Learning Health Systems最新文献_第3页

Enriched core competencies for health services and policy research—An update 充实了卫生服务和政策研究的核心能力——最新情况

IF 2.6 Q2 HEALTH POLICY & SERVICES

Learning Health Systems

Pub Date : 2025-09-24 DOI: 10.1002/lrh2.70032

Meghan McMahon, Rhonda Boateng, Richard H. Glazier, Stephen Bornstein, Shanthi Johnson, Carl-Ardy Dubois, Matthew Menear, Tara Sampalli, Tracy Wasylak, Deborah Marshall, Denis Roy, Deepa Singal, Adalsteinn Brown

Objective

Doctoral and postdoctoral training in health services and policy research (HSPR) needs to evolve to address changing career trajectories, emerging health system challenges, and the advancement of learning health systems. This changing landscape necessitates examination of the core competencies that underpin training. This study presents a refreshed set of core competencies for HSPR to guide the modernization of training and considerations for implementation.

Methods

Qualitative methods and an iterative development process with extensive community engagement throughout were used. Data were obtained from multiple sources, including literature reviews, surveys, key informant interviews, focus groups, Task Force meetings, a consensus workshop, and a validation process (Fall 2022 to May 2024). The study setting is Canada.

Results

The refreshed core competencies include nine essential domains that maintain an emphasis on rigorous scholarly preparation and prioritize leadership and other professional skills deemed essential to contribute to evidence-informed system improvement and learning health systems. Additionally, the framework features two new transversal domains: Equity, Diversity, Inclusion, Accessibility, and Anti-Oppression; and Indigenous Cultural Safety and Humility. These domains are considered fundamental principles to be embedded into all aspects of HSPR competencies and training, fostering more inclusive and equitable leaders and health systems.

Conclusions

As health systems continuously evolve, so too should the questions researchers address, the methods they use, and the skills needed to maximize contributions to evidence-informed health system improvement and learning health systems. The refreshed core competencies for HSPR maintain important continuity with the inaugural competency framework while also including several important additions. The framework allows for flexibility in its implementation and us; it can be used to guide the enhancement of existing training programs, the development of new ones, and the growth and development of a HSPR workforce with the skills to lead and contribute within learning health systems.

卫生服务和政策研究（HSPR）的博士和博士后培训需要不断发展，以应对不断变化的职业轨迹、新出现的卫生系统挑战以及学习型卫生系统的进步。这种不断变化的形势要求对支撑培训的核心能力进行审查。本研究提出了一套更新的HSPR核心能力，以指导培训的现代化和实施的考虑。方法采用定性方法和广泛社区参与的迭代开发过程。数据来自多种来源，包括文献综述、调查、关键线人访谈、焦点小组、工作组会议、共识研讨会和验证过程（2022年秋季至2024年5月）。研究地点在加拿大。结果：更新后的核心能力包括九个基本领域，强调严格的学术准备，优先考虑领导能力和其他专业技能，这些技能被认为是促进循证系统改进和学习型卫生系统所必需的。此外，该框架还具有两个新的横向领域：公平、多样性、包容性、可及性和反压迫；土著文化安全和谦逊。这些领域被认为是基本原则，应纳入HSPR能力和培训的各个方面，以培养更具包容性和公平性的领导者和卫生系统。随着卫生系统的不断发展，研究人员解决的问题、他们使用的方法以及为改善循证卫生系统和学习卫生系统做出最大贡献所需的技能也应不断发展。更新后的HSPR核心竞争力与最初的竞争力框架保持了重要的连续性，同时还增加了一些重要的内容。该框架允许在实施和我们方面具有灵活性；它可用于指导加强现有培训计划，开发新的培训计划，以及HSPR工作人员的成长和发展，使其具备领导和促进学习型卫生系统的技能。

{"title":"Enriched core competencies for health services and policy research—An update","authors":"Meghan McMahon, Rhonda Boateng, Richard H. Glazier, Stephen Bornstein, Shanthi Johnson, Carl-Ardy Dubois, Matthew Menear, Tara Sampalli, Tracy Wasylak, Deborah Marshall, Denis Roy, Deepa Singal, Adalsteinn Brown","doi":"10.1002/lrh2.70032","DOIUrl":"https://doi.org/10.1002/lrh2.70032","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Doctoral and postdoctoral training in health services and policy research (HSPR) needs to evolve to address changing career trajectories, emerging health system challenges, and the advancement of learning health systems. This changing landscape necessitates examination of the core competencies that underpin training. This study presents a refreshed set of core competencies for HSPR to guide the modernization of training and considerations for implementation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Qualitative methods and an iterative development process with extensive community engagement throughout were used. Data were obtained from multiple sources, including literature reviews, surveys, key informant interviews, focus groups, Task Force meetings, a consensus workshop, and a validation process (Fall 2022 to May 2024). The study setting is Canada.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The refreshed core competencies include nine essential domains that maintain an emphasis on rigorous scholarly preparation and prioritize leadership and other professional skills deemed essential to contribute to evidence-informed system improvement and learning health systems. Additionally, the framework features two new transversal domains: Equity, Diversity, Inclusion, Accessibility, and Anti-Oppression; and Indigenous Cultural Safety and Humility. These domains are considered fundamental principles to be embedded into all aspects of HSPR competencies and training, fostering more inclusive and equitable leaders and health systems.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>As health systems continuously evolve, so too should the questions researchers address, the methods they use, and the skills needed to maximize contributions to evidence-informed health system improvement and learning health systems. The refreshed core competencies for HSPR maintain important continuity with the inaugural competency framework while also including several important additions. The framework allows for flexibility in its implementation and us; it can be used to guide the enhancement of existing training programs, the development of new ones, and the growth and development of a HSPR workforce with the skills to lead and contribute within learning health systems.</p>\u0000 </section>\u0000 </div>","PeriodicalId":43916,"journal":{"name":"Learning Health Systems","volume":"10 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lrh2.70032","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146002474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Multi-site research using electronic health record data: Lessons learned from a case study 使用电子健康记录数据的多站点研究：从案例研究中吸取的经验教训

IF 2.6 Q2 HEALTH POLICY & SERVICES

Learning Health Systems

Pub Date : 2025-09-16 DOI: 10.1002/lrh2.70039

Brittany Garcia, Michael Hogarth, Yu Wang, Xi Zhu, Shin-Ping Tu

Introduction

Multi-site research collaboration is necessary to increase generalizability, diversity, and innovation; however, there are complexities and challenges surrounding research processes, including regulatory oversight, data management, and data sharing activities. This report highlights the specific challenges of collaborative research identified in the conduct of a federally funded multi-site study and presents lessons learned to inform ways to overcome these challenges. The purpose of our current research project is to determine how interprofessional teamwork affects quality outcomes and develop tools to improve teamwork in cancer care.

