1
|
Annaswamy TM, Grover P, Douglas NF, Poploski KM, Anderson CA, Clark MA, Flores AM, Hafner BJ, Hoffman JM, Kinney AR, Ressel K, Sánchez J, Whitten MJ, Resnik L, McDonough CM. Relevance of learning health systems to physiatrists and its synergy with implementation science: A commentary. PM R 2024. [PMID: 38967539 DOI: 10.1002/pmrj.13213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 01/17/2024] [Accepted: 02/25/2024] [Indexed: 07/06/2024]
Abstract
As health care attempts to bridge the gap between evidence and practice, the concept of the learning health system (LHS) is becoming increasingly relevant. LHS integrates evidence with health systems data, driving health care quality and outcomes through updates in policy, practice, and care delivery. In addition, LHS research is becoming critically important as there are several initiatives underway to increase research capacity, expertise, and implementation, including attempts to stimulate increasing numbers of LHS researchers. Physical Medicine & Rehabilitation (PM&R) physicians (physiatrists), nurses, therapists (physical therapists, occupational therapists, speech therapists, clinical psychologists), and scientists are affiliated with LHSs. As LHS research expands in health care systems, better awareness and understanding of LHSs and LHS research competencies are key for rehabilitation professionals including physiatrists. To address this need, the Agency of Healthcare Research and Quality (AHRQ) identified 33 core competencies, grouped into eight domains, for training LHS researchers. The domains are: (1) Systems Science; (2) Research Questions and Standards of Scientific Evidence; (3) Research Methods; (4) Informatics; (5) Ethics of Research and Implementation in Health Systems; (6) Improvement and Implementation Science; (7) Engagement, Leadership, and Research Management; and the recently added (8) Health and Healthcare Equity and Justice. The purpose of this commentary is to define LHS and its relevance to physiatrists, present the role of implementation science (IS) in LHSs and application of IS principles to design LHSs, illustrate current LHS research in rehabilitation, and discuss potential solutions to improve awareness and to stimulate interest in LHS research and IS among physiatrists in LHSs.
Collapse
Affiliation(s)
- Thiru M Annaswamy
- Department of Physical Medicine & Rehabilitation, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Prateek Grover
- Department of Physical Medicine & Rehabilitation, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Natalie F Douglas
- Department of Communication Sciences and Disorders, The Herbert H. and Grace A. Dow College of Health Professions, Central Michigan University, Mount Pleasant, Michigan, USA
| | - Kathleen M Poploski
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Catherine A Anderson
- Department of Counseling, Rehabilitation and Human Services, College of Education, Hospitality, Health and Human Sciences, University of Wisconsin, Stout, Wisconsin, USA
| | - Melissa A Clark
- Departments of Health Services Policy and Practice and Obstetrics and Gynecology, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Ann Marie Flores
- Departments of Physical Therapy and Human Movement Sciences and Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois, USA
| | - Brian J Hafner
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Jeanne M Hoffman
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Adam R Kinney
- VA Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC), Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
| | - Kristin Ressel
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jennifer Sánchez
- Department of Counselor Education, College of Education, Florida Atlantic University, Boca Raton, Florida, USA
| | - Margarite J Whitten
- Departments of Health Services Policy and Practice and Obstetrics and Gynecology, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Linda Resnik
- Departments of Health Services Policy and Practice and Obstetrics and Gynecology, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Christine M McDonough
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
2
|
Kogan J, Eichner J, Simhan H, Dalton E, Jutca A, Quinn B, Chaney J, Patterson A, Keyser D. Leveraging data to support health equity in an integrated delivery and finance system. Learn Health Syst 2024; 8:e10423. [PMID: 38883869 PMCID: PMC11176591 DOI: 10.1002/lrh2.10423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 03/25/2024] [Accepted: 04/03/2024] [Indexed: 06/18/2024] Open
Abstract
Introduction To accelerate healthcare transformation and advance health equity, scientists in learning health systems (LHSs) require ready access to integrated, comprehensive data that includes information on social determinants of health (SDOH). Methods We describe how an integrated delivery and finance system leveraged its learning ecosystem to advance health equity through (a) a cross-sector initiative to integrate healthcare and human services data for better meeting clients' holistic needs and (b) a system-level initiative to collect and use patient-reported SDOH data for connecting patients to needed resources. Results Through these initiatives, we strengthened our health system's capacity to meet diverse patient needs, address health disparities, and improve health outcomes. By sharing and integrating healthcare and human services data, we identified 281 000 Shared Services Clients and enhanced care management for 100 adult Medicaid/Special Needs Plan members. Over a 1-year period, we screened 9173 (37%) patients across UPMC's Women's Health Services Line and connected over 700 individuals to social services and supports. Conclusions Opportunities exist for LHSs to improve, expand, and sustain their innovative data practices. As learnings continue to emerge, LHSs will be well positioned to accelerate healthcare transformation and advance health equity.
