Learning health systems in primary care: a systematic scoping review

BACKGROUND

Learning health systems have been gaining traction over the past decade. The purpose of this study was to understand the spread of learning health systems in primary care, including where they have been implemented, how they are operating, and potential challenges and solutions.

METHODS

We completed a scoping review by systematically searching OVID Medline®, Embase®, IEEE Xplore®, and reviewing specific journals from 2007 to 2020. We also completed a Google search to identify gray literature.

RESULTS

We reviewed 1924 articles through our database search and 51 articles from other sources, from which we identified 21 unique learning health systems based on 62 data sources. Only one of these learning health systems was implemented exclusively in a primary care setting, where all others were integrated health systems or networks that also included other care settings. Eighteen of the 21 were in the United States. Examples of how these learning health systems were being used included real-time clinical surveillance, quality improvement initiatives, pragmatic trials at the point of care, and decision support. Many challenges and potential solutions were identified regarding data, sustainability, promoting a learning culture, prioritization processes, involvement of community, and balancing quality improvement versus research.

CONCLUSIONS

We identified 21 learning health systems, which all appear at an early stage of development, and only one was primary care only. We summarized and provided examples of integrated health systems and data networks that can be considered early models in the growing global movement to advance learning health systems in primary care.

Accelerating learning healthcare system development through embedded research: Career trajectories, training needs, and strategies for managing and supporting embedded researchers

BACKGROUND

Health systems and organizations seeking to achieve learning healthcare system principles are increasingly relying on embedded research teams to optimize delivery of evidence-based, high-quality care that improves patient and staff experience alike. However, building organizational capacity to conduct and benefit from embedded research may be challenging in the absence of clearer guidance on career pathways and training, as well as strategies for managing and supporting this unique workforce.

METHODS

In February 2018, 115 attendees from multiple agencies, institutions and professional societies participated in a conference to accelerate development of learning healthcare systems through embedded research. Workgroups engaged in structured brainstorming discussions of key domains; 21 diverse members focused on strengthening the embedded research community through more explicit development and support of multilevel career trajectories.

RESULTS

Emphasis emerged on the need for training that goes beyond traditional curricula in rigorous scientific methods to include leadership, communication, and other organizational and business skills rarely offered in research training programs. These skills are required for effective engagement of multilevel stakeholders supporting evidence-based changes in routine care. Improving readiness of other stakeholders to effectively act on evidence was noted as equally crucial, as was creation of mid-career development opportunities for researchers and implementers.

CONCLUSIONS

Further development and support of the embedded research workforce will require explicit attention to novel training programs and support of researchers and the stakeholders in the systems they aim to improve.

IMPLICATIONS

Strategies for improving career entry and mastery of skills that foster effective multilevel stakeholder engagement hold promise for strengthening the embedded research community and their contributions to systematic improvements in health and health care.

The Ebola epidemic in West Africa: challenges, opportunities, and policy priority areas

The ongoing Ebola epidemic in West Africa has drawn attention to global health inequalities, in particular the inadequacies of health care systems in sub-Saharan African countries for appropriately managing and containing infectious diseases. The purpose of this article is to examine the sociopolitical and economic conditions that created the environment for the Ebola epidemic to occur, identify challenges to and opportunities for the prevention and control of Ebola and future outbreaks, and discuss policy recommendations and priority areas for addressing the Ebola epidemic and future outbreaks in West Africa. Articles in peer-reviewed journals on health system reforms in developing countries and periodicals of international organizations were used to gather the overview reported in this article. We identify individual, structural, and community challenges that must be addressed in an effort to reduce the spread of Ebola in West Africa. The Ebola epidemic in West Africa underscores the need for the overhaul and transformation of African health care systems to build the capacity in these countries to address infectious diseases. Public-private partnerships for investment in developing countries' health care systems that involve the international community are critical in addressing the current Ebola epidemic and future outbreaks.