The size of the node indicates the number of times a keyword was used. Emerging developments and their implications. Developing a learning health system: insights from a qualitative process evaluation of a pharmacist-led electronic audit and feedback intervention to improve medication safety in primary care. In the relatively small number of included studies where implementation outcomes were measured, studies tended to focus on outcomes related to the early stages of implementation, assessing the feasibility [28,47-54], appropriateness [28,41,44-46,52,54,55], acceptability [28,44-46,52,56], and adoption [28,35,45,46,57,58]. We have identified a more fundamental explanation: the majority of developments in LHS are not identified as LHS. From "Invented here" to "Use it everywhere!": A Learning health system Federal government websites often end in .gov or .mil. Realising the Potential of Learning Health Systems Psek et al [73], for example, interviewed 41 senior leaders across an integrated health delivery system, identifying 10 themes related to operationalizing an LHS, such as balancing learning and workflow and integrating cultural and operational silos. Although not strictly implementation evaluation studies, all 5 studies under this category identified barriers and facilitators relevant to the realization of an LHS, including the usability of systems [71] and time constraints, such as time for participation in quality improvement activities [70]. With a goal of advancing the interdisciplinary area of learning health systems, the journal promotes research, scholarship, and dialogue focused on theory, complex issues, conceptual syntheses . The rise of rapid implementation: a worked example of solving an existing problem with a new method by combining concept analysis with a systematic integrative review. 8600 Rockville Pike Realising the Potential of Primary Health Care - OECD iLibrary Realising the Potential of Primary Health Care | en | OECD All authors provided critical feedback and helped shape the final manuscript. Kunjan K, Doebbeling B, Toscos T. Dashboards to support operational decision making in health centers: a case for role-specific design. Notably, almost three-quarters of the studies were from the United States. 1. Combining lean and applied research methods to improve rigor and efficiency in acute care outcomes research: a case study. During data cleaning, keywords were consolidated in the case of plurals (eg, intervention vs interventions); however, keywords were kept independent in the case of arguably consistent meaning but different phrasing (eg, learning health care system vs learning health system) in order to represent the variability of terms used in the LHS field. Can learning health systems help organisations deliver personalised Mukherjee M, Cresswell K, Sheikh A. Identifying strategies to overcome roadblocks to utilising near real-time healthcare and administrative data to create a Scotland-wide learning health system. We have focused limited attention on the review of service and patient outcomes measured and reported in the included studies, and this warrants further investigation. Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Sydney, 2113, Australia, Phone: 61 298502484, Fax: 61 298502499, learning health systems, learning health care systems, implementation science, evaluation, health system, health care system, empirical research, medical informatics, review. However, at the same time, it is important for a pragmatic approach to be undertaken, in which implementation science frameworks may be used flexibly but pragmatically to guide rapid-cycle design and analysis. Toward rapid learning in cancer treatment selection: an analytical engine for practice-based clinical data. Pannick S, Archer S, Johnston MJ, Beveridge I, Long SJ, Athanasiou T, Sevdalis N. Translating concerns into action: a detailed qualitative evaluation of an interdisciplinary intervention on medical wards. Two other studies outlined the development and application of implementation frameworks specifically for LHSs [31,75]. A summary of the key characteristics of the included studies is presented in Table 2 (also see Multimedia Appendix 1 for details of all included studies). A total of 76 studies were included in this review. Over two-thirds of the studies were concerned with implementing a particular program, system, or platform (53/76, 69.7%) designed to contribute to achieving an LHS. Friedman CP, Allee NJ, Delaney BC, Flynn AJ, Silverstein JC, Sullivan K, Young KA. McWilliams A, Schoen M, Krull C, Bilancia J, Bacon M, Pena E, McCall A, Howard D, Roberge J. The Science of Learning Health Systems: Scoping Review of Empirical Political pressures to implement therapies or technologies with uncertain or little evidence [34], technical challenges and implications for security of patient data [36,37], practical constraints in reconfiguring clinician-patient relationships [36,38], and the ability to meet patient expectations and satisfaction regarding care [39] were also frequently reported barriers. It didnt really say much, and it didnt really help us.: A qualitative study of VA health system evidence