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Easterling D, Perry AC, Woodside R, Patel T, Gesell SB. Clarifying the concept of a learning health system for healthcare delivery organizations: Implications from a qualitative analysis of the scientific literature. Learn Health Syst 2022; 6:e10287. [PMID: 35434353 PMCID: PMC9006535 DOI: 10.1002/lrh2.10287] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 07/01/2021] [Accepted: 07/07/2021] [Indexed: 12/21/2022] Open
Abstract
The "learning health system" (LHS) concept has been defined in broad terms, which makes it challenging for health system leaders to determine exactly what is required to transform their organization into an LHS. This study provides a conceptual map of the LHS landscape by identifying the activities, principles, tools, and conditions that LHS researchers have associated with the concept. Through a multi-step screening process, two researchers identified 79 publications from PubMed (published before January 2020) that contained information relevant to the question, "What work is required of a healthcare organization that is operating as an LHS?" Those publications were coded as to whether or not they referenced each of 94 LHS elements in the taxonomy developed by the study team. This taxonomy, named the Learning Health Systems Consolidated Framework (LHS-CF), organizes the elements into five "bodies of work" (organizational learning, translation of evidence into practice, building knowledge, analyzing clinical data, and engaging stakeholders) and four "enabling conditions" (workforce skilled for LHS work, data systems and informatics technology in place, organization invests resources in LHS work, and supportive organizational culture). We report the frequency that each of the 94 elements was referenced across the 79 publications. The four most referenced elements were: "organization builds knowledge or evidence," "quality improvement practices are standard practice," "patients and family members are actively engaged," and "organizational culture emphasizes and supports learning." By dissecting the LHS construct into its component elements, the LHS-CF taxonomy can serve as a useful tool for LHS researchers and practitioners in defining the aspects of LHS they are addressing. By assessing how often each element is referenced in the literature, the study provides guidance to health system leaders as to how their organization needs to evolve in order to become an LHS - while also recognizing that each organization should emphasize elements that are most aligned with their mission and goals.
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Affiliation(s)
- Douglas Easterling
- Department of Social Sciences and Health PolicyWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Anna C. Perry
- Wake Forest Clinical and Translational Science Institute, Wake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Rachel Woodside
- Wake Forest Clinical and Translational Science Institute, Wake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Tanha Patel
- North Carolina Translational and Clinical Sciences InstituteUniversity of North Carolina School of MedicineChapel HillNorth CarolinaUSA
| | - Sabina B. Gesell
- Department of Social Sciences and Health PolicyWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
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Enticott JC, Melder A, Johnson A, Jones A, Shaw T, Keech W, Buttery J, Teede H. A Learning Health System Framework to Operationalize Health Data to Improve Quality Care: An Australian Perspective. Front Med (Lausanne) 2021; 8:730021. [PMID: 34778291 PMCID: PMC8580135 DOI: 10.3389/fmed.2021.730021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/16/2021] [Indexed: 11/13/2022] Open
Abstract
Our healthcare system faces a burgeoning aging population, rising complexity, and escalating costs. Around 10% of healthcare is harmful, and evidence is slow to implement. Innovation to deliver quality and sustainable health systems is vital, and the methods are challenging. The aim of this study is to describe the process and present a perspective on a coproduced Learning Health System framework. The development of the Framework was led by publicly funded, collaborative, Academic Health Research Translation Centres, with a mandate to integrate research into healthcare to deliver impact. The focus of the framework is “learning together for better health,” with coproduction involving leadership by an expert panel, a systematic review, qualitative research, a stakeholder workshop, and iterative online feedback. The coproduced framework incorporates evidence from stakeholders, from research, from data (practice to data and data to new knowledge), and from implementation, to take new knowledge to practice. This continuous learning approach aims to deliver evidence-based healthcare improvement and is currently being implemented and evaluated.
