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Pomare C, Mahmoud Z, Vedovi A, Ellis LA, Knaggs G, Smith CL, Zurynski Y, Braithwaite J. Learning health systems: A review of key topic areas and bibliometric trends. Learn Health Syst 2022; 6:e10265. [PMID: 35036549 PMCID: PMC8753300 DOI: 10.1002/lrh2.10265] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The emergent field of learning health systems (LHSs) has been rapidly evolving as the concept continues to be embraced by researchers, managers, and clinicians. This paper reports on a scoping review and bibliometric analysis of the LHS literature to identify key topic areas and examine the influence and spread of recent research. METHODS We conducted a scoping review of LHS literature published between January 2016 and May 2020. The authors extracted publication data (eg, journal, country, authors, citation count, keywords) and reviewed full-texts to identify: type of study (empirical, non-empirical, or review), degree of focus (general or specific), and the reference used when defining LHSs. RESULTS A total of 272 publications were included in this review. Almost two thirds (65.1%) of the included articles were non-empirical and over two-thirds (68.4%) were from authors in the United States. More than half of the publications focused on specific areas, for example: oncology, cardiovascular care, and genomic medicine. Other key topic areas included: ethics, research, quality improvement, and electronic health records. We identified that definitions of the LHS concept are converging; however, many papers focused on data platforms and analytical processes rather than organisational and behavioural factors to support change and learning activities. CONCLUSIONS The literature on LHSs remains largely theoretical with definitions of LHSs focusing on technical processes to reuse data collected during the clinical process and embedding analysed data back into the system. A shift in the literature to empirical LHS studies with consideration of organisational and human factors is warranted.
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Affiliation(s)
- Chiara Pomare
- Australian Institute of Health InnovationMacquarie UniversitySydneyAustralia
| | - Zeyad Mahmoud
- Australian Institute of Health InnovationMacquarie UniversitySydneyAustralia
| | - Alex Vedovi
- Australian Institute of Health InnovationMacquarie UniversitySydneyAustralia
- Partnership Center for Health System SustainabilityMacquarie UniversitySydneyAustralia
| | - Louise A. Ellis
- Australian Institute of Health InnovationMacquarie UniversitySydneyAustralia
- Partnership Center for Health System SustainabilityMacquarie UniversitySydneyAustralia
| | - Gilbert Knaggs
- Australian Institute of Health InnovationMacquarie UniversitySydneyAustralia
- Partnership Center for Health System SustainabilityMacquarie UniversitySydneyAustralia
| | - Carolynn L. Smith
- Australian Institute of Health InnovationMacquarie UniversitySydneyAustralia
- Partnership Center for Health System SustainabilityMacquarie UniversitySydneyAustralia
| | - Yvonne Zurynski
- Australian Institute of Health InnovationMacquarie UniversitySydneyAustralia
- Partnership Center for Health System SustainabilityMacquarie UniversitySydneyAustralia
| | - Jeffrey Braithwaite
- Australian Institute of Health InnovationMacquarie UniversitySydneyAustralia
- Partnership Center for Health System SustainabilityMacquarie UniversitySydneyAustralia
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Shuman AG, Gornick MC, Brummel C, Kent M, Spector-Bagdady K, Biddle E, Bradford CR, Brenner JC. Patient and Provider Perspectives Regarding Enrollment in Head and Neck Cancer Research. Otolaryngol Head Neck Surg 2019; 162:73-78. [PMID: 31818193 DOI: 10.1177/0194599819889976] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The advent of precision oncology complicates how clinicians and participants understand how clinical care and research interface. Here we examine how key stakeholders perceive the utility of, and evaluate the decision to participate in, genomic sequencing head and neck cancer research. The goal of this study was to highlight unique considerations for our community as this type of research proliferates across the country. STUDY DESIGN Prospective multimethod qualitative and quantitative embedded ethics protocol. SETTING Single-institution National Cancer Institute-designated academic cancer center. SUBJECTS AND METHODS Multimethod study using paired surveys and semistructured interviews among patients and providers involved in a prospective precision head and neck oncology sequencing protocol (116 survey patient-participants, response rate 82%) with 18 interviewees. RESULTS Participants were generally enthusiastic about enrollment in research, both to help future patients and as a way of giving back to the community. They described reliance on information from and trust in their cancer doctor regarding the decision to participate in research, but paradoxically there was discordance in how doctors and patients reported their respective influence in the decision-making process. Clinicians also stressed the importance in separating clinical and research-informed consent processes, although patients did not describe this tension. CONCLUSION As we enter an era of increasing personalized medicine and targeted therapies, the relationship between clinicians, scientists, and patients plays a larger role in how we individualize and contextualize cancer research. Our data are another step toward the ultimate goal of respecting and protecting patients as participants in head and neck translational oncology.