Methods

Our research team is comprised of 23 members across five academic institutions. Our study cohort includes approximately 20 000 adult patients with breast, colorectal, and non-small cell lung cancers diagnosed at the respective sites between January 1, 2016, and December 31, 2021. Electronic health record (EHR) access log data was extracted 12 months pre- and 24 months post-diagnosis for each patient, and outcome data of potentially preventable emergency department visits and unplanned hospitalizations was extracted from the California state All-Payer Claims database.

Results

Major challenges experienced related to single institutional review board processes, establishment of contract agreements, and data management, analysis, acquisition, and transfer. Lessons learned included: (1) start research planning as early as possible, including engaging with information technology and compliance teams to identify processes and develop and share data dictionaries; (2) work closely with the institution contracting team to identify the most optimal timing and ordering for multiple data use agreement (DUA) contracts; and (3) ensure that research team members are abreast of current Health Insurance Portability and Accountability Act and institutional guidelines as they pertain to research and data practices.

Conclusions

Multi-site research involving big data from the EHR requires ample planning and execution time. Adopting a single standardized DUA and developing data dictionaries that can be shared for research will improve the data acquisition phase of multi-site research studies.

多站点研究合作是提高普遍性、多样性和创新性的必要条件；然而，研究过程中存在着复杂性和挑战，包括监管监督、数据管理和数据共享活动。本报告强调了在联邦资助的多地点研究中确定的合作研究的具体挑战，并介绍了为克服这些挑战提供信息的经验教训。我们当前研究项目的目的是确定跨专业团队合作如何影响质量结果，并开发工具来改善癌症治疗中的团队合作。方法我们的研究团队由来自5个学术机构的23名成员组成。我们的研究队列包括2016年1月1日至2021年12月31日期间在各自部位诊断的约20,000名乳腺癌、结直肠癌和非小细胞肺癌成年患者。提取每位患者诊断前12个月和诊断后24个月的电子健康记录（EHR）访问日志数据，并从加利福尼亚州全付款人索赔数据库中提取潜在可预防的急诊就诊和计划外住院的结果数据。结果：所经历的主要挑战与单一机构审查委员会流程、合同协议的建立以及数据管理、分析、获取和转移有关。经验教训包括：(1)尽早开始研究规划，包括与信息技术和合规团队合作，确定流程，开发和共享数据字典；(2)与机构签约团队密切合作，确定多个数据使用协议（DUA）合同的最佳时机和顺序；(3)确保研究团队成员了解与研究和数据实践有关的现行《健康保险流通与责任法案》和机构准则。结论涉及电子病历大数据的多地点研究需要充足的计划和执行时间。采用单一的标准化DUA，开发可共享的数据字典，将改善多站点研究的数据采集阶段。

{"title":"Multi-site research using electronic health record data: Lessons learned from a case study","authors":"Brittany Garcia, Michael Hogarth, Yu Wang, Xi Zhu, Shin-Ping Tu","doi":"10.1002/lrh2.70039","DOIUrl":"https://doi.org/10.1002/lrh2.70039","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Multi-site research collaboration is necessary to increase generalizability, diversity, and innovation; however, there are complexities and challenges surrounding research processes, including regulatory oversight, data management, and data sharing activities. This report highlights the specific challenges of collaborative research identified in the conduct of a federally funded multi-site study and presents lessons learned to inform ways to overcome these challenges. The purpose of our current research project is to determine how interprofessional teamwork affects quality outcomes and develop tools to improve teamwork in cancer care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Our research team is comprised of 23 members across five academic institutions. Our study cohort includes approximately 20 000 adult patients with breast, colorectal, and non-small cell lung cancers diagnosed at the respective sites between January 1, 2016, and December 31, 2021. Electronic health record (EHR) access log data was extracted 12 months pre- and 24 months post-diagnosis for each patient, and outcome data of potentially preventable emergency department visits and unplanned hospitalizations was extracted from the California state All-Payer Claims database.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Major challenges experienced related to single institutional review board processes, establishment of contract agreements, and data management, analysis, acquisition, and transfer. Lessons learned included: (1) start research planning as early as possible, including engaging with information technology and compliance teams to identify processes and develop and share data dictionaries; (2) work closely with the institution contracting team to identify the most optimal timing and ordering for multiple data use agreement (DUA) contracts; and (3) ensure that research team members are abreast of current Health Insurance Portability and Accountability Act and institutional guidelines as they pertain to research and data practices.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Multi-site research involving big data from the EHR requires ample planning and execution time. Adopting a single standardized DUA and developing data dictionaries that can be shared for research will improve the data acquisition phase of multi-site research studies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":43916,"journal":{"name":"Learning Health Systems","volume":"9 4","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lrh2.70039","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145375260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Co-creating an everyday language illustration of learning health systems alongside patient, caregiver, and community partners 与患者、护理人员和社区合作伙伴共同创建学习卫生系统的日常语言说明

IF 2.6 Q2 HEALTH POLICY & SERVICES

Learning Health Systems

Pub Date : 2025-09-08 DOI: 10.1002/lrh2.70033

Shelley Vanderhout, Maureen Smith, Nakia Lee-Foon, Amanda Doherty-Kirby, Rona Fleming, Don Grant, Annie-Danielle Grenier, John Grogan, Roger Farley, Margaret King, Chris Johnston, Virgil Luca, Lisa Ridgway, Donna Rubenstein, Candace Skrapek, Kerry Kuluski

Introduction

Patients, caregivers, and community partners (PCC) can have a variety of roles in learning health systems (LHS), such as contributing their data from healthcare encounters to embedded, continuous engagement where they identify health system priorities, guide operational, research, and quality improvement decisions, and facilitate knowledge sharing and implementation. Despite many LHS models placing emphasis on PCC, little has been done to help members of the public understand what a LHS is or initiate dialogue about how they can learn more and become engaged. We brought together a national network of PCC to co-create an everyday language, arts-based resource for the public to learn what a LHS is and how it relates to patient care journeys.

Methods

Thirteen PCC with LHS experience from across Canada attended two 2-h virtual workshops to generate ideas on how to better define LHS using everyday language, determine accessible ways to share this information, and co-design a comic strip that can be widely shared across diverse settings and communities.

Results

We co-created a six-panel comic strip that depicts a relatable patient experience of waiting in an emergency department. The comic shows that in a LHS, patients are invited to contribute their perspectives about improving healthcare and support implementing and testing new ideas in clinical settings. Creating this comic was considered important for various reasons: to promote a common language around LHS, to build trust between health systems and the public, and to widen the community of PCC who are engaged in LHS activities.

