Using a Learning Health System to Improve Physical Therapy Care for Patients with Intermittent Claudication: Lessons Learned from the ClaudicatioNet Quality System.

Routinely collected outcomes data can be used to improve physical therapy care through benchmarking, personalization, continued education, and treatment optimization. In this article, we describe how we created a nationwide infrastructure to routinely collect data from daily practice and how we utilized these data through a support system (called the ClaudicatioNet Quality system) to improve physical therapy care for patients with intermittent claudication in the Netherlands. ClaudicatioNet is a nationwide network of 2100 specialized physical therapists, providing high-quality supervised exercise therapy in combination with lifestyle counseling. The ClaudicatioNet Quality system utilizes a large national registry in which specific relevant health outcomes have been routinely collected since 2015. These data have then been used in turn to assess quality of care and provide transparency to therapists and other stakeholders. The Quality system is intended to serve as a learning health system, to support continuous learning at the therapist, practice, and network level. In our approach, we provide individual patients and physical therapists opportunities to personalize, benchmark, and evaluate (and possibly alter) a treatment plan using routinely collected data from historical patients. In this article, the Quality system is described based on the essential elements of a learning health system. We also describe the challenges and lessons learned in developing the Quality system.