A Call to Improve Health by Achieving the Learning Health Care System

Collard, Harold R.; Grumbach, Kevin

doi:10.1097/acm.0000000000004949

Cited by 6 publications

(8 citation statements)

References 13 publications

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“…[1][2][3] Without such rapid adaptation, these systems risk deterioration of their care quality, professional standing, and financial viability. To support rapid change and improvement, some academic and nonacademic health systems are becoming learning health systems (LHSs), [4][5][6][7][8][9] where "science and informatics, patient-clinician partnerships, incentives, and culture are aligned to promote and enable continuous and real-time improvement in both the effectiveness and efficiency of care." 10 Research on care needs and delivery can contribute to LHS improvement when it is appropriately organized and directed toward the objectives and needs of care systems.…”

Section: Discussionmentioning

confidence: 99%

Funding Learning Health System Research: Challenges and Strategies

Harrison,

Borsky

2024

Acad Med

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Purpose A growing number of health systems are establishing learning health system (LHS) programs, where research focuses on rapidly improving the health system’s internal operations and performance. The authors examine funding challenges facing such initiatives and identify strategies for managing tensions between reliance on external research funding and directly contributing to improvement and learning within the researchers’ own system. Method Qualitative case studies of LHS research programs in 5 health systems were performed via 38 semistructured interviews (October 2019–April 2021) with 35 diverse respondents. Inductive and deductive rapid qualitative analysis supported interview, system-level, and cross-system summaries and analysis. Results External funding awards to LHS researchers facilitated some internal improvement and learning, scientific advancements, and the reputation of researchers and their systems, but reliance on external funding also challenged researchers’ responsiveness to concerns of system leaders, managers, practitioners, and system needs. Gaps between external funding requirements and internally focused projects arose in objectives, practical applicability, audiences, timetables, routines, skill sets, and researchers’ careers. To contribute more directly to system improvement, LHS researchers needed to collaborate with clinicians and other nonresearchers and pivot between long research studies and shorter, dynamic improvement, evaluation, and data analysis projects. With support from system executives, LHS program leaders employed several strategies to enhance researchers’ internal contributions. They aligned funded-research topics with long-term system needs, obtained internal funding for implementing and sustaining practice change, and diversified funding sources. Conclusions To foster LHS research contributions to internal system learning and improvement, LHS program leaders need to manage tensions between concentrating on externally funded research and fulfilling their mission of providing research-based services to their own system. Health system executives can support LHS programs by setting clear goals for them; appropriately staffing, budgeting, and incentivizing LHS researchers; and developing supportive, system-wide teamwork, skill development programs, and data infrastructures.

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Section: Discussionmentioning

confidence: 99%

Funding Learning Health System Research: Challenges and Strategies

Harrison,

Borsky

2024

Acad Med

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“…As described by the University of Michigan and recently adapted by one of the authors (H.R.C. ), 18 the LHS is built on a learning loop of iterative flow among data, knowledge, and performance. To cycle through this learning loop requires the shared skill sets of providers, researchers, and educators and the leadership of institutions that understand how to implement and sustain activities across these domains.…”

Section: Discussionmentioning

confidence: 99%

Defining the Learning Health Care System: An International Health System Leadership Perspective

Maggio,

Villalba,

German

et al. 2023

Acad Med

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Purpose Over the past 2 decades, many academic health centers (AHCs) have implemented learning health systems (LHSs). However, the LHS has been defined with limited input from AHC leaders. This has implications because these individuals play a critical role in LHS implementation and sustainability. This study aims to demonstrate how an international group of AHC leaders defines the LHS, and to identify key considerations they would pose to their leadership teams to implement and sustain the LHS. Method A semistructured survey was developed and administered in 2022 to members of the Association of Academic Health Centers President’s Council on the Learning Health System to explore how AHC leaders define the LHS in relation to their leadership roles. The authors then conducted a focus group, informed by the survey, with these leaders. The focus group was structured using the nominal group technique to facilitate consensus on an LHS definition and key considerations. The authors mapped the findings to an existing LHS framework, which includes 7 components: organizational, performance, ethics and security, scientific, information technology, data, and patient outcomes. Results Thirteen AHC leaders (100%) completed the survey and 10 participated in the focus group. The AHC leaders developed the following LHS definition: “A learning health system is a health care system in which clinical and care-related data are systematically integrated to catalyze discovery and implementation of new knowledge that benefits patients, the community, and the organization through improved outcomes.” The key considerations mapped to all LHS framework components, but participants also described as important the ability to communicate the LHS concept and be able to rapidly adjust to unforeseen circumstances. Conclusions The LHS definition and considerations developed in this study provide a shared foundation and road map for future discussions among leaders of AHCs interested in implementing and sustaining an LHS.

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“…We read with interest the article by Collard and Grumbach, 1 which advocates for the implementation of learning health care systems at academic health centers. While we agree with the leadership role played by academic institutions, we wish to highlight that the learning health care system model also represents a strategy to involve hard-to-reach communities in care and research.…”

Section: To the Editormentioning

confidence: 99%