Podcast: A Learning Health Network to Improve Bipolar Outcomes With Andrew Nierenberg, MD

“Psychopharm Today” is a video-podcast series, created collaboratively with the American Society of Clinical Psychopharmacology (ASCP), in which members converse about the latest hot topics in psychopharmacology.

In this episode of “Psychopharm Today,” host Jessica Gannon, MD speaks with Andrew A. Nierenberg, MD, the Thomas P. Hackett, MD, Endowed Chair in Psychiatry at Massachusetts General Hospital (MGH) and director of the Dauten Family Center for Bipolar Treatment Innovation. Most clinicians cannot say how their patients are doing overall. The Bipolar Action Network aims to change that, shared Nierenberg.

He described the network as a learning health network, a model developed at Cincinnati Children's Hospital. In these networks, health care systems share outcomes data and use improvement science to tackle complex conditions.¹ One example is ImproveCareNow, a network of more than 100 clinics caring for about 30,000 young people with inflammatory bowel disease.²

Measuring Outcomes

According to Nierenberg, a health system must first decide whether better patient outcomes are a priority, and then ask whether it knows those outcomes. None of the participating systems did. To limit the burden on patients and clinicians, the network uses the Clinical Global Impression-Severity (CGI-S) scale as its core measure.

The data showed that of the roughly 425 patients with bipolar disorder in Nierenberg's clinic, about 30% are doing well and 70% are not. For patients who are struggling, the network offers structured peer consultation, and the results feed back into a shared database. Members are also adopting previsit planning, which means collecting labs and patient-reported data before an appointment so the clinician has actionable information during the visit.

Experts by Experience

Patients and family members, whom the network calls "experts by experience," help redesign care. Because the network is an actor-oriented organization, any member can test an idea without asking permission. Their projects include a mood-tracking app and a tool that records a patient's medication history.

"They solve the problems we wouldn't even know about," said Nierenberg.

The network holds about 3 learning sessions a year, where members share projects and use plan-do-study-act cycles to test changes. Nierenberg said the strategy is to start small, show better outcomes, and let other sites adopt what works.

Dr Gannon is an associate professor of Psychiatry at the University of Pittsburgh.

Dr Nierenberg is a professor of psychiatry at Harvard Medical School and a psychiatrist at Massachusetts General Hospital.

References

1. Britto MT, Fuller SC, Kaplan HC, et al. Using a network organisational architecture to support the development of learning healthcare systems. BMJ Qual Saf. 2018;27(11):937-946.

2. Crandall WV, Margolis PA, Kappelman MD, et al. Improved outcomes in a quality improvement collaborative for pediatric inflammatory bowel disease. Pediatrics. 2012;129(4):e1030-e1041.