An attending physician within the Therapeutics Committee oversees all required adverse event reporting to the FDA. for any tradition of learning while performing. performing . With this model, we optimise the trade-off between learning and performing where little to no sacrifice is made to the conditions of high-quality study yet priority care is ensured to all patients within the system. Indeed, this approach expands the reach of strong learning while performing to many private hospitals and healthcare settings often excluded from randomized tests. During the pandemic, our large, integrated healthcare system in the US approached treatment of individuals with COVID-19 with two goals: i.) enhancing access to treatment, no matter geography and socioeconomic status, and ii.) coordinating treatment through an integrated, adaptive platform trial. To accomplish these goals, clinician engagement was paramount. In addition, success required management investment, a strong data and analytics infrastructure, and therapeutics oversight via system-level treatment recommendations with local collaboration. 4.?Initial experience with monoclonal antibody treatment and expanding individual access Prior to the launch of the adaptive WP1066 platform trial, we designed a strong outpatient infusion infrastructure across a large geographical region in western Pennsylvania and New York. The supply of mAb changed over time. Initially, treatment was only bamlanivimab monotherapy and mAb was only available at outpatient infusion centers [5,12]. After evaluating the evidence, the System COVID-19 Therapeutics Committee identified equivalence WP1066 existed among the available mAbs. The Committee used a restorative interchange policy for mAb distribution in December 2020 and updated it with growing data and federal guidance, first including bamlanivimab monotherapy, bamlanivimab and etesevimab, and casirivimab and imdevimab. Bamlanivimab monotherapy was removed from the policy on March 31, 2021.Bamlanivimab and etesevimab enrollment was paused from June 25 through WP1066 September WP1066 16, 2021 due to federal decisions to temporarily halt distribution based on prevalence of variants of concern (i.e., Beta and Gamma) during that time period. Sotrovimab was added to the platform on July 13, 2021 after initial supply was donated to the system by the manufacturer specifically for use in the trial; this was later on transitioned to government-purchased supply allocated via federal Health and Human being Solutions distribution channels. All pharmacies supplying all infusion sites WP1066 experienced equal opportunity to order any EUA-available mAb from a central supply facility. 5.?Starting a platform trial of monoclonal antibodies for COVID-19 in 21?days We held a collaborative conversation with the US government on February 17th, 2021 about increasing mAb access (Do) while simultaneously addressing the knowledge gaps surrounding mAb treatment (Learn). Subsequently, we designed and implemented a pragmatic, open-label, adaptive platform trial integrated with our ongoing, systemwide mAb attempts. This comparative performance evaluation was possible due to preceding placebo-controlled tests confirming the benefits and security of mAb therapy. The goal was to design an entire system, including outreach, learning, and quick implementation. The 1st individual was allocated mAb within the trial on March 10th, 2021, just 21?days later. Monoclonal antibody access was expanded from outpatient infusion centers to all system EDs on March 23, 2021. We undertook several additional methods to expand consciousness and increase the use of mAb therapy across our region. A paper/fax referral process existed for clinicians outside of the health system, including rural clinicians in neighboring says. To reach disadvantaged neighborhoods and patients with limited access to health care, we created a telephone hotline staffed by nurses for patient self-referrals. Using a collaborative relationship with a home infusion company, patients without transportation could receive treatment at home or be transported to an infusion center (at no cost to the patient). Proactively, we identified all patients with a positive SARS-CoV-2 ITM2A polymerase chain reaction (PCR), or rapid antigen test performed within the system who also met EUA criteria using an EHR-derived screening dashboard. These patients were subsequently called at home by a member of the centralized mAb operations team to assess for symptoms, offer mAb information, and place a mAb referral order (if appropriate). We also educated patients about vaccination during these phone encounters. To further alleviate patient access issues, we created a team of Revenue Cycle analysts to work with all major payors to improve patient cost transparency. 6.?The OPTIMISE-C19 platform trial The OPTIMISE-C19 (Optimizing Treatment and Impact of Monocolonal Antibodies through Evaluation for COVID-19) trial launched on March 10, 2021. This trial was approved by the University of Pittsburgh IRB (STUDY21020179) and UPMC Quality Improvement Review Committee (Project ID 3280) and is listed on ClinicalTrials.gov (“type”:”clinical-trial”,”attrs”:”text”:”NCT04790786″,”term_id”:”NCT04790786″NCT04790786). OPTIMISE-C19 evaluates the mAb therapeutic interchange policy and patient outcomes. It.