Introduction:The Learning Health Care System (LHCS) model seeks to utilize sophisticated technologies and competencies to integrate clinical operations, research and patient participation in order to continuously generate knowledge, improve care, and deliver value. Transitioning from concept to practical application of an LHCS presents many challenges but can yield opportunities for continuous improvement. There is limited literature and practical experience available in operationalizing the LHCS in the context of an integrated health system. At Geisinger Health System (GHS) a multi-stakeholder group is undertaking to enhance organizational learning and develop a plan for operationalizing the LHCS system-wide. We present a framework for operationalizing continuous learning across an integrated delivery system and lessons learned through the ongoing planning process.Framework:The framework focuses attention on nine key LHCS operational components: Data and Analytics; People and Partnerships; Patient and Family Engagement; Ethics and Oversight; Evaluation and Methodology; Funding; Organization; Prioritization; and Deliverables. Definitions, key elements and examples for each are presented. The framework is purposefully broad for application across different organizational contexts.Conclusion:A realistic assessment of the culture, resources and capabilities of the organization related to learning is critical to defining the scope of operationalization. Engaging patients in clinical care and discovery, including quality improvement and comparative effectiveness research, requires a defensible ethical framework that undergirds a system of strong but flexible oversight. Leadership support is imperative for advancement of the LHCS model. Findings from our ongoing work within the proposed framework may inform other organizations considering a transition to an LHCS.

Introduction:Healthcare leaders need operational strategies that support organizational learning for continued improvement and value generation. The learning health system (LHS) model may provide leaders with such strategies; however, little is known about leaders’ perspectives on the value and application of system-wide operationalization of the LHS model. The objective of this project was to solicit and analyze senior health system leaders’ perspectives on the LHS and learning activities in an integrated delivery system.Methods:A series of interviews were conducted with 41 system leaders from a broad range of clinical and administrative areas across an integrated delivery system. Leaders’ responses were categorized into themes.Findings:Ten major themes emerged from our conversations with leaders. While leaders generally expressed support for the concept of the LHS and enhanced system-wide learning, their concerns and suggestions for operationalization where strongly aligned with their functional area and strategic goals.Discussion:Our findings suggests that leaders tend to adopt a very pragmatic approach to learning. Leaders expressed a dichotomy between the operational imperative to execute operational objectives efficiently and the need for rigorous evaluation. Alignment of learning activities with system-wide strategic and operational priorities is important to gain leadership support and resources. Practical approaches to addressing opportunities and challenges identified in the themes are discussed.Conclusion:Continuous learning is an ongoing, multi-disciplinary function of a health care delivery system. Findings from this and other research may be used to inform and prioritize system-wide learning objectives and strategies which support reliable, high value care delivery.

We identified a set of polices related to high HPV vaccine uptake. Future studies should examine how these policies and others, individually and in combination, are associated with HPV vaccine uptake. Public Health Implications. This study provides insight into what sets of policies are consistently related to high HPV vaccine uptake.

A sthma is a prevalent chronic disease that is associated with substantial morbidity, health care utilization, and cost [1][2][3]. Both the US Department of Health and Human Services and the Centers for Disease Control and Prevention recognize that surveillance of population-level trends in prevalence, health care utilization, and morbidity can support efforts to plan for and reduce the consequences of asthma [3][4][5]. Currently, national estimates of asthma prevalence and health care utilization allow comparisons across states and regions [6][7][8] but cannot be used by states to support more targeted efforts to reduce the burden of asthma.The North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) collects statewide population data on all emergency department (ED) visits [9,10]. ED visits are critical to asthma surveillance, because they may identify preventable asthma exacerbations and because they may be the occasion for implementation of evidence-based public health interventions that can support state and local efforts to improve asthma control [11][12][13]. Using 2008 NC DETECT data, we examine statewide patterns of ED use in North Carolina for asthma, both overall and by age, sex, geography, insurance status, and month (seasonality). We also identify patterns of frequent use of the ED for asthma treatment. Methods Data SourcesWe used NC DETECT [10] to identify all visits to civilian, acute care, hospital-affiliated EDs in North Carolina made by residents of the state during 2008. While analysis focuses on ED visits made by NC residents during 2008, additional NC DETECT data was used to identify additional ED visits made by the patients between December 1, 2007 and December 31, 2009. NC DETECT received data for an estimated 99.5% of all ED visits in the state that year. We used county-level population estimates for 2008 from the North Carolina Office of State Budget and Management [14]. Our estimate of the percentage of North Carolina residents who were uninsured in 2008 comes from Current Population Survey data [15]. MeasuresAsthma ED visits. We defined asthma ED visits as visits with an ICD-9-CM code of asthma (493.xx) as the first or second diagnosis, a strategy supported by our analysis of NC DETECT visit data (abstract under review). With the NC DETECT data, we were able to link visits made by an individual to the same facility, but not visits made by an individual to different facilities, because there is no common patient identifier used by all facilities. We began by prospectively counting the number of asthma ED visits made by each patient to the same facility during the 365 days following his