, social determinants of health, risk communication, and health equity. She began her career on the affiliate clinical staff at Johns Hopkins Hospital and taught health policy and health communications for several years as an Adjunct Associate Professor at Johns Hopkins University Bloomberg School of Public Health, while serving in executive positions at non-profit and corporate settings.  Her co-edited book Consumer Informatics and Digital Health was released in February 2019 by Springer.  

In today’s episode, Dr. Natalie Leland presents “Developing and executing stakeholder-engaged rehabilitation research.”

Dr. Leland is Associate Professor and Vice Chair for Research in the Department of Occupational Therapy at the University of Pittsburgh. She is an expert in stakeholder engagement, secondary data analysis, implementation science, and evaluating the impact of health services in post-acute and long-term care settings. Spanning her interests in occupational therapy, aging, and health services research, Dr. Leland is actively engaged with the American Occupational Therapy Association (AOTA), Gerontological Society of America, and AcademyHealth.

In today’s episode, Dr. Brian Mittman presents “Implementation in Complex Systems: Lessons Learned from Embedded Research, Multilevel Interventions and Complex Health Interventions,”  

Dr. Brian Mittman, Research Scientist at the Kaiser Permanente Department of Research and Evaluation, Division of Health Services Research and Implementation Science. He co-leads the UCLA Clinical and Translational Science Institute’s Implementation and Improvement Science Initiative, and has additional affiliations with the US Department of Veterans Affairs and RAND Health Program. Mittman chaired the planning committee that launched the journal Implementation Science, and is currently co-editor-in-chief emeritus. He was a founding member of the Institute of Medicine Forum on the Science of Health Care Quality Improvement and Implementation, and past chair of the NIH Special Emphasis Panel on Dissemination and Implementation Research in Health.

In today’s episode, Dr. Pamela Duncan presents “Systems Comprehensive Post Acute Stroke Services (COMPASS): An Example for Learning Health Systems.”

Dr. Duncan, is a Professor in the Department of Neurology at Wake Forest School of Medicine, and Senior Policy Advisor for Innovations & Transitional Outcomes at the Wake Forest Baptist Medical Center. She currently serves on the advisory board of the University of Pittsburgh Pepper Center. She joined the Wake Forest Faculty in 2011 to develop and evaluate innovative models of care to manage post-acute services for patients with medically and socially complex chronic conditions. She is the principal investigator of a PCORI funded large pragmatic trial to implement and evaluate an evidenced-based COMprehensive Post-Acute Stroke Services (or COMPASS) model.

In today’s minisode, we hear from Dr. Peter Coyle and Dr. Tracy Mroz, Learning Health System Scholars from the first year of the program as they describe their work, recount success stories from their Scholar year, and discuss how the experience has impacted their future work.

Dr. Coyle and Dr. Mroz also provide advice for applicants about the most relevant skills or experiences to include in the Letter of Intent, strategies for integrating Learning Health System priorities in the application, and how applicants can present their skillset to the Learning Health System and LeaRRn teams