The “learning health system” (LHS) model represents a relatively new, highly promising, and paradigm-shifting approach to the delivery of health care. A LHS is characterized by its capacity to continuously study every health care interaction to generate objective evidence and actionable knowledge, engage stakeholders, and develop targeted processes to improve outcomes. The LHS requires development of infrastructure where science, informatics, incentives and culture are aligned, and advances in Health Information Technology (HIT) facilitate the generation of new evidence as an integral byproduct of care delivery. Realizing this vision also requires dramatic transformation of many existing drivers of healthcare delivery and scholarly pursuit, in particular the creation of an appropriate workforce of well trained, diverse investigators who will become leaders in LHS research and operations. Our proposed Center of Excellence in Promoting LHS Operations and Research at Einstein/Montefiore (EXPLORE) is a collaboration between the Albert Einstein College of Medicine and Montefiore Health System (MHS), a large, integrated, accountable-care-oriented academic medical center that serves the Bronx and New York's Lower Hudson Valley region. We will leverage the efforts of MHS to deliver high quality services to a largely minority, socioeconomically disadvantaged community, while at the same time responding to the financial and service delivery imperatives of accountable care. Our proposed program will engage and build upon a strong education and training infrastructure at Einstein and an innovative informatics and value-based care delivery infrastructure at MHS. We will leverage the educational and research support resources of Einstein's Institute for Clinical and Translational Research (ICTR), the home our Clinical and Translational Science Award (CTSA), including didactic components of its Masters in Clinical Research and its AHRQ/PCORI- sponsored R25 patient-centered outcomes research coursework, the informatics infrastructure of the Center for Health Data Innovations, and the resources of Montefiore's Network Performance Group (responsible for quality of care, operational excellence, and patient safety at MHS), to create a novel career development program in LHS research. We will identify the most talented, motivated, and multidisciplinary clinicians and other faculty to enroll, equip them with the knowledge and skills to conduct, implement, and disseminate high quality and actionable LHS research, and provide them a sustainable career path as LHS research leaders. Our Scholars and mentors will contribute to a national LHS Research Collaborative, with Einstein-Montefiore's contribution driven by the expertise within and experience gleaned from our unique institutional program and resources. This will be accomplished through curriculum sharing and cross-institutional education; inter-institutional PI/PD and Scholar-Mentor interactions, including cross-institutional mentoring when feasible and appropriate; research cooperation, including dissemination of research findings and multi-center research initiatives; and sharing PCOR/CER methodological advances. !

Project Narrative The Center of Excellence in Promoting LHS Operations and Research at Einstein/Montefiore(EXPLORE) A Learning Health System is characterized by its capacity and commitment to optimize the outcomes of every clinical intervention through continuous study of all health care interactions, via learning cycles that include data collection and analysis, to generate objective evidence and actionable knowledge, engage stakeholders, and ultimately change behaviors and develop targeted processes to improve outcomes. Realizing this vision also requires dramatic transformation including the creation of an appropriate workforce of well-trained, diverse investigators who will become leaders in learning health system research and operations. Our proposed Center of Excellence in Promoting LHS Operations and Research at Einstein/Montefiore (EXPLORE) will engage and build upon a strong education and training infrastructure at Albert Einstein College of Medicine, and an innovative informatics and value-based care delivery infrastructure at MHS to create a novel career development program in Learning Health Systems Research.