needs. Barned C, Dobson J, Stintzi A, Mack D, O'Doherty KC. Making implementation science more rapid: use of the RE-AIM framework for mid-course adaptations across five health services research projects in the Veterans Health Administration. Value-based healthcare strives to achieve the best possible health outcomes [ 1, 2] or the best possible care [ 3] at the lowest cost. Realising the potential of learning health systems Leadership perspectives on operationalizing the learning health care system in an integrated delivery system. Studies that examined implementation outcomes were further reviewed and classified by the 2 authors (LAE and MS) according to 8 implementation outcome categories [23], distinguishing these from service and client outcomes, and with definitions tailored to suit the LHS context (Table 1). This resulted in a focused review of empirical studies rather than a broader and more theoretical (eg, one that included commentaries and opinion pieces) contribution [13,14]. What is a Learning Health System? - Johns Hopkins Berman Institute of This will enrich our understanding of how to make progress toward an LHS. Before Congratulations to Tom Foley and his co-authors on the publication of 'Realising the Potential of Learning Health Systems', from The Health Foundation and Gerrard Cowan on LinkedIn: Realising the Potential of Learning Health Should health care resources be redirected toward implementing new systems whose benefits are not yet empirically proven? Fig. Its precise impact will depend on a variety of factors, such as the mix and importance of different functions, as well as the scale of an industry's revenue (Exhibit 4). They also found that of the empirical evaluations, most suffered from substantial methodological and data limitations. Barba P, Burns LJ, Litzow MR, Juckett MB, Komanduri KV, Lee SJ, Devlin SM, Costa LJ, Khan S, King A, Klein A, Krishnan A, Malone A, Mir MA, Moravec C, Selby G, Roy V, Cochran M, Stricherz MK, Westmoreland MD, Perales M, Wood WA. Taking an implementation science lens, the review aims to map out the empirical research that has been conducted to date, identify limitations, and identify future directions for the field. Primary Schoolers' Response to a Multisensory Serious Game on - PubMed What types of empirical contributions within the LHS domain have been conducted? Although there is a plethora of implementation science theories, models, and frameworks available [22], their use in LHS research remains limited. Franklin P, Chenok K, Lavalee D, Love R, Paxton L, Segal C, Holve E. Framework to guide the collection and use of patient-reported outcome measures in the learning healthcare system. It outlines the benefits of learning health systems and the actions needed to build such systems. Zandi PP, Wang Y, Patel PD, Katzelnick D, Turvey CL, Wright JH, Ajilore O, Coryell W, Schneck CD, Guille C, Saunders EFH, Lazarus SA, Cuellar VA, Selvaraj S, Dill Rinvelt P, Greden JF, DePaulo JR. Development of the National Network of Depression Centers Mood Outcomes Program: a multisite platform for measurement-based care. In another study, Holdsworth et al [46] outlined an adapted rapid assessment procedure (RAP), which incorporates the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework and CFIR implementation science frameworks, and iterative working with stakeholders, as well as rapid team analysis and triangulation of data sources [46]. However, a word of caution is needed. Smith M, Saunders R, Stuckhardt L, McGinnis JM, editors. Notable strengths of this review center on our focus on empirical studies and the adoption of an implementation science lens. Integrating qualitative research methods into care improvement efforts within a learning health system: addressing antibiotic overuse. Glasgow RE, Battaglia C, McCreight M, Ayele RA, Rabin BA. Nilsen P. Making sense of implementation theories, models, and frameworks. Realising the Potential: Integrating Libraries into Adult Education Strategies 14 June 2022 Introduction Libraries are arguably one of the original lifelong learning institutions. This classification system was used to break down studies and separately synthesize information on the study field, setting, population, and study design, as well as implementation determinants and outcomes examined. For 10 (13.2%) of 76 studies, ethics, policy, or governance was the primary focus. Colors represent different topic areas. A framework for value-creating learning health systems The size of the node is indicative of frequency (larger nodes indicate a higher number of papers using the keyword). Geisinger documented its efforts to improve patient-clinician engagement with patient-reported experience measures (PREMS) serving as the primary metric for measuring success, moving Geisinger into closer alignment with the LHS vision [11]. For example, Brown-Johnson et al [18] outlined their qualitative approach and communication tool, the Stanford Lightning Report Method, which, using the coding structure of the CFIR, compared implementation evaluation barriers and enablers across 4 projects to explore the sensitivity of the method and the potential depth and