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Affiliation(s)
- Andrew G Shuman
- Department of Otolaryngology-Head and Neck Surgery, Medical School, University of Michigan, Ann Arbor, Michigan, USA.,Center for Bioethics and Social Sciences in Medicine, Medical School, University of Michigan, Ann Arbor, Michigan, USA.,Michigan Otolaryngology and Translational Oncology Laboratory, Medical School, University of Michigan, Ann Arbor, Michigan, USA.,University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, USA
| | - Michele C Gornick
- Center for Bioethics and Social Sciences in Medicine, Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Collin Brummel
- Department of Otolaryngology-Head and Neck Surgery, Medical School, University of Michigan, Ann Arbor, Michigan, USA.,Michigan Otolaryngology and Translational Oncology Laboratory, Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Madison Kent
- Center for Bioethics and Social Sciences in Medicine, Medical School, University of Michigan, Ann Arbor, Michigan, USA.,Michigan Otolaryngology and Translational Oncology Laboratory, Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Kayte Spector-Bagdady
- Center for Bioethics and Social Sciences in Medicine, Medical School, University of Michigan, Ann Arbor, Michigan, USA.,Department of Obstetrics and Gynecology, Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Elliot Biddle
- Michigan Otolaryngology and Translational Oncology Laboratory, Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery, Medical School, University of Michigan, Ann Arbor, Michigan, USA.,Michigan Otolaryngology and Translational Oncology Laboratory, Medical School, University of Michigan, Ann Arbor, Michigan, USA.,University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, USA
| | - J Chad Brenner
- Department of Otolaryngology-Head and Neck Surgery, Medical School, University of Michigan, Ann Arbor, Michigan, USA.,Michigan Otolaryngology and Translational Oncology Laboratory, Medical School, University of Michigan, Ann Arbor, Michigan, USA.,University of Michigan Rogel Cancer Center, Ann Arbor, Michigan, USA
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Spector-Bagdady K, Prince A, Yu JH, Appelbaum PS. Analysis of state laws on informed consent for clinical genetic testing in the era of genomic sequencing. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2018; 178:81-88. [PMID: 29566453 PMCID: PMC5994926 DOI: 10.1002/ajmg.c.31608] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 02/08/2018] [Accepted: 02/13/2018] [Indexed: 12/18/2022]
Abstract
This article assesses the adequacy of informed consent to clinical genetic testing laws based on an examination of 15 states with institutions that had been involved in a National Institutes of Health-supported Clinical Sequencing Exploratory Research Consortium project. We identified relevant statutory provisions through a legal search engine and included statutes that describe the informed consent requirements for clinical genetic testing and/or the protections for genetic material, information, or data. We found that statutory definitions were often limited in problematic ways, such as focusing only on variants known to be associated with disease or negative health effects or associated with asymptomatic disease. Some statutes required complex levels of detail if applied to genomic technologies and set confusing disclosure standards for current use and future access. Others had exceptions from informed consent requirements for future research use, limited requirements for the destruction of specimens as opposed to derived data, or linked key definitional components to the evolving concept of "identifiability." Further reform and research are needed to ensure that state law protections advance as rapidly as the science they aspire to enable.
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Affiliation(s)
- Kayte Spector-Bagdady
- Prof. Kayte Spector-Bagdady, JD, MBE, is an Assistant Professor in the Department of Obstetrics and Gynecology and Chief of the Research Ethics Service under the Center for Bioethics & Social Sciences in Medicine at the University of Michigan Medical School
| | - Anya Prince
- Prof. Anya Prince, JD, MPP, is an Associate Professor of Law at the University of Iowa College of Law and Member of the University of Iowa Genetics Cluster
| | - Joon-Ho Yu
- Dr. Joon-Ho Yu MPH, PhD, is a Research Assistant Professor in the Division of Genetic Medicine and Division of Bioethics in the Department of Pediatrics at the University of Washington and a member of the Treuman Katz Center for Pediatric Bioethics
| | - Paul S. Appelbaum
- Dr. Paul S. Appelbaum, MD is the Elizabeth K. Dollard Professor of Psychiatry, Medicine and Law, and the Director of the Center for Law, Ethics and Psychiatry, in the College of Physicians and Surgeons at Columbia University
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