Vanderbilt University Medical Center has established a Center for Learning Healthcare that will bring together clinicians, health system executives and researchers to generate evidence in the course of healthcare delivery to continuously improve the quality, value and safety of healthcare offered to patients.
The concept of a learning health system is that every patient encounter is documented and studied, and the resulting insights employed to drive change. Vanderbilt is joined by Duke University, the University of Michigan and other academic medical centers at the forefront of this movement.
The new center, which is part of the Vanderbilt Institute for Clinical and Translational Research (VICTR), will partner with personnel from across the Vanderbilt Health system to compare available treatments and approaches to healthcare delivery, understand which work best, and implement the findings into practice to improve outcomes for patients.
The center will also support researchers across the Vanderbilt community who are interested in conducting comparative effectiveness research and pragmatic trials, helping them obtain grants and share the findings through high-impact publications.
The Center for Learning Healthcare will be led by Matthew Semler, M.D., assistant professor of medicine in the Division of Allergy, Pulmonary and Critical Care Medicine, and Cheryl Gatto, Ph.D., research assistant professor of biostatistics and VICTR associate director.
The new center builds on work led over the past five years by the VICTR Learning Healthcare System Platform. Sponsored by VUMC’s Clinical and Translational Science Award (CTSA), the platform has brought together experts in clinical trials, biostatistics, regulatory affairs, project management, data science, healthcare administration and operations, and community engagement to complete more than 25 randomized trials addressing common uncertainties in routine practice.
“A good example of the type of research that will be done in this center is our recent research on IV fluids. For more than a century, one of the most common treatments that patients receive in the hospital has been IV fluids,” Semler said in a statement. “There were two types: saline and balanced crystalloid solutions. The two types had never been compared. Some clinicians used saline; some used balanced crystalloids, and no one knew which was better. Vanderbilt’s Learning Healthcare System identified that variation as an opportunity to improve care,” he said.
The Vanderbilt Learning Healthcare System embedded a large clinical trial inside routine practice and determined that balanced crystalloids were better for patients in terms of survival and preventing damage to the kidneys. Because of that research, the Vanderbilt Health system switched to using primarily balanced crystalloids.
“That’s an example of a treatment that patients were receiving globally, all day every day for about 100 years. The Vanderbilt Health system, by applying rigorous scientific methods, figured out what was best for patients and improved outcomes for patients by putting that knowledge into practice,” Semler added.
Gatto emphasizes that learning health care means continuous improvement. “Our charge through this center is to empower a culture that expects continuous learning around how to best provide care to our patients. As a learning health care system, we should always be learning by virtue of the fact that we are always seeing patients. The center will support the infrastructure, collaboration, and investigative processes required to facilitate this learning,” Gatto said in a statement.
Changes at VICTR
Gordon Bernard, M.D., a leader in clinical and translational medicine at Vanderbilt University Medical Center for more than 40 years, will step aside from his institutional leadership roles in July 2023 to focus more on his research interests and allow a new generation of leaders to take center stage.
Bernard, the Melinda Owen Bass Professor of Medicine, will relinquish his roles as Executive Vice President for Research at VUMC and as senior associate dean for Clinical Sciences in the Vanderbilt University School of Medicine.
He also will step down as program director of the Vanderbilt Institute for Clinical and Translational Research (VICTR) after more than 15 years, although he will remain an investigator on Vanderbilt’s multimillion-dollar Clinical and Translational Science Award (CTSA) from the National Institutes of Health, which partially supports the institute.
This month VICTR Deputy Director Wesley Self, M.D., M.P.H., Vice President for Clinical Research Networks & Strategy at VUMC, will be promoted to VUMC Senior Vice President for Clinical Research. In July 2023, he also will be appointed VICTR director and principal investigator for Vanderbilt’s CTSA.
Self, associate professor and vice chair for research in the Department of Emergency Medicine, is a physician scientist who is nationally known for designing and conducting clinical research and for advancing the treatment of patients with severe infections. He was appointed co-PI of the CTSA in September 2022.
At the national level, Self is the clinical coordinating center PI for multiple clinical trial platforms supported by the NIH, and he is founder and PI for the Influenza and Other Viruses in the Acutely Ill research network supported by the Centers for Disease Control and Prevention.
Since it was founded in 2007, VICTR has fostered the development of innovations including BioVU, Vanderbilt’s DNA repository, ResearchMatch, an online national volunteer recruitment registry launched in 2009, and REDCap, a web-based research management application used worldwide.
Under Bernard’s leadership, VICTR also removed administrative and regulatory roadblocks locally and nationally, including the creation of the IRB Reliance Exchange, a web-based platform supporting single Institutional Review Board review nationally.
VICTR has one of three TICs in the nationwide consortium of more than 50 CTSA “hubs” funded by the National Center for Advancing Translational Sciences. It has the only Recruitment Innovation Center, which develops and tests innovative approaches to engaging minorities, women and older adults in clinical trials.
Other major collaborative initiatives at VICTR include:
- The Data and Research Center (DRC) for All of Us, the national research enterprise of the NIH with 1 million volunteers that aims to extend precision medicine to all diseases. Partners in the DRC include the Broad Institute of MIT and Harvard and Verily Life Sciences.
- The Coordinating Center for eMERGE, organized and funded by the National Human Genome Research Institute, which combines DNA biorepositories with electronic medical record systems for large-scale, high-throughput genetic research supporting the implementation of genomic medicine.