breadth of the method findings. Study protocols, review papers, journal commentaries, and editorials were excluded. The level of evidence was rated medium for 11 (14.5%) quantitative studies with case comparisons or controls and 4 (5.3%) cross-sectional studies with special strengths because they incorporated implementation science frameworks within the design and analysis phases. As the first point of contact, primary health care that provides comprehensive . Summary of key characteristics of the included publications (N=76). The challenge of implementation science application in healthcare practice. For example, the study of Ciemins et al [78] surveyed 4 community-based health systems and found that although engaging clinicians in research is a step toward LHS attainment, infrastructure support and cultural commitment across the health care system are also required. The remaining 23 studies were classified into 1 of 3 key areas: ethics, policies, and governance (10/76, 13.2%); stakeholder perspectives of LHSs (5/76, 6.6%); or LHS-specific research strategies and tools (8/76, 10.5%). Development of the learning health system researcher core competencies. Two academic databases (PubMed and Scopus) were searched using the terms learning health* system* for papers published between January 1, 2016, to January 31, 2021, that had an explicit empirical focus on LHSs. Complexities arise not only from the design of many DHIs, but also from their poor fit with broader system capacities and from the lack of enabling legal frameworks. There is increasing international policy and clinical interest in developing learning health systems and delivering precision medicine, which it is hoped will help reduce variation in the quality and safety of care, improve efficiency, and lead to increasing the personalisation of healthcare. Understanding the roles of three academic communities in a prospective learning health ecosystem for diagnostic excellence. We map out the empirical research that has been conducted to date, identify limitations, and identify future directions for the field. Copyright 2023 The Learning Healthcare Project Powered by Customify. Yet, many health systems, especially in LMICs, still do not have adequate capacity to generate and use the knowledge that they need to be effective. Relevant information was extracted at the full-text review stage using a purpose-designed workbook in Microsoft Excel 365 and included (1) publication details (paper title, year, country of residence of corresponding author, paper type, and paper keywords); (2) primary study focus (thematically coded after data extraction); (3) study context (clinical, hospital, health care system); (4) study design (quantitative, qualitative, mixed methods); (5) study data type (primary or secondary); (6) implementation framework, model, or theory used; and (7) implementation determinants or outcomes examined. In contrast, the Proctor taxonomy of implementation outcomes [23] and RE-AIM [85] are examples of implementation science frameworks that can be applied to evaluate implementation [22]. LHS: learning health system. Embedding in organisational contexts is thus necessary to support 'learning health systems' with locally relevant data and deliberation [106,107,108,109]. Curran GM, Bauer M, Mittman B, Pyne JM, Stetler C. Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact. For this review, we defined an empirical study as one that reports primary or secondary data gathered by means of a specific methodological approach [16]. Mixed-methods studies, including the incorporation of quantitative data from secondary sources and primary qualitative data, incorporate a more robust design for the LHS field, which has traditionally lacked mixed-methods approaches [46]. Sarkies M, Robinson S, Ludwick T, Braithwaite J, Nilsen P, Aarons G, Weiner BJ, Moullin J. Geisinger's effort to realize its potential as a learning health system: a progress report. Papers were included if they were (1) published from January 1, 2016, to January 31, 2021, (2) had an explicit focus on LHSs, and (3) were empirical studies. In particular, the routine use of implementation determinant and outcome frameworks will improve the assessment and reporting of barriers, enablers, and implementation outcomes in this field and will enable comparison and identification of trends across studies. If LHSs are intended to directly improve clinical care delivery, then a comparable evidence standard would be required to demonstrate benefits and reassure decision makers regarding potential unintended consequences [90]. An LHS has been described by the US Institute of Medicine (IoM; now the National Academy of Medicine) as one where science, informatics, incentives, and culture are aligned for enduring continuous improvement and innovation; best practices are seamlessly embedded in the care process; patients and families are active participants in all elements; and new knowledge is captured as an integral by-product of the care experience [7]. Other frameworks for implementing and assessing telemedicine applications, such as the Model for Assessment of Telemedicine (MAST), have also been