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.
Numerous studies have shown that salicylates markedly alter metabolism, enzymic activity, and cell growth (1 -5). In both human erythrocytes (6) and molluscan neurones (7), salicylate increases the permeability of the cell membrane to K+ ion; in the latter study it was shown that salicylate simultaneously lowered the permeability to chloride ion. In the neuronal studies (7), these changes resulted in an increased potential difference across the cell membrane and the authors postulated that salicylate analgesia may result from an impaired ability of the neurone to conduct impulses along the hyperpolarized cell.The present paper deals with the metabolic and membrane effects of salicylic acid on commercial baker's yeast. While corroborating earlier studies (2) of the inhibitory effects of the compound on glucose metabolism, we present new information that salicylic acid increases endogenous fermentation and causes a leakage of K+ ions from the cells. The first and last mentioned effects are reversed by washing the cells free of salicylic acid.Methods. Experiments were done on suspensions of nongrowing baker's yeast as reported earlier (8). Suspensions were maintained at appropriate pH by use of a trissuccinate-tartrate (TST) buffer consisting of equimolar concentrations of succinic and tartaric acids adjusted to pH with tris-hydroxymethylaminomethane. With the exception of the experiment shown in Fig. 3, no K+ was added to the experiment. Any K+ found in the medium came through release of this ion by the cells. In all experiments, nitrogen gas was used to maintain anaerobic conditions and to keep suspensions from settling. K+ efflux experiments were done via a modification of the cell column technique of Rothstein and Bruce (9); in our experiments we replaced the sintered glass filters used by these investiga-tors with a 0.45-pm microfilter 47 mm in diameter. Eluting fluid was forced through the yeast column under 5-6 psi of nitrogen. Gas exchange was measured via standard manometric techniques. Experiments were conducted at 30" or 6".Estimations of glucose in diluted, filtered suspending medium were made either by means of a commercial glucose oxidase preparation (Worthington Biochemical Corp.) or the reducing sugar method of Nelson (10). Alcohol was determined quantitatively by use of a commercial alcohol dehydrogenase preparation (Worthington) and was identified as ethyl alcohol through gas chromatography.' K+ in the medium, a measure of K+ lost from the cell, was determined on filtrates of cell suspensions through direct flame photometry. Yeast concentrations are expressed in milligrams wet weight of cells per milliliter of suspension. For convenience, the total concentration of the salicylate-salicylic acid will be referred to in the text as "salicylate." Through calculation, the actual concentrations of the two species can be determined in each case from total "salicylate" concentration, the pH and the pK, of salicylic acid (3.0).Results. In Table I are shown the effects of 5 mM salicylate on glucose utilizati...
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IntroductionThe learning health system (LHS) concept represents a bold innovation that combines organizational learning, strategic analysis of patient data, stakeholder engagement and the systematic translation of research into practice – all in service of improving the quality of health care delivered across the organization. This innovation has been diffused and widely adopted by healthcare organizations over the past 15 years, but academic health centers (AHCs) have been slower on the uptake. The irony is that AHCs have the resources (e.g., trained researchers, sophisticated clinical data systems, informatics infrastructure) that are necessary to do the highest‐quality and most impactful LHS work.MethodsBased on a review of publications describing how AHCs have implemented LHS work, as well as the authors' direct experience promoting the adoption of the LHS paradigm at Atrium Health Wake Forest Baptist (AHWFB), we:identify a set of factors that have inhibited broader adoption of the LHS paradigm among AHCs; distinguish between the forms of LHS work that are consistent and inconsistent with the mission of AHCs; and offer recommendations for broader adoption and fuller implementation of the LHS paradigm.ResultsThe LHS paradigm represents an expansion of the scientific paradigm which serves as the foundation of research enterprise within AHCs. Both paradigms value rigorous studies of new treatments and practices, including pragmatic clinical trials. The LHS paradigm also places a high value on quality improvement studies, organizational learning, and the translation of research findings into improved patient care and operations within the local health system. The two paradigms differ on the origin of the research question, i.e., a pressing patient‐care issue facing the health system versus the investigator's own research interests. Academic researchers have been disincentivized from pursuing at least some forms of LHS research. However, a growing number of AHCs are finding ways to integrate the LHS paradigm into their research enterprise, either by providing research faculty with institutional funding to cover their effort on studies that address the health system's priority issues, or by establishing an institute dedicated to LHS research.ConclusionsThe LHS paradigm is a disruptive intervention for AHCs, one that was initially resisted but is increasingly being embraced. AHCs are developing strategies for conducting LHS research, typically in parallel to the more traditional biomedical science that is core to academic medicine. Full implementation of the LHS paradigm will require further alignment between LHS and science, including a shift in the criteria for promotion and tenure to support those researchers who choose to focus on the pressing issues facing the health system.
OBJECTIVES/GOALS: The LHS concept has been promoted as a means for health systems to improve quality, safety, efficiency and equity. NAMs definition has been widely adopted, but is broad and has led to variation in how LHS is operationalized. Drawing on a taxonomy developed through a review of literature, we developed a tool that shows how LHSs are implemented in practice. METHODS/STUDY POPULATION: The LHS Implementation Assessment Tool (LHS-IAT) will indicate which forms of work are being carried out by a health system that purports to operate a LHS. LHS-IAT is based on the LHS Consolidated Framework (LHS-CF); which was developed through a qualitative analysis of LHS literature. LHS-CF contains 38 primary elements’ and 56 secondary elements’ that have been associated with the LHS construct. These elements are organized into 5 bodies of work• (e.g.; translating evidence into practice) and 4 enabling conditions• (e.g.; supportive culture). LHS-IAT assesses whether a health system operating as an LHS is implementing each of the key elements in LHS-CF. The usefulness of LHS-IAT will be demonstrated by applying the tool to 5 LHSs that have been described in the literature. RESULTS/ANTICIPATED RESULTS: LHS-IAT produces a quantitative profile for any given health system operating as a LHS; each LHS element is assessed as either emphasized; otherwise present; or absent. With this information, we create profiles for each implementation of LHS, using spider graphs. Systems that emphasize different elements will have different shapes for their spider graphs. Based on our initial coding of publications, we expect at least 4 distinct profiles within our sample, reflecting differences in emphasis on factors such as: continuous improvement practices, adoption of internally and externally tested interventions, research conducted to address patient care issues prioritized by institutional leaders, investigator-initiated research, clinician-engaged research, and engagement of patients and families. DISCUSSION/SIGNIFICANCE: The LHS-IAT will show differences in how health systems are translating the LHS concept into practice. This will allow for a shared language for those studying and/or implementing LHS. With the ability to map out an approach, health system leaders will have a tool to clarify intent and gain consensus as to which LHS model they want to implement and invest in.
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