How Dissemination and Implementation Science Can Contribute to the Advancement of Learning Health Systems

Abstract

Many health systems are working to become learning health systems (LHSs), which aim to improve the value of health care by rapidly, continuously generating evidence to apply to practice. However, challenges remain to advance toward the aspirational goal of becoming a fully mature LHS. While some important challenges have been well described (i.e., building system-level supporting infrastructure and the accessibility of inclusive, integrated, and actionable data), other key challenges are underrecognized, including balancing evaluation rapidity with rigor, applying principles of health equity and classic ethics, focusing on external validity and reproducibility (generalizability), and designing for sustainability. Many LHSs focus on continuous learning cycles, but with limited consideration of issues related to the rapidity of these learning cycles, as well as the sustainability or generalizability of solutions. Some types of data have been consistently underrepresented, including patient-reported outcomes and preferences, social determinants, and behavioral and environmental data, the absence of which can exacerbate health disparities. A promising approach to addressing many challenges that LHSs face may be found in dissemination and implementation (D&I) science. With an emphasis on multilevel dynamic contextual factors, representation of implementation partner engagement, pragmatic research, sustainability, and generalizability, D&I science methods can assist in overcoming many of the challenges facing LHSs. In this article, the authors describe the current state of LHSs and challenges to becoming a mature LHS, propose solutions to current challenges, focusing on the contributions of D&I science with other methods, and propose key components and characteristics of a mature LHS model that others can use to plan and develop their LHSs.

Funding Learning Health System Research: Challenges and Strategies

“…[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.…”

“…The authors of these papers often offer suggestions for addressing these issues. 7,9,11,19,20 Some papers empirically document challenges facing embedded LHS researchers 21,22 and suggest possible responses to these challenges. 4,11,17,18 However, limited studies examine these responses in practice.…”

How the VA is training the Next‐Generation workforce for learning health systems

“…For example, similar innovation fellowships are being replicated across medical schools such as the Dell Medical School 42 and organizations such as the Institute for Healthcare Improvement 43 provide quality improvement learning opportunities. Others have described optimizing LHS‐focused clinical education in large health systems 44‐47 . However, to date, few entities have described how LHS training can better align research and clinical care priorities to inform both quality improvement and research impacts over time.…”

“…Others have described optimizing LHS‐focused clinical education in large health systems. 44 , 45 , 46 , 47 However, to date, few entities have described how LHS training can better align research and clinical care priorities to inform both quality improvement and research impacts over time.…”

“…Others have described optimizing LHS-focused clinical education in large health systems. [44][45][46][47] However, to date, few entities have In general, recruitment and retention of LHS investigators, especially those from under-represented groups, is an ongoing challenge.…”