The Care and Learn Model: a Practice and Research Model for Improving Healthcare Quality and Outcomes

Abstract

The Agency for Healthcare Research and Quality conducted internal work to formulate a model that could be used to analyze the Agency's research portfolio, identify gaps, develop and prioritize its research agenda, and evaluate its performance. Existing models described the structure and components of the healthcare system. Instead, we produced a model of two functions: caring and learning. Central to this model is the commitment to and participation of people-patients, communities, and health professionals-and the organization of systems to respond to people's problems using evidence. As a product of caring, the system produces evidence that is then used to adapt and continuously improve this response, closely integrating caring and learning. The Agency and the health services research and improvement communities can use this Care and Learn Model to frame an evidencebased understanding of vexing clinical, healthcare delivery, and population health problems and to identify targets for investment, innovation, and investigation. KEY WORDS: health services research; healthcare delivery; health policy; evidence-based medicine; quality improvement. J Gen Intern Med 34(1):154-8

Multi‐level analysis of the learning health system: Integrating contributions from research on organizations and implementation

“…Some community factors that affect care, such as the services available in a community and the needs and capacities of its members (eg, for self-management and interaction with health providers), may also affect organizational learning. 19 Although helpful, the socio-ecological framework concentrates on programs and factors affecting individual health behavior and hence is less readily adaptable to investigations of learning and LHS operations than the CFIR. Additionally, the promising distinction between the community and system levels does not adequately fit the full range of factors affecting organizational learning.…”

“…This vision is captured in discussions of the learning health system (LHS) [9][10][11][12][13] and learning organizations. [14][15][16][17][18][19] The National Academy of Medicine (NAM) 1 defines the "Continuously Learning Health Care System" as "one in which 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"( 13 , p. 17).…”

Prioritizing Evidence-based Interventions for Dissemination and Implementation Investments

“…Consistent with its "Care and Learn" model, 1 AHRQ requires that its DI investments include an evaluation in order to contribute to the evidence on implementation. Each of these funded projects is expected to improve care for individuals, produce learning for primary care practices, hospitals, and health systems, and evidence for both AHRQ and the larger health care community on implementation.…”

“…The Agency for Healthcare Research and Quality (AHRQ) envisions an efficient model of care and research, with patients at the center of both. AHRQ’s Care and Learn model describes a learning health system where evidence, produced in conjunction with patient care, is then used to improve the ability of the health system to care for patients 1. AHRQ is specifically charged to disseminate findings from patient-centered outcomes research (PCOR) conducted by the Patient-Centered Outcomes Research Institute (PCORI), the National Institutes of Health (NIH), and others.…”

“…AHRQ's Care and Learn model describes a learning health system where evidence, produced in conjunction with patient care, is then used to improve the ability of the health system to care for patients. 1 AHRQ is specifically charged to disseminate findings from patient-centered outcomes research (PCOR) conducted by the Patient-Centered Outcomes Research Institute (PCORI), the National Institutes of Health (NIH), and others. AHRQ's challenge has been to identify and choose among those evidence-based interventions that improve patient-centered outcomes, but are not yet in common practice.…”