Harnessing COVID-19 Data Through Collaboration—The Consortium of HCA Healthcare and Academia for Research Generation

What should a health system do when in possession of the largest and most coherent data set that could help accelerate the understanding of COVID-19 and its treatment?For HCA Healthcare, a large health care organization comprised of 185 hospitals and more than 2000 sites of care in 20 US states and the UK, the answer to this question was a matter of social responsibility: harness the potential of this asset through data sharing and research collaborations with public-sector and academic institutions.Although straightforward in concept, this goal was technically and ethically complex.By building on a legacy of multi-institution research partnerships and in conjunction with the Agency for Healthcare Research and Quality (AHRQ), a COVID-19 research consortium known as CHARGE (Consortium of HCA Healthcare and Academia for Research Generation) was rapidly initiated.1 A Framework for Change Since 2006, the learning health system model has provided guiding principles for incorporating evidence into care delivery and harvesting knowledge generated from clinical care.2,3 At HCA Healthcare, this model was pursued through more than a decade of investment in the technical infrastructure for data capture, standardization, storage, and analytics, including data interoperability among disparate electronic health records and other production systems.These efforts have facilitated the use of data from an average of 32 million patient encounters per year for real-time decision support, operational and quality improvement, and research.This commitment to a learning health system also fostered partnerships for health services research at a scale and speed not previously available.The first of these projects, the Randomized Evaluation of Decolonization vs Universal Clearance to Eliminate methicillin-resistant Staphylococcus aureus (REDUCE MRSA) trial, involved nearly 74 000 patients participating in a cluster-randomized comparative effectiveness trial in 44 hospitals.In just 18 months, this study found that universal decolonization of patients in the intensive care unit was associated with a 44% reduction in bloodstream infections.4 Embedding the research protocol within hospitals' routine care delivery processes reduced the overall trial cost and increased staff buy-in during implementation.5 This model has persisted beyond the REDUCE MRSA trial, supporting several other high-impact studies and collaborative projects.[6][7][8] Responding to COVID-19Within this framework, the COVID-19 pandemic provided both an opportunity to further test the model and a challenge for learning from the clinical data.As the pandemic progressed and the patient care burden increased, the amount of data-and questions about treatment-were too vast for a single institution to manage.HCA Healthcare created a curated registry of data during the care of 121 000 inpatients with COVID-19 in 2020 and engaged external partners to collaborate in research, starting with AHRQ.With a legacy of health services research, AHRQ helped guide the development of CHARGE as a long-term collaboration to facilitate external researchers using registry data to expand evidence regarding the best management of COVID-19.