CERTAIN developed in response to the growing need for a healthcare system that is able to monitor the risks, benefits, and value of new healthcare treatments and technology to determine whether or not these developments actually improve quality of care and the health of patients. This type of system is called a learning healthcare system and is vital in this time of ever advancing healthcare technology and options available to healthcare stakeholders.
CERTAIN was built on the clinician and hospital relationships that created the Surgical Care and Outcomes Assessment Program (SCOAP). SCOAP is a unique performance data-sharing, benchmarking, and quality improvement (QI) platform for surgical and interventional procedures in Washington State. SCOAP is based in a grassroots, voluntary, clinician-led collaborative including doctors; statewide insurers; policymakers; professional organizations of nurses, physicians, nurse anesthetists and hospitals; and the state chapter of the American College of Surgeons. The program is administered by the non-profit Foundation for Health Care Quality (FHCQ). CERTAIN partners with FHCQ in the development, deployment, and evaluation of SCOAP activities. SCOAP has had remarkable success. However, CERTAIN developed out of a need to move beyond QI and to perform real world assessments of risks and benefits. QI alone, while important and worthwhile, cannot accomplish these assessments: QI registries are often limited and cannot capture long-term care and outcomes, do not cross care delivery sites (inpatient vs. outpatient), do not include patient perspectives, are extremely labor intensive, and are limited in dissemination and generalizability.
CERTAIN received an initial $11.7 million grant from the Agency for Health Care Research and Quality (AHRQ) to develop the infrastructure and pilot projects in leveraging electronic data, linking disparate institutions in a network, and conducting community-based research and translation in peripheral arterial disease. In 2011, the Life Sciences Discovery Fund (LSDF) awarded CERTAIN a $2.3 million grant to further develop the program by developing infrastructure around broader stakeholder engagement, more clinical disciplines (orthopedic spine, cancer, urologic) and supporting translation into healthcare system change. In 2013, CERTAIN was awarded an additional AHRQ grant of $735,830 to build a platform for collecting patient-reported outcomes and engage with healthcare stakeholders to conduct research prioritization activities.
Today, CERTAIN is the learning healthcare system in Washington State, a network of over 60 diverse healthcare provider organizations participating in over 20 projects, studies, and initiatives that are continuously evaluating healthcare delivery, generating new evidence through research, and continually learning from care provided to improve the care of patients in Washington State. CERTAIN is a suite of projects and programs that track quality, benchmark best practices, drive improvement, and allow all healthcare stakeholders to have their input heard as to what is needed to improve the system and includes:
- A network Clinical Practice Partners including hospitals, clinician’s offices (primary and specialty care), and long-term care facilities (skilled nursing facilities) joined together to track quality and benchmark best practices in healthcare delivery.
- Projects focused on Leveraging Healthcare Data like automating data extraction from electronic medical records and incorporating other sources of information like payer data.
- A mechanism for patients to “tell their story” related to healthcare – the Patient Voices initiative – so that the system comes to understand the real impact of healthcare interventions and so researchers focus on the things that matter most to patients.
- Forums, advisory groups, and partnerships that allow Stakeholder Input from across the healthcare spectrum (patients, providers, policy makers, payers [including insurers and employers], product manufacturers) to take part in continuous learning and healthcare system improvement.
- Informed by the input of healthcare data, patients and other stakeholders, CERTAIN investigators lead Research and Evidence Development across clinical disciplines to conduct community-based research and generate new-or-refined evidence base.
- Dissemination and Implementation projects moving research and evidence back into practice and driving continuous healthcare improvement, like PROs in Practice.
CERTAIN organizational infrastructure is composed of:
- Stakeholder Advisory Board;
- an executive leadership committee;
- cores of investigators and skilled staff to meet the core components and execute key activities of the CERTAIN learning healthcare system: administration, informatics, CER and PCOR methods, dissemination and implementation, patient voices and stakeholder engagement; and
- clinical practice partners that are key contributors to healthcare data and essential sources of stakeholder and patient input.