The journey to a Learning Health System in primary care: a qualitative case study utilising an embedded research approach

Abstract

Background Healthcare systems may be resilient and adaptive, but they are not fit for purpose in their current state. Increasing threats to health system sustainability have underscored the need to move towards a learning health system in which research and data are used routinely in clinical practice to facilitate system improvement. This study aimed to evaluate a university-based general practice to establish which elements of the learning health system were being realised within the practice and determine acceptability from staff to embrace further transition towards a learning health system. Methods Semi-structured interviews were conducted with practice staff, including clinical and administrative staff, to determine the current state of the learning health system in the practice. An embedded researcher was placed within the general practice on a part-time basis to investigate the LHS model. Interviews were transcribed and thematically analysed using a framework approach. Results In total, 32 (91%) practice staff were interviewed, comprising general practitioners (n = 15), nurses (n = 3), administrative staff (n = 13), and a psychologist (n = 1). Participants indicated that the practice was operating with several characteristics of a learning health system, supported by the university-based setting, and resultant culture of learning. Nevertheless, there were still areas of the practice where the learning health system could be strengthened, specifically relating to the use of patient data and informatics. Staff generally expressed willingness to engage with the process of strengthening the learning health system within their practice. Conclusion Although the idea of a learning health system has been gaining traction in recent years, there are still comparatively few empirical studies presented in the literature. This research presents a case study of a general practice that is operating as a learning health system and highlights the utility of using the learning health system framework.

High-performing primary care: reinvigorating general practice as a learning health system

“…We have initiated a programme of work in Australia investigating how the concept of an LHS may be applied in our unique primary health system, with applications to other primary care systems including those in Britain. 15 Our recent case study, modelling a university-based general…”

“…practice in Sydney against LHS principles, has indicated that the practice is operating across several dimensions of the LHS framework, and that staff are willing to embrace additional elements of an LHS. 15 Practical examples of how the domains of an LHS are implemented at the practice-level are also provided, which serve as useful references for practices operating in different contexts. The study also shows overlap between the dimensions of the LHS framework and the quadruple aim framework, 16 which is often used as a key measure for health system performance.…”