Healthcare leaders can learn four important lessons from a recent study indicating universal colonization as superior to other strategies for reducing methicillin-resistant Staphylococcus aureus among intensive care unit patients, according to a commentary on the Institute of Medicine website.
The authors examine how their study on MRSA prevention techniques, published in the New England Journal of Medicine, can help hospitals become continuously learning organizations. The study assigned 43 hospitals under Nashville, Tenn.-based Hospital Corporation of America to one of three MRSA prevention strategies: screening and isolation, targeted decolonization and universal decolonization.
Results showed universal decolonization was the most effective strategy for reducing rates of MRSA and bloodstream infections from any pathogen, with a 44 percent decrease in the latter.
Learning health systems tackle difficult problems and develop evidence, according to the commentary. The MRSA study exemplifies learning health systems because it targeted a dangerous infection and added strong evidence to a process — MRSA prevention techniques — that lacked evidence for a best practice.
The authors share four lessons this study has for learning health systems:
1. "Embedding pragmatic clinical trials into routine practice settings provides information that can directly inform care delivery," the authors state. The MRSA study incorporated the prevention strategies into hospitals' existing processes.
2. Interoperable information systems can allow organizations to easily compare data and learn from each other. The MRSA study took place within a single health system that had an integrated IT system.
3. "Randomization is sometimes necessary, and cluster randomization is especially well suited to pragmatic trials," the authors state. Hospitals participating in the MRSA study were randomly assigned to a prevention strategy, which allowed researchers to compare strategies across like institutions. However, it is important to ensure ethical oversight of studies involving randomization, according to the commentary.
4. Learning health systems require financial and organizational support to improve performance. While the MRSA study's interventions cost less than conventional clinical trials, they still required an outlay of close to $3 million.
The commentary is part of the Learning Health System Commentary Series of the IOM Roundtable on Value & Science-Driven Health Care.
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The authors examine how their study on MRSA prevention techniques, published in the New England Journal of Medicine, can help hospitals become continuously learning organizations. The study assigned 43 hospitals under Nashville, Tenn.-based Hospital Corporation of America to one of three MRSA prevention strategies: screening and isolation, targeted decolonization and universal decolonization.
Results showed universal decolonization was the most effective strategy for reducing rates of MRSA and bloodstream infections from any pathogen, with a 44 percent decrease in the latter.
Learning health systems tackle difficult problems and develop evidence, according to the commentary. The MRSA study exemplifies learning health systems because it targeted a dangerous infection and added strong evidence to a process — MRSA prevention techniques — that lacked evidence for a best practice.
The authors share four lessons this study has for learning health systems:
1. "Embedding pragmatic clinical trials into routine practice settings provides information that can directly inform care delivery," the authors state. The MRSA study incorporated the prevention strategies into hospitals' existing processes.
2. Interoperable information systems can allow organizations to easily compare data and learn from each other. The MRSA study took place within a single health system that had an integrated IT system.
3. "Randomization is sometimes necessary, and cluster randomization is especially well suited to pragmatic trials," the authors state. Hospitals participating in the MRSA study were randomly assigned to a prevention strategy, which allowed researchers to compare strategies across like institutions. However, it is important to ensure ethical oversight of studies involving randomization, according to the commentary.
4. Learning health systems require financial and organizational support to improve performance. While the MRSA study's interventions cost less than conventional clinical trials, they still required an outlay of close to $3 million.
The commentary is part of the Learning Health System Commentary Series of the IOM Roundtable on Value & Science-Driven Health Care.
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