Kern Center Drives Learning Health System Approach at Mayo Clinic

The focus of learning health system efforts at Mayo Clinic is its Kern Center for the Science of Health Care Delivery, where projects arise from real-world challenges experienced by Mayo's patients and clinicians. During a recent presentation, Sean C. Dowdy, M.D., Mayo Clinic’s chief value officer and associate dean for practice transformation, detailed its structure and governance, and provided a few examples of its work.

Speaking during the NIH Pragmatic Trials Collaboratory Grand Rounds on Oct. 31, Dowdy, who is also a professor in Mayo’s Division of Gynecologic Oncology, began by noting that the center was launched about 15 years ago and has evolved significantly since then, learning from its mistakes. 

The Kern Center brings together diverse experts to create and evaluate data-driven solutions. “We do a lot of evaluation, in addition to creation, especially now in the era of AI tools,” Dowdy said. “We want to create not just clinical knowledge, but also practical knowledge that improves care directly for patients.”

The center does between 200 and 300 projects per year. Some projects are very small. A clinical team might need help with data analysis or implementation. But there are some very big projects as well. "Quality measurement science is something that we think is extremely important for measuring effectiveness,” he said. “We feel that our ability to measure quality, safety and experience is really in its infancy, and that we really need a lot more development in how to define what quality is in healthcare.”

The Kern Center also does clinical and economic evaluations. “We have new care models outside of brick-and-mortar hospitals. We have lots of AI tools that need to be evaluated for effectiveness,” he said. “A lot of what we do is trying to figure out how to implement an idea in actual practice — human factors engineering, ergonomics, cognitive burden. For instance, we don't have residents work 100 hours a week anymore, because we recognize the impact of cognitive burden.”

Dowdy stressed that governance is critical to the center’ success and that they have developed a very close relationship with the practice field, not the research field. “We don't need another arm of research. We have a whole big group of people that does that. We need a group of experts that can help inform the practice and tackle the problems that they're facing on a day-to-day basis.”

How does Mayo Clinic pay for this? Dowdy explained that it is organized as a shared service. “So this is essentially a tax on all the hospitals within the Mayo Clinic organization. And because of that, I have a lot of people I have to keep happy. I have a lot of bosses. We have some projects that we do that are geared toward the enterprise, and some that are site-specific, because there are different needs at different hospitals. Earlier this year, we appointed site-based scientific directors who are employed within the Kern Center, and they have a partner, so they create a dyad leadership team that's the medical director for practice engagement, and this really helps us develop relationships at the sites and helps us accelerate project prioritization, as well as the speed with which these projects are initiated and completed.”

He stressed that they have to focus on clinical priorities. The governance of this is the clinical practice committee (CPC). “Over the last couple of years, we've been able to pivot basically all of our projects to Mayo Clinic CPC priorities,” Dowdy said. “As part of this, we have another review process where we talk to the individual CPC leaders at each site to make sure that we support those projects.”

He also noted that they have to work on a very fast timeline. “The practice does not move at the speed of a grant cycle. We need to be agile and adaptive,” he said, adding that these days they do a lot more testing and development of AI tools, and they help create processes to use AI tools within the practice. 

Dowdy said that about four years ago, when he came to this role, the Kern Center was in somewhat of an existential crisis. “They weren't working on the right things, and many people didn't see their value.” But now with the combined leadership approach and the deeper practice engagement, the Kern Center is seen as indispensable to practice transformation, and that's what keeps the organization relevant, he added. 

Next, he gave a few examples of the type of projects the Kern Center takes on. Earlier in the pandemic, they did a multi-center randomized trial of not only the safety, but the effectiveness of a hospital-at-home program. They enrolled over 1,000 patients and found that the hospital-at-home model was not inferior to the brick-and-mortar hospital model. They also found it was effective — patient experience was significantly higher when they managed patients at home. 

The Kern Center also is looking at direct oral anticoagulation stewardship. These anticoagulants are used by about 6 million Americans, and like any other intervention, if they're not used correctly, you can have complications associated with that, he said. A project was completed in 2024 and now they are implementing it across the entire organization. Compared to controls, the bleeding event rates were much lower in the stewardship program, as were thrombotic event rates, as was hospital readmission, as well as length of stay, “and all those things are very expensive,” Dowdy said. An analysis shows cost savings of $7,000 per patient once they get beyond six months. “So we show not only the effectiveness and the importance of this to patients, but also the financial impact.”

Dowdy was speaking on a panel with two other thought leaders in the learning health system space: Peter Margolis, M.D, Ph.D., adjunct professor of pediatrics at the Stanford University School of Medicine, and former co-director of the James M. Anderson Center for Health Systems Excellence at Cincinnati Children’s Hospital Medical Center, and Sarah Greene, M..PH., a consultant and senior advisor to the National Academy of Medicine. 

Greene began by explaining that the National Academy of Medicine recently developed a set of shared commitments, which she described as a foundational set of guiding principles that can allow everybody who works in healthcare to find common ground. She noted that they build upon the NAM’s quality chasm aims involving safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity. But to ensure that the learning health system can be brought to reality everywhere, in every system, they added accountable, transparent, secure and adaptive, “because those really reflect contemporary healthcare, the importance of health data and the need to be very agile and adaptive in how we go about learning and improvement.”

Ideally in a learning health system that works, Margolis stressed, patients and clinicians and system leaders focus together on outcomes. “They measure performance. Improvers help close gaps in performance. That leads to unaddressed problems being surfaced. These are opportunities for researchers and others to use a variety of methods to study those questions, share the results back with the participants, and then the community implements new approaches.”