Success of an international learning health care system in hematopoietic cell transplantation: The American Society of Blood and Marrow Transplantation Clinical Case Forum. Although qualitative data analysis methods are traditionally labor intensive, new qualitative approaches are emerging that include rapid qualitative data analysis [18,46] and the use of tailored implementation science frameworks for applicability in the context of patient-centered health care interventions [75] and for guiding future PROM implementation efforts across LHSs [31]. The first review of the LHS literature was conducted 5 years ago, identifying only a small number of published papers that had empirically examined the implementation or testing of an LHS. The field of LHSs would benefit from the systematic and integrated use of frameworks such as these, not just for the initial planning and summative evaluation, but also to evaluate interim progress, ensure the suppression of unintended consequences, and help guide appropriate adaptations [86]. Jones RD, Krenz C, Gornick M, Griffith KA, Spence R, Bradbury AR, De Vries R, Hawley ST, Hayward RA, Zon R, Bolte S, Sadeghi N, Schilsky RL, Jagsi R. Patient preferences regarding informed consent models for participation in a learning health care system for oncology. Relevant information was extracted at the full-text review stage using a purpose-designed workbook in Microsoft Excel 365 and included (1) publication details (paper title, year, country of residence of corresponding author, paper type, and paper keywords); (2) primary study focus (thematically coded after data extraction); (3) study context (clinical, hospital, health care system); (4) study design (quantitative, qualitative, mixed methods); (5) study data type (primary or secondary); (6) implementation framework, model, or theory used; and (7) implementation determinants or outcomes examined. PDF www3.ncrn.cornell.edu A Learning Health System can also improve value, reduce unjustified variation, support research and enhance workforce education, training and performance. Can learning health systems help organisations deliver personalised Franklin et al [31] developed an implementation framework to guide PROM data collection, interpretation, and use. GRADE recommends that design factors, such as concurrent controls, can improve the quality of evidence; therefore, studies with concurrent controls without important limitations were assessed as providing medium-quality evidence. Although PDSA cycles may be useful to identify whether an approach or intervention is effective, more timely feedback is needed to inform how and why an intervention is successful or unsuccessful [18]. Network of co-occurring keywords with in-degree 2. We aim to refresh The Potential of Learning Healthcare Systems [1], which was published in 2015. Each of these studies was classified into an area of primary focus, with over two-thirds of them being concerned with implementing a particular program, system, or platform designed to contribute to achieving an LHS. Of the 53 LHS program-specific studies, only 1 (1.9%) structured its evaluation using an implementation science framework [35]. The Institute of Medicine defines a continuously 'learning health system' as one in which, 'science, informatics, incentives, and culture are aligned for continuous improvement and innovation, with best practices seamlessly embedded in the delivery process and new knowledge captured as an integral by-product of the delivery experience.' A #LearningHealthSystem requires strategy, a learning culture & implementation science. Learning Health Systems | Learning Health Sciences | Michigan Medicine So you can still do all of the other stuff. To overcome this, studies suggested that the segregation between research and quality improvement was not appropriate and collective governance was recommended for all improvement practices [61] as were accelerated ethical processes [65]. Realising the Potential of Primary Health Care - OECD iLibrary Studies reporting primary or secondary data were considered empirical so long as they provided sufficient information about their methodological approach [16,24]. A white paper", Associate Professor Yvonne Zurynski and colleagues examine LHS definitions and schematic frameworks, the barriers and enablers to the adoption of the LHS model, and case studies of healthcare organisations on the journey to becoming LHSs. 2022 August; 10(8): e41424, https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-020-01563-4, http://europepmc.org/abstract/MED/25342177, http://qualitysafety.bmj.com/lookup/pmidlookup?view=long&pmid=29438072, https://linkinghub.elsevier.com/retrieve/pii/S1532-0464(16)30131-9, https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-021-06215-8, http://europepmc.org/abstract/MED/27163980, https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-019-1382-x, http://europepmc.org/abstract/MED/20957426, https://gdt.gradepro.org/app/handbook/handbook.html#h.hnedbo8gqjqk, https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups, http://europepmc.org/abstract/MED/27280328, http://europepmc.org/abstract/MED/29881737, http://europepmc.org/abstract/MED/30602195, https://dx.plos.org/10.1371/journal.pone.0177102, https