Conclusions

This comic is intended to build capacity for LHS culture, where the public can understand how continuous learning and improvement fit within health care, and learn about opportunities for engagement in LHS.

患者、护理人员和社区合作伙伴（PCC）可以在学习型卫生系统（LHS）中扮演各种角色，例如将他们在医疗保健遭遇中的数据贡献给嵌入式持续参与，从而确定卫生系统的优先事项，指导运营、研究和质量改进决策，并促进知识共享和实施。尽管许多LHS模式强调PCC，但在帮助公众了解LHS是什么或就如何了解和参与进行对话方面做得很少。我们汇集了PCC的全国网络，共同创建了一个日常语言，以艺术为基础的资源，让公众了解LHS是什么，以及它与患者护理过程的关系。方法来自加拿大各地的13个具有LHS经验的PCC参加了两个2小时的虚拟研讨会，讨论如何使用日常语言更好地定义LHS，确定可访问的方式来分享这些信息，并共同设计一个可以在不同环境和社区广泛共享的连环漫画。我们共同创作了一幅六页连环画，描绘了患者在急诊室等待的相关经历。漫画显示，在LHS中，患者被邀请贡献他们关于改善医疗保健的观点，并支持在临床环境中实施和测试新想法。创作这部漫画被认为很重要，原因有很多：促进LHS周围的共同语言，在卫生系统和公众之间建立信任，扩大参与LHS活动的PCC社区。本漫画旨在为LHS文化建设能力，使公众能够了解持续学习和改进如何适应医疗保健，并了解参与LHS的机会。

{"title":"Co-creating an everyday language illustration of learning health systems alongside patient, caregiver, and community partners","authors":"Shelley Vanderhout, Maureen Smith, Nakia Lee-Foon, Amanda Doherty-Kirby, Rona Fleming, Don Grant, Annie-Danielle Grenier, John Grogan, Roger Farley, Margaret King, Chris Johnston, Virgil Luca, Lisa Ridgway, Donna Rubenstein, Candace Skrapek, Kerry Kuluski","doi":"10.1002/lrh2.70033","DOIUrl":"https://doi.org/10.1002/lrh2.70033","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Patients, caregivers, and community partners (PCC) can have a variety of roles in learning health systems (LHS), such as contributing their data from healthcare encounters to embedded, continuous engagement where they identify health system priorities, guide operational, research, and quality improvement decisions, and facilitate knowledge sharing and implementation. Despite many LHS models placing emphasis on PCC, little has been done to help members of the public understand what a LHS is or initiate dialogue about how they can learn more and become engaged. We brought together a national network of PCC to co-create an everyday language, arts-based resource for the public to learn what a LHS is and how it relates to patient care journeys.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Thirteen PCC with LHS experience from across Canada attended two 2-h virtual workshops to generate ideas on how to better define LHS using everyday language, determine accessible ways to share this information, and co-design a comic strip that can be widely shared across diverse settings and communities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We co-created a six-panel comic strip that depicts a relatable patient experience of waiting in an emergency department. The comic shows that in a LHS, patients are invited to contribute their perspectives about improving healthcare and support implementing and testing new ideas in clinical settings. Creating this comic was considered important for various reasons: to promote a common language around LHS, to build trust between health systems and the public, and to widen the community of PCC who are engaged in LHS activities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This comic is intended to build capacity for LHS culture, where the public can understand how continuous learning and improvement fit within health care, and learn about opportunities for engagement in LHS.</p>\u0000 </section>\u0000 </div>","PeriodicalId":43916,"journal":{"name":"Learning Health Systems","volume":"9 4","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lrh2.70033","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145375117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Achieving an Intelligent HealthScience System: Aligning science, health, business, policy and technology for patients and society 实现智能健康科学系统：为患者和社会协调科学、健康、商业、政策和技术

IF 2.6 Q2 HEALTH POLICY & SERVICES

Learning Health Systems

Pub Date : 2025-09-08 DOI: 10.1002/lrh2.70020

SYNERGY Forum

Background

All societies benefit from a healthy population, and access to affordable, quality, evidence-based medical care can improve health, productivity, and prosperity for all. Two decades ago, experts and stakeholders met at the Institute of Medicine and called for a “new health system for the 21st century.” More recently, efforts have been made to achieve a Learning Health System (LHS). Still, reform efforts in the United States have only marginally succeeded in improving the situation despite innovation, technology, enormous economic resources, and one of the strongest medical research endeavors in the world.

Objectives

To bring together diverse stakeholders in healthcare, science, technology, business, government and patient advocacy, to envision what lies beyond the so-called Learning Health System approach.

Methods

In December 2022, the SYNERGY Forum was hosted by the National Academy of Medicine, convened in Washington, DC. This envisioning exercise, the first in a planned series of such events, was proposed and organized by the global non-profit Alliance for Clinical Research Excellence and Safety (ACRES). The two-day exercise combined didactic lectures on systems thinking, focused working-groups, and interactive discussion, to create a vision for an integrated Intelligent HealthScience System (IHSS).

Results

The participants proposed creation of a platform and an engine of People, Processes, Policy, and Technology to design and realize this vision through an effective hard and soft systems approach.

Conclusions

This report captures what the multi-stakeholder collaboration recommends toward achieving such a System and a proposal for continuation of a SYNERGY Forum to further advance needed change and a design process.

所有社会都受益于健康的人口，获得负担得起的优质循证医疗服务可以改善所有人的健康、生产力和繁荣。20年前，专家和利益相关者在医学研究所会面，呼吁建立“21世纪的新卫生系统”。最近，为实现学习型卫生系统（LHS）作出了努力。尽管有创新、技术、巨大的经济资源和世界上最强大的医学研究努力之一，但美国的改革努力在改善这种状况方面只取得了微小的成功。目标将医疗保健、科学、技术、商业、政府和患者倡导方面的不同利益相关者聚集在一起，设想所谓的学习卫生系统方法之外的前景。方法2022年12月，SYNERGY论坛由美国国家医学院主办，在华盛顿特区召开。这次设想活动是一系列计划中的此类活动中的第一次，由全球非营利临床研究卓越与安全联盟（ACRES）提出并组织。为期两天的演习结合了系统思维的教学讲座，重点工作组和互动讨论，以创建一个集成的智能健康科学系统（IHSS）的愿景。与会者建议创建一个平台和一个人、过程、政策和技术的引擎，通过有效的硬系统和软系统方法来设计和实现这一愿景。本报告阐述了多方利益相关方协作对实现这样一个系统的建议，并提出了继续举办SYNERGY论坛以进一步推进所需的变革和设计过程的建议。