Collapse
Affiliation(s)
- Jane Kogan
- UPMC Insurance Services Division and UPMC Center for High-Value Health Care Pittsburgh Pennsylvania USA
| | - Joan Eichner
- UPMC Insurance Services Division and UPMC Center for Social Impact Pittsburgh Pennsylvania USA
| | - Hyagriv Simhan
- Department of Obstetrics, Gynecology and Reproductive Sciences University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA
- UPMC Magee Womens Hospital Pittsburgh Pennsylvania USA
| | - Erin Dalton
- Allegheny County Department of Human Services Pittsburgh Pennsylvania USA
| | - Alex Jutca
- Allegheny County Department of Human Services Pittsburgh Pennsylvania USA
| | - Beth Quinn
- UPMC Magee Womens Hospital Pittsburgh Pennsylvania USA
| | | | - Anna Patterson
- UPMC Insurance Services Division and UPMC Center for High-Value Health Care Pittsburgh Pennsylvania USA
| | - Donna Keyser
- UPMC Insurance Services Division and UPMC Center for High-Value Health Care Pittsburgh Pennsylvania USA
| |
Collapse
|
3
|
Somerville M, Cassidy C, Curran JA, Johnson C, Sinclair D, Elliott Rose A. Implementation strategies and outcome measures for advancing learning health systems: a mixed methods systematic review. Health Res Policy Syst 2023; 21:120. [PMID: 38012681 PMCID: PMC10680228 DOI: 10.1186/s12961-023-01071-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 11/09/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Learning health systems strive to continuously integrate data and evidence into practice to improve patient outcomes and ensure value-based healthcare. While the LHS concept is gaining traction, the operationalization of LHSs is underexplored. OBJECTIVE To identify and synthesize the existing evidence on the implementation and evaluation of advancing learning health systems across international health care settings. METHODS A mixed methods systematic review was conducted. Six databases (CINAHL, Embase, Medline, PAIS, Scopus and Nursing at Allied Health Database) were searched up to July 2022 for terms related to learning health systems, implementation, and evaluation measures. Any study design, health care setting and population were considered for inclusion. No limitations were placed on language or date of publication. Two reviewers independently screened the titles, abstracts, and full texts of identified articles. Data were extracted and synthesized using a convergent integrated approach. Studies were critically appraised using relevant JBI critical appraisal checklists. RESULTS Thirty-five studies were included in the review. Most studies were conducted in the United States (n = 21) and published between 2019 and 2022 (n = 24). Digital data capture was the most common LHS characteristic reported across studies, while patient engagement, aligned governance and a culture of rapid learning and improvement were reported least often. We identified 33 unique strategies for implementing LHSs including: change record systems, conduct local consensus discussions and audit & provide feedback. A triangulation of quantitative and qualitative data revealed three integrated findings related to the implementation of LHSs: (1) The digital infrastructure of LHSs optimizes health service delivery; (2) LHSs have a positive impact on patient care and health outcomes; and (3) LHSs can influence health care providers and the health system. CONCLUSION This paper provides a comprehensive overview of the implementation of LHSs in various healthcare settings. While this review identified key implementation strategies, potential outcome measures, and components of functioning LHSs, further research is needed to better understand the impact of LHSs on patient, provider and population outcomes, and health system costs. Health systems researchers should continue to apply the LHS concept in practice, with a stronger focus on evaluation.
Collapse
Affiliation(s)
| | - Christine Cassidy
- Faculty of Health, School of Nursing, Dalhousie University, Halifax, NS, Canada
| | | | | | | | | |
Collapse
|