://implementationsciencecomms.biomedcentral.com/articles/10.1186/s43058-020-00053-1, https://implementationscience.biomedcentral.com/articles/10.1186/s13012-020-0976-1, https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-016-0122-3, https://bmjopen.bmj.com/lookup/pmidlookup?view=long&pmid=28385912, https://bmjopen.bmj.com/lookup/pmidlookup?view=long&pmid=31420396, https://dx.plos.org/10.1371/journal.pone.0205419, https://linkinghub.elsevier.com/retrieve/pii/S1553-7250(20)30234-8, https://implementationscience.biomedcentral.com/articles/10.1186/s13012-020-0972-5, https://linkinghub.elsevier.com/retrieve/pii/S2451-8654(18)30132-7, http://europepmc.org/abstract/MED/31233126, https://linkinghub.elsevier.com/retrieve/pii/S1532-0464(16)00006-X, http://europepmc.org/abstract/MED/33409427, http://europepmc.org/abstract/MED/26718665, https://implementationscience.biomedcentral.com/articles/10.1186/1748-5908-4-50, https://bmcmedethics.biomedcentral.com/articles/10.1186/s12910-018-0343-9, http://europepmc.org/abstract/MED/27917391, https://bmcmedethics.biomedcentral.com/articles/10.1186/s12910-017-0185-x, http://europepmc.org/abstract/MED/31367650, http://europepmc.org/abstract/MED/27683668, https://journals.sagepub.com/doi/10.1177/1460458220977579?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed, http://europepmc.org/abstract/MED/28777456, https://bmjopen.bmj.com/lookup/pmidlookup?view=long&pmid=33371049, https://dx.plos.org/10.1371/journal.pmed.1002288, http://europepmc.org/abstract/MED/22310560, https://implementationscience.biomedcentral.com/articles/10.1186/s13012-019-0892-4, https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-05289-0, Health care professionals satisfaction with various aspects of the LHS initiative (eg, content, complexity, comfort, delivery, and credibility), Fit, relevance, compatibility, suitability, usefulness, and practicability perceived by health care professionals and patients, The actual fit, utility, and practicability of the program within a health service setting and its subsystems, as reported by health care professionals and managers, The LHS initiative delivered, as intended; adherence by health care professionals; and quality of program delivery, Financial impact of LHS implementation to the health service or organization, Spread or reach of the LHS initiative assessed at the organization or setting level, The extent to which the LHS program is maintained or institutionalized within a health services standard operations, Consolidated Framework for Implementation Research, Grading of Recommendations Assessment, Development and Evaluation, Preferred Reporting Items of Systematic Review and Meta-Analyses Extension for Scoping Reviews, Reach, Effectiveness, Adoption, Implementation, and Maintenance. Based on the full-text assessment, a further 13 (14.6%) of 89 studies did not meet the inclusion criteria, and hence 76 (85.4%) studies were included in this review (Figure 2). Taking an implementation science lens, the review aims to map out the empirical research that has been conducted to date, identify limitations, and identify future directions for the field. Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Sydney, 2113, Australia, Phone: 61 298502484, Fax: 61 298502499, learning health systems, learning health care systems, implementation science, evaluation, health system, health care system, empirical research, medical informatics, review. Car J, Sheikh A, Wicks P, Williams MS. The scoping review was designed to answer questions in 3 key research areas: Among the empirical studies examining implementation: Our scoping review followed a protocol that was developed in accordance with the Preferred Reporting Items of Systematic Review and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) [20]. The remaining 16 studies (30.2%) focused on whole hospital systems (n=4, 25%) or on other broad health care systems encompassing multiple facilities (n=12, 75%), such as the US Veterans Health Administration (VHA). AHRQ series on improving translation of evidence: linking evidence reports and performance measures to help learning health systems use new information for improvement. A Just Culture environment provides benefits for patients, EMS practitioners, EMS agencies, In 1 study of a US multicenter research program embedded within the VHA system, a survey of LHS decision makers who accessed the VHA Evidence Synthesis Program (ESP) identified that that the ESP information and reports are most frequently used to develop clinical guidance, identify future research needs, and determine implementation strategies, particularly surrounding adoption decisions and medical device procurement [30]. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. This progression from the predominantly theoretical contributions to the LHS literature to more applied and empirical evaluations has begun to uncover the potential methodological flaws and limitations of data systems in realizing the promise of an LHS. This mixed-methods study sought to evaluate the VHA Innovation Ecosystem, which includes the Diffusion of Excellence (DoE) program that identifies and diffuses gold status practices across VHA facilities.
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