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Affiliation(s)
- Joanne C Enticott
- Southern Synergy, Department of Psychiatry, Monash University, Melbourne, VIC, Australia.,Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia.,Monash Partners Academic Health Science Centre, Clayton, VIC, Australia
| | - Angela Melder
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia.,Monash Partners Academic Health Science Centre, Clayton, VIC, Australia
| | - Alison Johnson
- Monash Partners Academic Health Science Centre, Clayton, VIC, Australia
| | - Angela Jones
- Monash Partners Academic Health Science Centre, Clayton, VIC, Australia
| | - Tim Shaw
- Sydney Health Partners, Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Wendy Keech
- Health Translation South Australia, Adelaide, SA, Australia
| | - Jim Buttery
- Centre for Health Analytics, Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia.,Monash Partners Academic Health Science Centre, Clayton, VIC, Australia
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Enticott J, Johnson A, Teede H. Learning health systems using data to drive healthcare improvement and impact: a systematic review. BMC Health Serv Res 2021; 21:200. [PMID: 33663508 PMCID: PMC7932903 DOI: 10.1186/s12913-021-06215-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/18/2021] [Indexed: 11/15/2022] Open
Abstract
Background The transition to electronic health records offers the potential for big data to drive the next frontier in healthcare improvement. Yet there are multiple barriers to harnessing the power of data. The Learning Health System (LHS) has emerged as a model to overcome these barriers, yet there remains limited evidence of impact on delivery or outcomes of healthcare. Objective To gather evidence on the effects of LHS data hubs or aligned models that use data to deliver healthcare improvement and impact. Any reported impact on the process, delivery or outcomes of healthcare was captured. Methods Systematic review from CINAHL, EMBASE, MEDLINE, Medline in-process and Web of Science PubMed databases, using learning health system, data hub, data-driven, ehealth, informatics, collaborations, partnerships, and translation terms. English-language, peer-reviewed literature published between January 2014 and Sept 2019 was captured, supplemented by a grey literature search. Eligibility criteria included studies of LHS data hubs that reported research translation leading to health impact. Results Overall, 1076 titles were identified, with 43 eligible studies, across 23 LHS environments. Most LHS environments were in the United States (n = 18) with others in Canada, UK, Sweden and Australia/NZ. Five (21.7%) produced medium-high level of evidence, which were peer-reviewed publications. Conclusions LHS environments are producing impact across multiple continents and settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06215-8.
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Affiliation(s)
- Joanne Enticott
- Monash Centre for Health Research and Implementation, Monash University, 43-51 Kanooka Grove, Clayton, VIC, 3168, Australia. .,Monash Partners Academic Health Science Centre, 43-51 Kanooka Grove, Clayton, VIC, 3168, Australia.
| | - Alison Johnson
- Monash Partners Academic Health Science Centre, 43-51 Kanooka Grove, Clayton, VIC, 3168, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, Monash University, 43-51 Kanooka Grove, Clayton, VIC, 3168, Australia. .,Monash Partners Academic Health Science Centre, 43-51 Kanooka Grove, Clayton, VIC, 3168, Australia.
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Enticott J, Braaf S, Johnson A, Jones A, Teede HJ. Leaders' perspectives on learning health systems: a qualitative study. BMC Health Serv Res 2020; 20:1087. [PMID: 33243214 PMCID: PMC7689994 DOI: 10.1186/s12913-020-05924-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 11/15/2020] [Indexed: 12/18/2022] Open
Abstract
Background Integrated utilisation of digital health data has the power to transform healthcare to deliver more efficient and effective services, and the learning health system (LHS) is emerging as a model to achieve this. The LHS uses routine data from service delivery and patient care to generate knowledge to continuously improve healthcare. The aim of this project was to explore key features of a successful and sustainable LHS to inform implementation in an Academic Health Science Centre context. Methods We purposively identified and conducted semi-structured qualitative interviews with leaders, experienced in supporting or developing data driven innovations in healthcare. A thematic analysis using NVivo was undertaken. Results Analysis of 26 interviews revealed five themes thought to be integral in an effective, sustainable LHS: (1) Systematic approaches and iterative, continuous learning with implementation into healthcare contributing to new best-practice care; (2) Broad stakeholder, clinician and academic engagement, with collective vision, leadership, governance and a culture of trust, transparency and co-design; (3) Skilled workforce, capability and capacity building; (4) Resources with sustained investment over time and; (5) Data access, systems and processes being integral to a sustainable LHS. Conclusions This qualitative study provides insights into the elements of a sustainable LHS across a range of leaders in data-driven healthcare improvement. Fundamentally, an LHS requires continuous learning with implementation of new evidence back into frontline care to improve outcomes. Structure, governance, trust, culture, vision and leadership were all seen as important along with a skilled workforce and sustained investment. Processes and systems to optimise access to quality data were also seen as vital in an effective, sustainable LHS. These findings will inform a co-designed framework for implementing a sustainable LHS within the Australian healthcare and Academic Health Science Centre context. It is anticipated that application of these findings will assist to embed and accelerate the use of routine health data to continuously generate new knowledge and ongoing improvement in healthcare delivery and health outcomes.
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Affiliation(s)
- Joanne Enticott
- Monash Centre for Health Research and Implementation, Monash University, 43-51 Kanooka Grove, Clayton, VIC, 3168, Australia. .,Monash Partners Academic Health Science Centre, 43-51 Kanooka Grove, Clayton, VIC, 3168, Australia.
| | - Sandra Braaf
- Monash Partners Academic Health Science Centre, 43-51 Kanooka Grove, Clayton, VIC, 3168, Australia.,School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Alison Johnson
- Monash Partners Academic Health Science Centre, 43-51 Kanooka Grove, Clayton, VIC, 3168, Australia
| | - Angela Jones
- Monash Partners Academic Health Science Centre, 43-51 Kanooka Grove, Clayton, VIC, 3168, Australia
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, Monash University, 43-51 Kanooka Grove, Clayton, VIC, 3168, Australia.,Monash Partners Academic Health Science Centre, 43-51 Kanooka Grove, Clayton, VIC, 3168, Australia
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