{"title":"Achieving an Intelligent HealthScience System: Aligning science, health, business, policy and technology for patients and society","authors":"SYNERGY Forum","doi":"10.1002/lrh2.70020","DOIUrl":"https://doi.org/10.1002/lrh2.70020","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>All societies benefit from a healthy population, and access to affordable, quality, evidence-based medical care can improve health, productivity, and prosperity for all. Two decades ago, experts and stakeholders met at the Institute of Medicine and called for a “new health system for the 21st century.” More recently, efforts have been made to achieve a Learning Health System (LHS). Still, reform efforts in the United States have only marginally succeeded in improving the situation despite innovation, technology, enormous economic resources, and one of the strongest medical research endeavors in the world.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To bring together diverse stakeholders in healthcare, science, technology, business, government and patient advocacy, to envision what lies beyond the so-called Learning Health System approach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In December 2022, the SYNERGY Forum was hosted by the National Academy of Medicine, convened in Washington, DC. This envisioning exercise, the first in a planned series of such events, was proposed and organized by the global non-profit Alliance for Clinical Research Excellence and Safety (ACRES). The two-day exercise combined didactic lectures on systems thinking, focused working-groups, and interactive discussion, to create a vision for an integrated Intelligent HealthScience System (IHSS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The participants proposed creation of a platform and an engine of People, Processes, Policy, and Technology to design and realize this vision through an effective hard and soft systems approach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This report captures what the multi-stakeholder collaboration recommends toward achieving such a System and a proposal for continuation of a SYNERGY Forum to further advance needed change and a design process.</p>\u0000 </section>\u0000 </div>","PeriodicalId":43916,"journal":{"name":"Learning Health Systems","volume":"9 4","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lrh2.70020","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145375118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Increasing physician-perceived comfort about ostomies in pediatric inflammatory bowel disease: An interprofessional quality improvement project 提高医生对儿童炎症性肠病造口术的感知舒适度：一个跨专业质量改进项目

IF 2.6 Q2 HEALTH POLICY & SERVICES

Learning Health Systems

Pub Date : 2025-09-04 DOI: 10.1002/lrh2.70034

Jennie G. David, Hannah McKillop, Meghan Fisher, Ashley M. Kroon Van Diest

Introduction

Pediatric inflammatory bowel disease (IBD) is a chronic disease with various treatments, including ostomy surgery, which is associated with stigma. Physicians' known discomfort in discussing ostomies can impact medical decision-making and the timing of clinical conversation. This quality improvement (QI) work developed and tested interprofessional tools to increase physician-perceived comfort in ostomy-related discussions at pediatric-IBD focused Learning Health Network site.

Methods

A multidisciplinary team of GI/IBD psychologists, ostomy nurses, and child life specialists developed tools designed to increase physician-perceived comfort in ostomy discussions at an institution that participates in ImproveCareNow, a pediatric-IBD Learning Health Network. Two Plan Do Study Act (PDSA) cycles were completed. PDSA Cycle 1 involved IBD attending physicians (n = 4) for 8 weeks and PDSA Cycle 2 involved GI medical fellows (n = 7) for 12 weeks. Each PDSA cycle involved (1) baseline information, (2) resource education, and (3) tracking of physician-perceived comfort.

Results

For IBD attendings, average physician-perceived comfort talking about ostomies increased from 68.8% to 83.3%. For GI medical fellows, average physician-perceived comfort increased from 41.4% to 62%.

Conclusions

Ostomy surgery in pediatric IBD is a complex medical decision with notable stigma, demonstrating a pressing need to facilitate non-stigmatizing and psychosocially mindful clinical discussions. This QI project demonstrated how interprofessional education and resources increased physician-perceived comfort in ostomy discussions among IBD attendings and GI medical fellows at an ImproveCareNow site.

儿童炎症性肠病（IBD）是一种慢性疾病，有多种治疗方法，包括造口手术，这与病耻感有关。医生在讨论造口术时的不适会影响医疗决策和临床对话的时机。这项质量改进（QI）工作开发并测试了跨专业工具，以提高医生在以儿科ibd为重点的学习健康网络网站上与造口相关的讨论中感受到的舒适度。方法一个由胃肠道/IBD心理学家、造口护士和儿童生活专家组成的多学科团队开发了一些工具，旨在提高医生在参加“改善儿科-IBD学习健康网络”（ImproveCareNow）的机构讨论造口术时的舒适度。完成了两个计划执行研究法案（PDSA）周期。PDSA周期1涉及IBD主治医生（n = 4），为期8周，PDSA周期2涉及GI医学研究员（n = 7），为期12周。每个PDSA周期包括(1)基线信息，(2)资源教育，(3)医生感知舒适度跟踪。结果IBD主治医师谈论造口术的平均医师感知舒适度从68.8%上升到83.3%。对于GI医学研究员来说，医生认为的平均舒适度从41.4%上升到62%。结论：儿童IBD造口手术是一个复杂的医疗决策，具有明显的耻辱感，迫切需要促进非耻辱感和心理社会意识的临床讨论。这个QI项目展示了在improecarenow网站上，跨专业的教育和资源如何提高IBD主治医生和GI医学研究员在造口术讨论中的医生感知舒适度。

{"title":"Increasing physician-perceived comfort about ostomies in pediatric inflammatory bowel disease: An interprofessional quality improvement project","authors":"Jennie G. David, Hannah McKillop, Meghan Fisher, Ashley M. Kroon Van Diest","doi":"10.1002/lrh2.70034","DOIUrl":"https://doi.org/10.1002/lrh2.70034","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Pediatric inflammatory bowel disease (IBD) is a chronic disease with various treatments, including ostomy surgery, which is associated with stigma. Physicians' known discomfort in discussing ostomies can impact medical decision-making and the timing of clinical conversation. This quality improvement (QI) work developed and tested interprofessional tools to increase physician-perceived comfort in ostomy-related discussions at pediatric-IBD focused Learning Health Network site.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A multidisciplinary team of GI/IBD psychologists, ostomy nurses, and child life specialists developed tools designed to increase physician-perceived comfort in ostomy discussions at an institution that participates in ImproveCareNow, a pediatric-IBD Learning Health Network. Two Plan Do Study Act (PDSA) cycles were completed. PDSA Cycle 1 involved IBD attending physicians (<i>n</i> = 4) for 8 weeks and PDSA Cycle 2 involved GI medical fellows (<i>n</i> = 7) for 12 weeks. Each PDSA cycle involved (1) baseline information, (2) resource education, and (3) tracking of physician-perceived comfort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>For IBD attendings, average physician-perceived comfort talking about ostomies increased from 68.8% to 83.3%. For GI medical fellows, average physician-perceived comfort increased from 41.4% to 62%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Ostomy surgery in pediatric IBD is a complex medical decision with notable stigma, demonstrating a pressing need to facilitate non-stigmatizing and psychosocially mindful clinical discussions. This QI project demonstrated how interprofessional education and resources increased physician-perceived comfort in ostomy discussions among IBD attendings and GI medical fellows at an ImproveCareNow site.</p>\u0000 </section>\u0000 </div>","PeriodicalId":43916,"journal":{"name":"Learning Health Systems","volume":"9 4","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lrh2.70034","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145375065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Learning about learning health systems: Strengthening theory through continuous evaluation and improvement 学习学习卫生系统：通过持续评估和改进加强理论