suggested as having potential applicability in understanding and evaluating the implementation of LHS programs, systems, and platforms [13]. Users can access the training at the Aged Care Quality and Safety Commission's aged care learning information system - Alis. It examines the major challenges facing healthcare, defines a Learning Healthcare System, outlines the building blocks that must be in place to realise it, provided use cases that are already in operation and discusses the longer term implications. These categories of focus are considered separately later. A search strategy was developed by the research team and executed in January 2021. Primary Care - OECD Social conditions that promote clinicians and patients to work together and minimize barriers to patient participation [36,43], promoting respect, trust, relationships, collaboration, and communication among clinicians [44], and constructive and nonpunitive approaches to providing feedback and reducing errors [45] also represented prominent solutions to overcome identified barriers. Empirical evidence standards for the LHS remain unclear at this stage of the fields development. The report Realising the Potential of Primary Health Care, released on 2 June 2020, discusses how primary care needs to evolve to meet the challenges that OECD healthcare systems - and societies more broadly - are facing, and identifying what high performing primary care will look like ten or twenty years from now.The report in particular identifies which countries appear to be at the . Consistent with the LHS review by Enticott et al [26], the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was applied to assess the overall quality of evidence based on the study design [26]. Comprehensive reporting of implementation and evaluation efforts is an important step to moving the LHS field forward. Less commonly studied implementation outcomes were implementation cost (3/16, 18.8%) [28,47,48], fidelity (2/16, 12.5%) [28,46], sustainability (1/16, 6.3%) [35], and penetration (1/16, 6.3%) [46]. Although most studies (n=46, 60.5%) utilized primary data alone, one-third of the studies (n=23, 30.3%) relied on secondary data sets, such as electronic health records and data repositories, and a smaller number (n=7, 9.2%) used both primary and secondary data sets. (Stockport E-Book), The Cost of Sepsis Care in the UK: Final Report, Guidance on implementing the overseas visitor charging regulations, Guidance on investigating cases, clusters and outbreaks of Legionnaires disease: For Public Health England health protection teams, Clinical Commissioning Policy Statement: Nusinersen for genetically confirmed Spinal Muscular Atrophy (SMA) type 1 for eligible patients under the Expanded Access Programme (EAP), Multi-professional framework for advanced clinical practice in England, Pharmaceutical Services Negotiating Committee. Budrionis A, Bellika JG. Realising the potential of Learning Health Systems for Better Care The studies were all qualitative and used either interviews [72-74] or focus groups [70,71]. May 17, 2021 Reports This report offers guidance for building a Learning Health System, focusing on tools, models and frameworks that might be helpful. Novel tools for a learning health system: a combined difference-in-difference/regression discontinuity approach to evaluate effectiveness of a readmission reduction initiative. Safaeinili et al [75] conducted a qualitative study to develop an adapted version of the CFIR that would be more accessible and relevant for assessing barriers and enablers in the context of patient-centered care transformations within an LHS [75]. Comprehensive reporting of implementation and evaluation efforts is an important step in moving the LHS field forward. . Dixon-Woods M, Campbell A, Chang T, Martin G, Georgiadis A, Heney V, Chew S, Van Citters A, Sabadosa KA, Nelson EC. The location of studies was predominantly restricted to high-income countries, with most coming from the United States (n=55, 72.4%), followed by the United Kingdom (n=9, 11.8%), and Canada (n=3, 3.9%). The concept of a learning health system (LHS) was first formally discussed at a Roundtable on Evidence-Based Medicine in 2007 [5]. The systemic potential of networking and collaborations requires new arrangements for governance and agency; and. Over half of the studies (n=42, 55.3%) were quantitative, with just over one-third (n=27, 35.5%) being qualitative studies and a smaller proportion (n=7, 9.2%) being mixed-methods studies. "It feels like a lot of extra work": resident attitudes about quality improvement and implications for an effective learning health care system. Smith M, Vaughan-Sarrazin M, Yu M, Wang X, Nordby P, Vogeli C, Jaffery J, Metlay JP. Learning the Cartesian coordinate system has the potential to promote numerical cognition through number-space associations, as well as core geometric concepts, including isometric transformations, symmetry, and shape perception. More recently, Enticott et al [15] identified 23 LHS environments internationally; most were enabled by digital data gathered by electronic health records.

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