Approach

The ACTS COVID-19 Guidance-to-Action Collaborative's Learning Community brings together individuals, organizations, and initiatives represented in the ACTS Stakeholder Community to accelerate progress toward their respective goals. A key, related goal is leveraging this collaboration to simultaneously advance progress toward a high-functioning healthcare knowledge ecosystem for COVID-19 and beyond, as envisioned in the ACTS Roadmap.

These Learning Community webpages (see page tree in left navigation sidebar) provide:

• an evolving shared framework for the healthcare knowledge ecosystem that participants operate in and are trying to improve through their individual and joint efforts
• Community of Practice (CoP) home pages where participants can share overviews and links to more detailed information about their initiatives. Together with weekly collaborative teleconferences and Learning Community online discussion forums (under development), these CoP home pages help participants collaborate and share learning, strategies, and tools in ways that add value to individual efforts and drive progress toward shared goals. 

Activities within the Learning Community are currently focused on enhancing through cross-fertilization initiatives already underway in various organizations to develop, deploy and evaluate 'living CDS interventions' for several specific COVID-19 clinical topics, as outlined below.

Participants

This Learning Community is a growing network of organizations and initiatives. The early draft diagram below outlines some of the initial participants.

Collaborative/Learning Community Overview Diagram [DRAFT]

Targets

The Learning Community is initially focused on coordinating and enhancing participant efforts to develop, implement and evaluate support for care team decisions and actions related to the targets outlined below. Related efforts to strengthen the evidence/knowledge/guidance 'supply chain,' incorporate this information into decision/action support tools and performance measures, implement these in clinical setting, evaluate the results and feed implications back into the 'knowledge ecosystem,' and scale these Learning Community efforts to other settings and targets, are also of interest (see tables on respective CoP home pages). 

• COVID-19 Patient Assessment, severity classification, decision making/recs 
  
  • Symptom eval/triage/test & mgt recs
    • At home - remote triage of patients with possible COVID-19 symptoms
    • ED - Severity assessment and optimal disposition
    • At home - monitoring /managing COVID patients: assess disease course, modify care plan as needed (e.g, send to hospital, follow-up after discharge)
  • Risk assessment/mgt support
    • Inpatient: patient’s risk of deterioration over the next 12-24 hours
    • ICU: patient’s risk of deterioration over the next 4-12 hours
  • Anticoagulation
    • Inpatient/ICU: whether/how individual patients should receiving anticoagulation medications
• Other Needs (addressed in a related initiative focused on patient-driven care planning)
  • Managing uncontrolled diabetes
  • Supporting preventive care decisions (prostate, breast, colon cancer screening)
  • Informing decisions related to statin use

Status Overviews

The tables below provide status overviews organized by: 1) organization implementing the living CDS/eCQMs, and 2) decision/action support target being addressed

1. By organizations implementing and evaluating the living CDS interventions and performance assessment

2. By decision/action support target being addressed

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EARLIER NOTES: To Be Filtered into LC Pages as appropriate by ACTS project team

I. Exploring Components of 'Supply Chain' for Addressing Clinical Questions/Needs in an LHS Cycle (working backwards from supporting patients and care teams)