IF 2.6 Q2 HEALTH POLICY & SERVICES

Learning Health Systems

Pub Date : 2025-09-04 DOI: 10.1002/lrh2.70038

Andreas Gremyr, Michael Seid, Peter A. Margolis, Rohit Ramaswamy

Introduction

Learning Health Systems (LHSs) offer potential for transforming healthcare through continuous learning and improvement. However, the current literature lacks a robust connection between theory and practice, limiting knowledge transferability across diverse healthcare environments. This article proposes a novel framework for integrating theorizing and continuous evaluation into LHSs, illustrated through the case of the Bipolar Action Network (The Network).

Methods

We use a process of theorizing to structure how mid-range theory, program theory and LHS design, development and evaluation can support improved practices and theories. We use the Conceptual Framework for Value-Creating Learning Health Systems as our initial mid-range theory, and the Bipolar Action Network serves as an illustrative case.

Results

The framework emphasizes continuous multi-level LHS theory refinement based on real-world data, ensuring that both the system and its theoretical underpinnings evolve in response to new insights and challenges by connecting four steps: (1) Selecting an initial mid-range theory, (2) Creating a program theory for a specific LHS, (3) Evaluating LHS performance using operational data, and (4) Using evaluation findings to refine both the LHS program and mid-range theory.

Conclusions

This article contributes to the field by offering a practical methodology for bridging the gap between LHS theory and practice. By promoting ongoing theorizing and evaluation, our framework aims to both enhance the effectiveness and adaptability of LHSs, as well as inform theory development. Challenges remain, including resource intensity for data infrastructure and potential limitations in data quality or accessibility, which must be addressed to realize the full potential of LHSs as adaptive, theory-driven systems.

学习型卫生系统（lhs）提供了通过持续学习和改进来改变卫生保健的潜力。然而，目前的文献缺乏理论与实践之间的强大联系，限制了知识在不同医疗环境中的可转移性。本文提出了一个新的框架，将理论化和持续评估整合到lhs中，并通过双相行动网络（网络）的案例进行了说明。方法通过理论化的过程来构建中期理论、规划理论和LHS设计、开发和评估如何支持改进的实践和理论。我们使用价值创造学习健康系统的概念框架作为我们最初的中期理论，双相情感障碍行动网络作为一个说明案例。该框架强调基于现实世界数据的持续多层次LHS理论改进，确保系统及其理论基础通过以下四个步骤来应对新的见解和挑战：(1)选择一个初始的中程理论；(2)为特定的LHS创建一个项目理论；(3)使用运行数据评估LHS的性能；(4)使用评估结果来完善LHS项目和中程理论。本文通过提供一种实用的方法来弥合LHS理论与实践之间的差距，从而对该领域做出了贡献。通过促进正在进行的理论化和评估，我们的框架旨在提高lhs的有效性和适应性，并为理论发展提供信息。挑战仍然存在，包括数据基础设施的资源强度和数据质量或可访问性的潜在限制，必须解决这些问题，以实现lhs作为自适应理论驱动系统的全部潜力。

{"title":"Learning about learning health systems: Strengthening theory through continuous evaluation and improvement","authors":"Andreas Gremyr, Michael Seid, Peter A. Margolis, Rohit Ramaswamy","doi":"10.1002/lrh2.70038","DOIUrl":"https://doi.org/10.1002/lrh2.70038","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Learning Health Systems (LHSs) offer potential for transforming healthcare through continuous learning and improvement. However, the current literature lacks a robust connection between theory and practice, limiting knowledge transferability across diverse healthcare environments. This article proposes a novel framework for integrating theorizing and continuous evaluation into LHSs, illustrated through the case of the Bipolar Action Network (The Network).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We use a process of theorizing to structure how mid-range theory, program theory and LHS design, development and evaluation can support improved practices and theories. We use the Conceptual Framework for Value-Creating Learning Health Systems as our initial mid-range theory, and the Bipolar Action Network serves as an illustrative case.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The framework emphasizes continuous multi-level LHS theory refinement based on real-world data, ensuring that both the system and its theoretical underpinnings evolve in response to new insights and challenges by connecting four steps: (1) Selecting an initial mid-range theory, (2) Creating a program theory for a specific LHS, (3) Evaluating LHS performance using operational data, and (4) Using evaluation findings to refine both the LHS program and mid-range theory.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This article contributes to the field by offering a practical methodology for bridging the gap between LHS theory and practice. By promoting ongoing theorizing and evaluation, our framework aims to both enhance the effectiveness and adaptability of LHSs, as well as inform theory development. Challenges remain, including resource intensity for data infrastructure and potential limitations in data quality or accessibility, which must be addressed to realize the full potential of LHSs as adaptive, theory-driven systems.</p>\u0000 </section>\u0000 </div>","PeriodicalId":43916,"journal":{"name":"Learning Health Systems","volume":"9 4","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lrh2.70038","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145375061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The PaTH from discovery to implementation: Using a PCORnet® Clinical Research Network's own research to prioritize topics for collaborative health improvement activities 从发现到实施的路径：使用PCORnet®临床研究网络自己的研究来优先考虑合作健康改善活动的主题

IF 2.6 Q2 HEALTH POLICY & SERVICES

Learning Health Systems

Pub Date : 2025-09-01 DOI: 10.1002/lrh2.70037

Autumn R. Boyer, Charles P. Friedman, Cynthia H. Chuang, Megan E. Hamm, April Wyncott, James Gregory Merritt, Michael J. Becich, Soledad A. Fernandez, Daniel E. Ford, Henry Lester Kirchner, Anuradha Paranjape, David A. Williams, Kathleen M. McTigue

Introduction

Applying research findings to health care practice has typically been a prolonged process, resulting in frustration to patients, providers, and other health system constituents. The PaTH Clinical Research Network developed the Discovery to Implementation (D2I) Initiative, rooted in Learning Health Systems principles, to engage constituents across seven academic sites/affiliated health systems in a process of identifying and prioritizing topics for future health improvement activities.

Aims

To develop a consensus process to prioritize topics derived from the network's own research for future implementation efforts conducted by network-based Learning Communities. To apply this process to identify priority topics based on the network's recently published research.

Methods

We developed a multi-institutional process for engaging a broad variety of perspectives to systematically review and evaluate PaTH-affiliated, patient-focused health research published between 2020 and 2022. Each site invited local constituents including patients, caregivers, clinicians, researchers, funders, health plan representatives, and health system leaders to help prioritize research topics and identify potential Learning Community areas of focus. D2I activities included brief surveys, review of data from the PCORnet® Common Data Model, and a multi-step deliberative process during two virtual events.

Results

The D2I Initiative included the participation of nearly 90 constituents in its iterative process to prioritize research topics. From 21 publications of patient-focused PaTH-affiliated research, three topics emerged as the highest priority for potential quality improvement work: back pain, hypertension, and frailty. Furthermore, the D2I Initiative mobilized interest in three potential Learning Communities to work toward implementing health care innovations.

Conclusions

The D2I format is an innovative, engaging, and scalable model for involving constituents throughout our health systems to prioritize topics for future improvement activities. The process aims, ultimately, to reduce the time from research discovery to health systems improvements while maintaining a focus on the needs and priorities of those involved at multiple system levels.

将研究成果应用于卫生保健实践通常是一个漫长的过程，导致患者、提供者和其他卫生系统组成部分感到沮丧。PaTH临床研究网络以学习卫生系统原则为基础，制定了从发现到实施（D2I）倡议，让七个学术站点/附属卫生系统的组成部分参与确定未来健康改善活动主题并确定优先顺序的过程。目的制定一个共识过程，优先考虑来自网络自身研究的主题，以便未来由基于网络的学习社区开展实施工作。将此过程应用于基于网络最近发表的研究来确定优先主题。我们开发了一个多机构流程，以广泛的视角系统地回顾和评估2020年至2022年间发表的path附属、以患者为中心的健康研究。每个站点都邀请了当地的成员，包括患者、护理人员、临床医生、研究人员、资助者、健康计划代表和卫生系统领导人，以帮助确定研究主题的优先级，并确定潜在的学习社区重点领域。D2I活动包括简短的调查，审查PCORnet®公共数据模型的数据，以及在两个虚拟事件期间的多步骤审议过程。D2I倡议包括近90个成员参与其迭代过程，以确定研究主题的优先级。从21篇以患者为中心的path附属研究中，有三个主题被认为是潜在质量改进工作的最高优先级：背痛、高血压和虚弱。此外，D2I倡议调动了三个潜在学习社区的兴趣，致力于实施医疗保健创新。D2I模式是一种创新的、有吸引力的、可扩展的模式，可以让我们整个卫生系统的组成部分参与进来，确定未来改进活动的优先主题。该进程的最终目的是减少从研究发现到改进卫生系统的时间，同时保持对多个系统级别相关人员的需求和优先事项的关注。

{"title":"The PaTH from discovery to implementation: Using a PCORnet® Clinical Research Network's own research to prioritize topics for collaborative health improvement activities","authors":"Autumn R. Boyer, Charles P. Friedman, Cynthia H. Chuang, Megan E. Hamm, April Wyncott, James Gregory Merritt, Michael J. Becich, Soledad A. Fernandez, Daniel E. Ford, Henry Lester Kirchner, Anuradha Paranjape, David A. Williams, Kathleen M. McTigue","doi":"10.1002/lrh2.70037","DOIUrl":"https://doi.org/10.1002/lrh2.70037","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Applying research findings to health care practice has typically been a prolonged process, resulting in frustration to patients, providers, and other health system constituents. The PaTH Clinical Research Network developed the Discovery to Implementation (D2I) Initiative, rooted in Learning Health Systems principles, to engage constituents across seven academic sites/affiliated health systems in a process of identifying and prioritizing topics for future health improvement activities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To develop a consensus process to prioritize topics derived from the network's own research for future implementation efforts conducted by network-based Learning Communities. To apply this process to identify priority topics based on the network's recently published research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We developed a multi-institutional process for engaging a broad variety of perspectives to systematically review and evaluate PaTH-affiliated, patient-focused health research published between 2020 and 2022. Each site invited local constituents including patients, caregivers, clinicians, researchers, funders, health plan representatives, and health system leaders to help prioritize research topics and identify potential Learning Community areas of focus. D2I activities included brief surveys, review of data from the PCORnet® Common Data Model, and a multi-step deliberative process during two virtual events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The D2I Initiative included the participation of nearly 90 constituents in its iterative process to prioritize research topics. From 21 publications of patient-focused PaTH-affiliated research, three topics emerged as the highest priority for potential quality improvement work: back pain, hypertension, and frailty. Furthermore, the D2I Initiative mobilized interest in three potential Learning Communities to work toward implementing health care innovations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The D2I format is an innovative, engaging, and scalable model for involving constituents throughout our health systems to prioritize topics for future improvement activities. The process aims, ultimately, to reduce the time from research discovery to health systems improvements while maintaining a focus on the needs and priorities of those involved at multiple system levels.</p>\u0000 </section>\u0000 </","PeriodicalId":43916,"journal":{"name":"Learning Health Systems","volume":"9 4","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lrh2.70037","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145375107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Clinical quality registries: Establishing the socio-technical infrastructure for learning health systems 临床质量登记：为学习卫生系统建立社会技术基础设施

IF 2.6 Q2 HEALTH POLICY & SERVICES

Learning Health Systems

Pub Date : 2025-08-23 DOI: 10.1002/lrh2.70036

Rob G. Stirling, Susannah Ahern, Jeremy Millar, Sue Evans, Paul Dawkins, John Zalcberg

Background

Clinical quality registries (CQR) systematically monitor and provide feedback on the appropriateness and effectiveness of health care within specific clinical domains, collecting data about medical care processes and outcomes, and providing benchmarked performance reports to health care providers for the purpose of driving improvements in safety and quality.

Aims

The successful development of a learning infrastructure requires the alignment of people, technologies, policies, and processes, brought together by shared needs and a culture of continuous quality improvement. The creation and description of such infrastructure is likely to successfully support the delivery of services critical to continuous quality improvement initiatives.

Materials and Methods

We aimed to describe the construction and impacts of healthcare improvement infrastructure within CQRs.

Results

Socio-technical infrastructure comprises participants that contribute to the design, evaluation, reporting and dissemination of quality improvement activities: employing effective and timely data acquisition, describing healthcare processes and outcomes; supported by directed policy process and supportive organisations. Review of CQR function identifies positive impacts on healthcare utilisation, improved clinical outcomes and significant improvement in survival supported by cost effective investment.

Discussion

Quality improvement frameworks and strategies have been developed to drive CQRs towards international best practice in learning health system structure for data collection and reporting; delivering efficiency and interoperability in data collection and exchange; promoting standardised approaches to CQR design.

Conclusion

Clinical quality registries have demonstrated significant national impacts in quality improvement in high burden disease domains. These registries rely on the construction and resourcing of socio-technical infrastructures that support quality improvement.

临床质量注册（CQR）系统地监测特定临床领域内医疗保健的适当性和有效性并提供反馈，收集有关医疗保健过程和结果的数据，并向医疗保健提供者提供基准绩效报告，以推动安全性和质量的改进。学习基础设施的成功开发需要人员、技术、政策和流程的一致性，通过共同的需求和持续质量改进的文化将它们结合在一起。这种基础设施的创建和描述很可能成功地支持对持续质量改进计划至关重要的服务的交付。材料和方法我们旨在描述cqr内医疗保健改善基础设施的构建和影响。社会技术基础设施包括参与设计、评估、报告和传播质量改进活动的参与者：采用有效和及时的数据采集，描述医疗保健过程和结果；得到直接的政策程序和支持组织的支持。对CQR功能的回顾确定了对医疗保健利用的积极影响，改善了临床结果，并在成本效益投资的支持下显著提高了生存率。制定了质量改进框架和战略，以推动CQRs在学习卫生系统数据收集和报告结构方面向国际最佳做法靠拢；在数据收集和交换方面提高效率和互操作性；促进CQR设计的标准化方法。结论临床质量登记在提高高负担疾病领域的质量方面具有显著的国家影响。这些登记处依赖于支持质量改进的社会技术基础设施的建设和资源。

{"title":"Clinical quality registries: Establishing the socio-technical infrastructure for learning health systems","authors":"Rob G. Stirling, Susannah Ahern, Jeremy Millar, Sue Evans, Paul Dawkins, John Zalcberg","doi":"10.1002/lrh2.70036","DOIUrl":"https://doi.org/10.1002/lrh2.70036","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Clinical quality registries (CQR) systematically monitor and provide feedback on the appropriateness and effectiveness of health care within specific clinical domains, collecting data about medical care processes and outcomes, and providing benchmarked performance reports to health care providers for the purpose of driving improvements in safety and quality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The successful development of a learning infrastructure requires the alignment of people, technologies, policies, and processes, brought together by shared needs and a culture of continuous quality improvement. The creation and description of such infrastructure is likely to successfully support the delivery of services critical to continuous quality improvement initiatives.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>We aimed to describe the construction and impacts of healthcare improvement infrastructure within CQRs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Socio-technical infrastructure comprises participants that contribute to the design, evaluation, reporting and dissemination of quality improvement activities: employing effective and timely data acquisition, describing healthcare processes and outcomes; supported by directed policy process and supportive organisations. Review of CQR function identifies positive impacts on healthcare utilisation, improved clinical outcomes and significant improvement in survival supported by cost effective investment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Quality improvement frameworks and strategies have been developed to drive CQRs towards international best practice in learning health system structure for data collection and reporting; delivering efficiency and interoperability in data collection and exchange; promoting standardised approaches to CQR design.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Clinical quality registries have demonstrated significant national impacts in quality improvement in high burden disease domains. These registries rely on the construction and resourcing of socio-technical infrastructures that support quality improvement.</p>\u0000 </section>\u0000 </div>","PeriodicalId":43916,"journal":{"name":"Learning Health Systems","volume":"9 4","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lrh2.70036","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145375025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Evaluation of four learning collaboratives for improving diagnostic excellence in radiology 对提高放射学诊断卓越性的四个学习协作的评价

IF 2.6 Q2 HEALTH POLICY & SERVICES

Learning Health Systems

Pub Date : 2025-08-22 DOI: 10.1002/lrh2.70035

Laura M. Holdsworth, Heather Z. Mui, Kandice Garcia Tomkins, Kay Zacharias-Andrews, Mythreyi Bhargavan-Chatfield, Marcy Winget, David Larson

Introduction

Learning collaboratives are frequently used within healthcare to facilitate practice improvement through collaboration among clinical teams across multiple organizations. The aim of this study was to use the Agency for Healthcare Research and Quality (AHRQ) collaborative taxonomy to identify collaborative elements that influence successful implementation of clinical practices and sustain improvements in four radiology learning collaboratives.

Methods

We used an ethnographic approach to evaluate a learning collaborative network using the AHRQ collaborative taxonomy. Data collection included observations, interviews, and review of site performance metrics.

Results

We identified four themes that spanned the four AHRQ taxonomy primary elements (innovation, time, communication, social system) that explained the influence of the collaborative structure on site improvements and sustained success: (1) structured education in quality improvement and access to quality improvement tools provides a framework for quality improvement; (2) an expert-guided, structured improvement process sets the pace of improvement; (3) intentional participant interaction and contribution in meetings reinforces accountability; and (4) credible leadership and facilitation sustains participation.

Conclusions

While we identified all four primary elements of the AHRQ framework as important for a successful learning collaborative, social system elements were particularly dominant in their influence on sites' success. In particular, expert, credible leaders who provided the right tools, at the right time and pace, with constructive guidance were critical for maintaining site engagement and driving problem-solving.

学习协作在医疗保健中经常使用，通过跨多个组织的临床团队之间的协作来促进实践改进。本研究的目的是利用医疗保健研究和质量局（AHRQ）的协作分类法来确定影响临床实践成功实施的协作要素，并在四个放射学学习协作中持续改进。方法采用人种志方法，利用AHRQ协作分类法对一个学习协作网络进行评估。数据收集包括观察、访谈和对站点性能指标的审查。结果：我们确定了四个主题，跨越了AHRQ分类的四个主要要素（创新、时间、沟通、社会系统），解释了协作结构对站点改进和持续成功的影响：(1)质量改进和获得质量改进工具的结构化教育为质量改进提供了框架；(2)由专家指导的、结构化的改进过程确定改进的速度；(3)参与者在会议中的有意互动和贡献加强了问责制；(4)可信的领导和促进维持参与。结论：虽然我们确定了AHRQ框架的所有四个主要元素对于成功的学习协作都很重要，但社会系统元素对网站成功的影响尤为重要。特别是，在正确的时间和速度提供正确工具的专家，可靠的领导者，以及建设性的指导，对于保持站点参与度和推动解决问题至关重要。

{"title":"Evaluation of four learning collaboratives for improving diagnostic excellence in radiology","authors":"Laura M. Holdsworth, Heather Z. Mui, Kandice Garcia Tomkins, Kay Zacharias-Andrews, Mythreyi Bhargavan-Chatfield, Marcy Winget, David Larson","doi":"10.1002/lrh2.70035","DOIUrl":"https://doi.org/10.1002/lrh2.70035","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Learning collaboratives are frequently used within healthcare to facilitate practice improvement through collaboration among clinical teams across multiple organizations. The aim of this study was to use the Agency for Healthcare Research and Quality (AHRQ) collaborative taxonomy to identify collaborative elements that influence successful implementation of clinical practices and sustain improvements in four radiology learning collaboratives.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used an ethnographic approach to evaluate a learning collaborative network using the AHRQ collaborative taxonomy. Data collection included observations, interviews, and review of site performance metrics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified four themes that spanned the four AHRQ taxonomy primary elements (innovation, time, communication, social system) that explained the influence of the collaborative structure on site improvements and sustained success: (1) structured education in quality improvement and access to quality improvement tools provides a framework for quality improvement; (2) an expert-guided, structured improvement process sets the pace of improvement; (3) intentional participant interaction and contribution in meetings reinforces accountability; and (4) credible leadership and facilitation sustains participation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>While we identified all four primary elements of the AHRQ framework as important for a successful learning collaborative, social system elements were particularly dominant in their influence on sites' success. In particular, expert, credible leaders who provided the right tools, at the right time and pace, with constructive guidance were critical for maintaining site engagement and driving problem-solving.</p>\u0000 </section>\u0000 </div>","PeriodicalId":43916,"journal":{"name":"Learning Health Systems","volume":"9 4","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lrh2.70035","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145375345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Improving information sharing in Medicaid home and community-based services with learning health systems: Implications for older adults and individuals living with disabilities and dementia 通过学习型卫生系统改善医疗补助家庭和社区服务的信息共享：对老年人和残疾和痴呆患者的影响

IF 2.6 Q2 HEALTH POLICY & SERVICES

Learning Health Systems

Pub Date : 2025-08-01 DOI: 10.1002/lrh2.70029

Chanee D. Fabius, Christin Diehl, Quincy M. Samus, Joseph J. Gallo, Jennifer L. Wolff

Introduction

Medicaid home and community-based services (HCBS) support community living for older adults and individuals living with disabilities. Information sharing and effective communication among home care team members are critical to HCBS care coordination but are often fragmented, resulting in potentially avoidable consequences, particularly for persons living with complex health conditions, like dementia. Medicaid HCBS programs collect a range of data that could be leveraged in a learning health system (LHS) model to strengthen coordination between home care team members to improve outcomes and equity in HCBS care delivery.

Methods

We leverage Friedman's Socio-technical Infrastructure for LHS to consider information sharing capabilities and needs within Medicaid HCBS in Maryland.

Results

Given longitudinal care complexities, significant costs, and data collection protocols, Medicaid HCBS is promising for LHS efforts. Recommendations for implementing an LHS in Medicaid HCBS highlight a socio-technical infrastructure (i.e., people, technology, policies, processes), information cycles (e.g., existing research relationships and opportunities for expansion), and governance (e.g., ensuring ethical LHS implementation). Additional considerations for persons living with dementia should be made, such as the integration of dementia-related policies into care delivery.

Conclusions

Integrating LHS strategies into Medicaid HCBS holds promise for strengthening efficiency and equity in information sharing across state agencies, care teams (e.g., direct care workers, nurses), and families.

医疗补助家庭和社区服务（HCBS）支持老年人和残疾人的社区生活。家庭护理团队成员之间的信息共享和有效沟通对于HCBS护理协调至关重要，但往往是分散的，导致可能可以避免的后果，特别是对于患有复杂健康状况的人，如痴呆症。医疗补助HCBS项目收集了一系列数据，这些数据可以在学习型医疗系统（LHS）模型中加以利用，以加强家庭护理团队成员之间的协调，从而改善HCBS医疗服务的结果和公平性。方法我们利用弗里德曼的LHS社会技术基础设施来考虑马里兰州医疗补助HCBS的信息共享能力和需求。结果考虑到纵向护理的复杂性、显著的成本和数据收集协议，医疗补助HCBS在LHS工作中是有希望的。在医疗补助HCBS中实施LHS的建议强调了社会技术基础设施（即人员、技术、政策、流程）、信息周期（例如，现有的研究关系和扩展机会）和治理（例如，确保道德的LHS实施）。还应考虑到痴呆症患者，例如将与痴呆症有关的政策纳入护理服务。将LHS战略纳入医疗补助HCBS有望加强州机构、护理团队（如直接护理人员、护士）和家庭之间信息共享的效率和公平性。

{"title":"Improving information sharing in Medicaid home and community-based services with learning health systems: Implications for older adults and individuals living with disabilities and dementia","authors":"Chanee D. Fabius, Christin Diehl, Quincy M. Samus, Joseph J. Gallo, Jennifer L. Wolff","doi":"10.1002/lrh2.70029","DOIUrl":"https://doi.org/10.1002/lrh2.70029","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Medicaid home and community-based services (HCBS) support community living for older adults and individuals living with disabilities. Information sharing and effective communication among home care team members are critical to HCBS care coordination but are often fragmented, resulting in potentially avoidable consequences, particularly for persons living with complex health conditions, like dementia. Medicaid HCBS programs collect a range of data that could be leveraged in a learning health system (LHS) model to strengthen coordination between home care team members to improve outcomes and equity in HCBS care delivery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We leverage Friedman's Socio-technical Infrastructure for LHS to consider information sharing capabilities and needs within Medicaid HCBS in Maryland.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Given longitudinal care complexities, significant costs, and data collection protocols, Medicaid HCBS is promising for LHS efforts. Recommendations for implementing an LHS in Medicaid HCBS highlight a socio-technical infrastructure (i.e., people, technology, policies, processes), information cycles (e.g., existing research relationships and opportunities for expansion), and governance (e.g., ensuring ethical LHS implementation). Additional considerations for persons living with dementia should be made, such as the integration of dementia-related policies into care delivery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Integrating LHS strategies into Medicaid HCBS holds promise for strengthening efficiency and equity in information sharing across state agencies, care teams (e.g., direct care workers, nurses), and families.</p>\u0000 </section>\u0000 </div>","PeriodicalId":43916,"journal":{"name":"Learning Health Systems","volume":"9 4","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lrh2.70029","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145375049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

首页上一页

1
2
3
4
5
6
7
...
10

下一页尾页

类型

全部化学•材料生命科学医学物理工程技术环境•农林材料科学地球科学法学管理学化学环境科学与生态学计算机科学教育学经济学农林科学人文科学生物学数学物理与天体物理心理学综合性期刊其他工业工程理学历史学农学文学信息工程

数据库

全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley

期刊

Learning Health Systems

全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.

﹀