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Oct 3, 2024

Learning Health Systems project grant awarded to effort to improve care for high-need, high-complexity patients

by Anne Gravel Sullivan
Dr. Sara Westergaard

The UW Institute for Clinical and Translational Research (ICTR) is pleased to announce that a Learning Health Systems (LHS) Demonstration Project grant has been awarded to Sara Westergaard, MD, MPH, an assistant clinical professor in the UW–Madison Department of Medicine’s Division of Hospital Medicine.

Dr. Westergaard’s proposal, “Implementation of a Primary Hospital Provider Team to Enhance the Care for High-Need, High-Complexity Patients Requiring Hospitalization,” was selected competitively for its focus on health equity and enhancing the patient experience, its pragmatic research design, and its alignment with UW Health strategic priorities.

Discontinuity of care is common, yet it disproportionately affects high-need, high-complexity (HNHC) patients experiencing poor health outcomes. The awarded project seeks to improve continuity of care for HNHC patients by ensuring that a consistent team of providers–seven physicians and two advanced practice providers–is available to provide inpatient care throughout the year.

Dr. Westergaard’s research will assess fragmentation of care in the readmission process and explore patient, as well as provider, perceptions of care between the new model and existing standard care practice.

Dr. Westergaard’s application hit many hallmarks of an effective LHS proposal by designing it as a pragmatic randomized clinical trial to examine a potential process redesign at UW Health, as well contributing general knowledge to the community on the science of personalized care in hospital medicine.

According to UW Health University Hospital CMO Dr. Ciara Barclay-Buchanan, “The insights gained from this research could guide policy development and best practices, contributing significantly to the broader healthcare community. I am confident this project will provide valuable data that can enhance patient care and operational efficiency, ultimately benefiting patients and healthcare providers alike.”

The award, jointly funded by UW Health and ICTR, provides $150,000 to fund the project over the course of a year.

The purpose of ICTR’s Learning Health System program is to harness evidence-based medicine to overcome inefficiencies in our healthcare delivery to improve patient outcomes, reduce health disparities, increase provider well-being and patient access to care, and close the gap between the translational research enterprise and health system.


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