October 18, 2018—(BRONX, NY)—Einstein-Montefiore has received a $3.3 million grant to establish a Learning Health System (LHS) Center of Excellence, called Excellence in Promoting LHS Operations and Research at Einstein/Montefiore (EXPLORE). One of 11 nationally and the only one in New York, the new center will embrace a range of disciplines—from physicians and nurses to pharmacists and data scientists—to improve the quality of patient care. By training seven scholars over the next five years, the center aims to accelerate advances in quality across the system, from improving sepsis care to bettering patient transfer from acute care to skilled nursing facilities, among other initiatives.

“This really is the first federal grant focused on training LHS investigators,” says Diane McKee, M.D., co-principal investigator on the grant, professor of family and social medicine at Einstein, and family physician at Montefiore. “There is now a recognition that health systems like Montefiore have shown the practical, real-world benefits of the LHS model. This grant validates our leadership in the field and our ability to apply academic rigor to this approach, not only by providing training, but making our findings generalizable, thereby helping patients around the country.”

The Learning Health System Model

Einstein-Montefiore was an early adopter of using electronic medical records (EMR) to conduct research, including projects aimed at improving the quality of care delivered to patients. The next generation of that approach, called the “learning health system” model, is emerging as a highly promising way to improve the delivery of healthcare. While the idea of improving care based on data isn’t new—think hand-washing reminders or surgery checklists—the advent of electronic medical records and informatics is super-charging the field, greatly expanding the possibilities.

Diane McKee, M.D.In recent years, a multidisciplinary group of Einstein and Montefiore researchers and clinicians have coalesced around the LHS approach. Breaking down technical and operational barriers, using artificial intelligence, and leveraging skills across a range of disciplines, they have improved care and, most importantly, saved lives. These initiatives include developing a predictive algorithm that monitors EMRs in real-time and flags critical care patients at high risk for acute respiratory failure, and systematically reviewing all pediatric healthcare-associated infections to ensure that lessons learned from each infection benefit future patients.

To have the greatest impact on the health system, the new training program has an unusual structure: the health system identifies the improvement initiatives and the trainees are matched to them based on interest and background. “This provides numerous benefits,” Dr. McKee explains. “The scholar can immediately join an existing team focused on the project, learning in the “real world” while taking courses to develop the necessary knowledge and skills for a career as a LHS investigator. It also revs up the team by providing another dedicated team member and accelerating a priority initiative for the health system.”

Each scholar will have both a research mentor and a health system mentor. This reflects the expected outcomes for the grant, which will include quality improvement metrics as well as more traditional scholarship criteria, such as publications in peer-reviewed journals.

A Grant with a Twist

Chinazo Cunningham, M.D., M.S.The program is unlike other federal training grants at Einstein in other ways as well. “We aren’t looking only for faculty who are already on the traditional physician-scientist research track,” says Chinazo Cunningham, M.D., M.S., co-principal investigator on the grant. “We are looking for applicants in a range of disciplines, who have a demonstrated interest in quality improvement, are committed to pushing the field ahead, and can bring a diversity of perspectives and skills to the group. Like most research, quality improvement requires a team approach, and we want to make sure our training program reflects that.” Dr. Cunningham is associate chief of general internal medicine and director of diversity affairs for the department of medicine.

“The LHS model is driven by data but also demands a significant institutional commitment,” adds Michael Rinke, M.D., Ph.D., medical director of pediatric quality at Children’s Hospital at Montefiore (CHAM), and associate professor of pediatrics and co-director of Health Research Implementation Core at the Institute for Clinical and Translational Research at Einstein and Montefiore. “An infrastructure where science and informatics are coupled with culture and incentives are what make lasting and meaningful change. With the full support of Montefiore and Einstein, we fully expect to make significant progress.”

Michael Rinke, M.D., Ph.D.EXPLORE will build upon existing career development education and training at Einstein as well as the innovative informatics and value-based care delivery model at Montefiore, including the Center for Health Data Innovations, the Block Institute for Clinical and Translational Research at Einstein and Montefiore, and Montefiore’s Network Performance Group.

The center is funded by an award through the Agency for Healthcare Research and Quality (AHRQ) and the Patient-Centered Outcomes Research Institute (PCORI). EXPLORE, along with the 10 other centers funded this cycle, will form the national LHS Research Collaborative. The collaborative will work together to share resources, information, and to disseminate findings for application at other institutions.