TRANSFORMING THE HEALTHCARE SYSTEM WITH THE BIPOLAR ACTION NETWORK

Background

The system of care for people with bipolar disorder is fragmented and disjointed. Gaps in care are significant: methods of assessment are inconsistent, treatments vary widely and are often not guideline-concordant, and care is poorly coordinated. At a population level, outcomes have not improved in over 20 years, outcomes are not systematically tracked, and patients often have no input in their care design.

Methods

To address these gaps, we designed a Learning Health Network (LHN) for bipolar disorder. LHNs use an organizational architecture that facilitates collaborative, data-driven improvements in population health outcomes. They promote a culture of continuous learning, data sharing, and innovation, with a focus on achieving outcomes that matter to all stakeholders and accelerating the rate of improvement.We used a structured, idealized system co-design process to align diverse stakeholders—patients, families, clinicians, and system leaders—around shared goals and to envision a radically improved future state of care. The Bipolar Action Network design process had four objectives: 1) Build a community by fostering a shared commitment to improving health and well-being among stakeholders, 2) Identify and test changes in care organization to enhance system performance, 3) Develop leaders and cultivate their skills in systems thinking and quality improvement (QI), and 4) Develop a rapid learning system by establishing measures to track the processes and outcomes of bipolar care, and the structures and actions to continuously evaluate and optimize the performance of the system.

Results

We engaged 17 healthcare systems and a design team comprising approximately 50 individuals representing patients, caregivers, clinicians, researchers, and advocacy organizations. The collaborative design processes yielded several outputs: a shared network vision, mission, theory of change documented in Key Driver Diagrams and logic models, an environmental scan of existing evidence and innovations, design concepts, and a patient journey map integrated into a “blueprint” of system changes. Stakeholders prioritized the design concepts based on potential impact and feasibility. We also developed core governance policies, data capture tools, a registry, an online knowledge repository and an evaluation plan. A dashboard was designed to provide network participants with a “common operating picture”, enabling situational awareness and collaborative decision-making. We also began building systems change capacity through quality improvement (QI) training for prospective clinical site leaders and co-production training for participants.

Conclusion

Through a deliberate design process, we established an LHN organization, encompassing collaborative relationships, design, structures, theories, tools, and measurement systems, to transform the system of care and achieve better outcomes for people living with bipolar disorder. This LHN can serve as a prototype to improve outcomes for people with other serious psychiatric disorders.

References

1. Considerations in the Development of Learning Health Networks for Mood Disorders. Lipschitz JM, Adler C, Almeida J, et al. Journal of Affective Disorders. 2025.
2. Nierenberg AA, Margolis P, Strakowski S, Trivedi M, Yatham LN, Bipolar Disorder Learning Health N. A Bipolar Learning Health Network: An innovation whose time has come. Bipolar Disord. May 2023;25(3)