• Address question/need with interventions that optimize workflow/information flow and enable performance results tracking and use
  • Apply user-centered design/human factors engineering approaches to design, create, test, implement, and enhance interventions; distill, disseminate, apply and continually enhance tools and processes for doing this
    • workflow modeling (current/future state) 
      • e.g., BPM+
    • Identify specific CDS intervention types and process/outcome measures
      • e.g., CDS: care management summaries/dashboards, severity/risk algorithms, order sets, documentation templates, etc.; Measures: CDS intervention use, clinical intervention use, morbidity/mortality results
    • standards-based intervention design
      • e.g., FHIR CPG Implementation Guide
  • Provide marketplace for implementers to find, evaluate and acquire the interventions
    • e.g., CDS Connect; clickable concept demo/requirements analysis from MAGIC team
  • Integrate interventions into pertinent tools and information systems
    • e.g., SMART on FHIR, CDS Hooks, NLM Value Set Authority Center (VSAC), US Health Information Knowledgebase (USHIK)
  • Provide change management support and training for those affected by the interventions
    • e.g., guidance from AHRQ's Patient Safety Network, collaborations supported by ACCME
  • Provide mechanism for gathering and analyzing performance results, and applying them to continuous improvement locally and beyond
    • e.g., collaborations with Medisolv, implementers
• Keep CDS interventions 'living' by continuously updating with latest evidence-based recommendations (DKP provides ready access to all these knowledge assets, and increasingly tools/standards for creating them)
  • Maintain guidance summaries on needs 
    • E.g., from Penn CEP on ACTS COVID website, guideline clearinghouses such as ECRI Guideline Trust, pertinent sources COVID-END list
  • Maintain living recommendations on needs
    • COVID
      • Assessment/triage, Risk/Severity prediction
        • e.g., NIH/CDC, ACEP, Australia
      •  Anticoagulation
        • E.g., NIH/CDC, ASH, Australia, others
    • Other
      • Diabetes
        • e.g., ADA, others
      • Preventive care
        • USPSTF
      • Statins
        • e.g., ACC/AHA
      • Integrating behavioral health and primary care
        • e.g., AHRQ Integration Academy
  • Maintain living systematic reviews on needs and support their application to living recommendations (see table below); DKP includes or leverages tools to:
    • Aggregate/find/access systematic reviews on topic
      • e.g., SRDR Plus, and pertinent sources COVID-END list for COVID topics
    • Create systematic review on topic
      • Monitor, access studies and reviews on topic 
        • e.g., leveraging infrastructure/processes in the AHRQ Effective Healthcare/EPC Program; COVID-END list and COKA for COVID topics; EBM on FHIR for making study/review components computable
      • Evaluate/process data from studies to create and update review; platforms for creating/maintaining systematic reviews
        • e.g., ClinicalTrials.gov; SRDR Plus; COVID-19 Knowledge Accelerator (COKA); DistillerSR
  • Provide feedback about care and results at the patient and population levels to drive the LHS cycle
    • E.g., leveraging AHRQ data resources such as HCUP, MEPS and others; CMS/ONC eCQI Resource Center 

II. Additional notes about initiatives focused on COVID-19 knowledge supply-demand chain/cycle

III. Related Documents

• Map: Collaboration of Collaborations
• early draft of map document, planned as a link from this Dashboard document to provide more details - needs work
• ACTS COVID-19 CDS Proposed Project Plan
  • This Dashboard document was developed as an outgrowth of the project plan document; table below replaces earlier tables and related notes in the project plan document
• ACTS COVID Pilot Planning
  • This is a predecessor to the Project Plan document above; some of its content has been superseded by later documents, but some of the content is still relevant and helpful.
• ACTS COVID-19 Pilot Charter
  • This is a predecessor to the Pilot Planning document above
• ACTS Roadmap 2020 Pilot Portfolio Proposal Notes
  • This is a very detailed draft document that the ACTS Roadmap WG was working on as the COVID-19 pandemic emerged. It reflects rich collaborative planning efforts and provides context/background for the ACTS COVID-19 Collaborative, and elements that will be useful for informing and scaling this COVID-19-focused work.
• Future Vision Scenarios from ACTS Future Vision Workgroups [these are earlier versions for background only- more refined/consolidated version coming; do not cite or share]
  • Care Delivery Future Vision
  • Resource Developer Future Vision
  • Learning Health System Future Vision (covers National and Organizational LHS perspectives)

Example of a paper that we could aim to write about the Learning Community:

Title: Optimizing information flow and outcomes around a virtuous healthcare quality ecosystem (LHS) cycle: concept demonstration by a learning community

Background: There are many problems with how data, evidence, and knowledge flow around the cycle that includes delivering care, assessing performance, producing evidence and knowledge, and applying information and tools to support care delivery. These problems result in major healthcare outcome shortcomings.

Objective: demonstrate that a learning community can begin improving this cycle for a a few high priority clinical issues (related to COVID-19) in several care delivery organizations in ways that could be scaled broady to healthcare targets and setting

Method: [ACTS/Collaborative/Learning Community]

Results: Describe good things that came out of LC

• Specific collaborations fostered by the LC that accelerated progress on local knowledge ecosystem efforts and overall ecosystem enhancement efforts [examples] 
• Enhanced development/implementation of standards
• Identification and spread of best practices for addressing portions of the cycle
• ...

Conclusion: