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.
{"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}
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.
{"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}
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.
{"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}
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.
{"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}
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.
{"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}
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.
{"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}
Sally A. Kraft, Chelsey R. Canavan, Gregory A. Norman, Rudolph Fedrizzi, Tina C. Foster
Introduction
Improving health equity requires engagement with partners outside of the clinical health system to address the socio-political-economic and structural drivers that shape health equity. Health systems need to focus on learning with communities to impact these conditions. The learning health system will need to evolve to a learning community to advance health equity.
Methods
We describe the experience of researchers, educators, clinicians, and community members (“four pillars”) working together to develop the Dartmouth Health Center for Advancing Rural Health Equity.
Results
Structures and processes were co-designed to create an infrastructure that supports partnerships dedicated to improving rural health equity through community-based projects, education and training, and advocacy efforts.
Conclusion
Co-designing an infrastructure to support enduring partnerships between research, education, clinical service, and community can support learning and improvement activities focused on improving health equity.
{"title":"It takes a village: Evolving from learning health system to learning community for health equity","authors":"Sally A. Kraft, Chelsey R. Canavan, Gregory A. Norman, Rudolph Fedrizzi, Tina C. Foster","doi":"10.1002/lrh2.70031","DOIUrl":"10.1002/lrh2.70031","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Improving health equity requires engagement with partners outside of the clinical health system to address the socio-political-economic and structural drivers that shape health equity. Health systems need to focus on learning with communities to impact these conditions. The learning health system will need to evolve to a learning community to advance health equity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We describe the experience of researchers, educators, clinicians, and community members (“four pillars”) working together to develop the Dartmouth Health Center for Advancing Rural Health Equity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Structures and processes were co-designed to create an infrastructure that supports partnerships dedicated to improving rural health equity through community-based projects, education and training, and advocacy efforts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Co-designing an infrastructure to support enduring partnerships between research, education, clinical service, and community can support learning and improvement activities focused on improving health equity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":43916,"journal":{"name":"Learning Health Systems","volume":"10 2","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12900615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146203280","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}
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.
{"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}
Romana Hasnain-Wynia, Rachel Everhart, Nancy Wittmer, Laura J. Podewils, Thomas D. MacKenzie
Introduction
A learning health system (LHS) strives to improve clinical practice and outcomes through applied research and quality improvement (QI). However, distinguishing between research and QI has been a persistent challenge. While research involving human subjects is highly regulated, QI remains largely unregulated, lacking in comparable oversight. With confusion and uncertainty surrounding this distinction and little practical guidance for QI activities, Denver Health's LHS developed a model of practice for reviewing QI projects.
Methods
In 2018, Denver Health, an integrated academic safety-net delivery system, established the Quality Improvement Review Committee (QuIRC) as a practical approach for distinguishing between QI and human subjects research. We describe the institutional structure and processes, from identifying the problem to establishing the committee and charter, to obtaining institution support, and finally implementation and improvement, ensuring transparency and protections of disseminated QI work.
Results
Over 7 years, the QuIRC has reviewed 379 submissions, with 78% approved as QI (non-human subjects research), 8% referred to the Colorado Multiple Institutional Review Board, and 13% requiring clarification or being withdrawn. A standardized review process, clear charter, broad organizational representation, executive sponsorship, and IRB collaboration enhanced transparency and engagement. The QuIRC has facilitated QI dissemination, supporting the LHS framework and increasing recognition of the impact of QI on clinical care and patient outcomes.
Conclusions
The QuIRC framework has improved clarity and oversight of QI activities at Denver Health. These practical approaches can be adapted by other health care systems, contributing to broader efforts to establish national guidance for QI oversight.
{"title":"From ethical guidance to practice: Oversight of quality improvement activities at Denver Health, a learning health system","authors":"Romana Hasnain-Wynia, Rachel Everhart, Nancy Wittmer, Laura J. Podewils, Thomas D. MacKenzie","doi":"10.1002/lrh2.70030","DOIUrl":"https://doi.org/10.1002/lrh2.70030","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>A learning health system (LHS) strives to improve clinical practice and outcomes through applied research and quality improvement (QI). However, distinguishing between research and QI has been a persistent challenge. While research involving human subjects is highly regulated, QI remains largely unregulated, lacking in comparable oversight. With confusion and uncertainty surrounding this distinction and little practical guidance for QI activities, Denver Health's LHS developed a model of practice for reviewing QI projects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In 2018, Denver Health, an integrated academic safety-net delivery system, established the Quality Improvement Review Committee (QuIRC) as a practical approach for distinguishing between QI and human subjects research. We describe the institutional structure and processes, from identifying the problem to establishing the committee and charter, to obtaining institution support, and finally implementation and improvement, ensuring transparency and protections of disseminated QI work.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Over 7 years, the QuIRC has reviewed 379 submissions, with 78% approved as QI (non-human subjects research), 8% referred to the Colorado Multiple Institutional Review Board, and 13% requiring clarification or being withdrawn. A standardized review process, clear charter, broad organizational representation, executive sponsorship, and IRB collaboration enhanced transparency and engagement. The QuIRC has facilitated QI dissemination, supporting the LHS framework and increasing recognition of the impact of QI on clinical care and patient outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The QuIRC framework has improved clarity and oversight of QI activities at Denver Health. These practical approaches can be adapted by other health care systems, contributing to broader efforts to establish national guidance for QI oversight.</p>\u0000 </section>\u0000 </div>","PeriodicalId":43916,"journal":{"name":"Learning Health Systems","volume":"9 4","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lrh2.70030","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145375300","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}
Deanna Chaukos, Sandalia Genus, Tim Guimond, Maria Mylopoulos
Background
Health care is fragmented, stigmatizing, and often does not meet the needs of people living with HIV who present to care with significant complexity. Integrated care is an evidence-based solution, but rarely is enacted across hospital and community settings. Education for community workers that builds capacity toward integrated care is an essential missing piece.
Methods
Here we describe a qualitative study of the ECHO HIV Psychiatry, a virtual educational series that supports a community of practice of community workers in the HIV sector in Toronto, Canada. The educational series is 9 sessions long and occurs twice/year, reporting here on 4 cycles of the series, from April 2023 to December 2024. Utilizing participant interviews (n = 29) and ethnographic observation of education sessions, we conducted an abductive analysis, utilizing concepts of adaptive expertise and Knowledge Building Communities (KBCs) to better understand our participant narratives. Adaptive expertise is a theoretical framework in health professions education that describes capabilities that support healthcare workers to navigate complexity in modern healthcare. KBCs in healthcare leverage collaboration and diverse perspectives to support the generation of new solutions.
Results
Participants' main learning from the ECHO was an approach to caring for clients with significant complexity (including mental health concerns), and the learning mechanisms which supported this include: (1) Explicit value placed on diverse domains of knowledge created psychological safety for risk taking; (2) Perspective exchange with people in different roles facilitated confidence for community workers, as well as epistemic humility (humility about what is known or knowable); and (3) Learning in the ECHO led to new knowledge creation through collaboration and improvisation.
Conclusions
Results of this study demonstrate how education can support community workers with an approach to complexity, and that this kind of learning may empower community workers to expand the scope of their role, collaborate across hospital and community, and create new solutions to difficult-to-solve problems in health care. These are features of a Knowledge Building Community.
{"title":"From “Community of Practice” to “Knowledge Building Community”—A qualitative study of project ECHO as facilitator of adaptive expertise in frontline community workers","authors":"Deanna Chaukos, Sandalia Genus, Tim Guimond, Maria Mylopoulos","doi":"10.1002/lrh2.70028","DOIUrl":"https://doi.org/10.1002/lrh2.70028","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Health care is fragmented, stigmatizing, and often does not meet the needs of people living with HIV who present to care with significant complexity. Integrated care is an evidence-based solution, but rarely is enacted across hospital and community settings. Education for community workers that builds capacity toward integrated care is an essential missing piece.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Here we describe a qualitative study of the ECHO HIV Psychiatry, a virtual educational series that supports a community of practice of community workers in the HIV sector in Toronto, Canada. The educational series is 9 sessions long and occurs twice/year, reporting here on 4 cycles of the series, from April 2023 to December 2024. Utilizing participant interviews (<i>n</i> = 29) and ethnographic observation of education sessions, we conducted an abductive analysis, utilizing concepts of adaptive expertise and Knowledge Building Communities (KBCs) to better understand our participant narratives. Adaptive expertise is a theoretical framework in health professions education that describes capabilities that support healthcare workers to navigate complexity in modern healthcare. KBCs in healthcare leverage collaboration and diverse perspectives to support the generation of new solutions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Participants' main learning from the ECHO was an <i>approach</i> to caring for clients with significant complexity (including mental health concerns), and the learning mechanisms which supported this include: (1) Explicit value placed on diverse domains of knowledge created psychological safety for risk taking; (2) Perspective exchange with people in different roles facilitated confidence for community workers, as well as epistemic humility (humility about what is known or knowable); and (3) Learning in the ECHO led to new knowledge creation through collaboration and improvisation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Results of this study demonstrate how education can support community workers with an approach to complexity, and that this kind of learning may empower community workers to expand the scope of their role, collaborate across hospital and community, and create new solutions to difficult-to-solve problems in health care. These are features of a Knowledge Building Community.</p>\u0000 </section>\u0000 </div>","PeriodicalId":43916,"journal":{"name":"Learning Health Systems","volume":"9 4","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lrh2.70028","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145375355","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}
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