Learning Health Systems最新文献

{"title":"Funding model for embedded research: Impacts, challenges, and lessons learned for investigators","authors":"C. Ann Vitous,&nbsp;Kaylee W. Burgan,&nbsp;John P. Donnelly,&nbsp;Nicholas W. Bowersox,&nbsp;Linda M. Kawentel","doi":"10.1002/lrh2.70015","DOIUrl":"https://doi.org/10.1002/lrh2.70015","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Embedding research mechanisms within Learning Health Systems can improve healthcare performance by informing program development and expansion, supporting strategic planning, and demonstrating value. The role of the investigator is crucial in partnered funding mechanisms, and there is a growing need to better understand how investigators operate in this space. This evaluation assessed the impacts, challenges, and lessons learned by investigators funded through an embedded research program.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was an outcome evaluation within the Department of Veterans Affairs healthcare system and followed an adapted version of the Centers for Disease Control and Prevention evaluation framework. Three data sources were used to generate information: a descriptive analysis of close-out reports, a comprehensive search of research databanks, and an online survey focused on high-priority areas. Participants were investigators whose projects took place during the FY2017–2021 funding period. During the funding period, 25 unique investigators completed projects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Investigators indicated that the embedded research program had significant, meaningful impacts on their professional development, including generating tangible products that advanced their professional goals and more subtle impacts, such as increasing knowledge and experience, increasing multidisciplinary collaboration, and creating opportunities for professional development. Investigators also reflected on challenges, including issues with the data, logistical concerns, and disruptions due to COVID-19. Investigators identified lessons learned for future collaboration efforts, including the need for feasible and appropriate goals, as well as dedicated and trained support staff.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The insights from this evaluation provide understanding on the impacts, challenges, and lessons learned from the experiences of investigators participating in embedded research mechanisms. The impacts illuminated explicit ways in which investigators professionally benefited from this program, as well as challenges and lessons learned that offer insights into how future programs can be tailored. These findings offer ways to improve practices in implementing LHS in other large healthcare organizations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":43916,"journal":{"name":"Learning Health Systems","volume":"9 4","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lrh2.70015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145375312","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}

{"title":"Artificial intelligence and physician burnout: A productivity paradox","authors":"David Alexander Goodson,&nbsp;Brittany Garcia,&nbsp;Michael Hogarth,&nbsp;Shin-Ping Tu","doi":"10.1002/lrh2.70013","DOIUrl":"https://doi.org/10.1002/lrh2.70013","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Physician burnout persists in the American healthcare system. In part, this burnout is believed to be driven by the Electronic Health Record (EHR) and its fraught role in the clinical work of physicians. Artificial intelligence (AI)-enabled healthcare technologies are often promoted on the basis of their promise to reduce burnout by introducing efficiencies into clinical work, particularly related to EHR utilization and documentation. Where documentation is perceived as the problem, AI scribes are offered as the solution.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This essay looks closely at existing studies of AI scribes in clinical context and draws upon experience and understanding of healthcare delivery and the EHR to anticipate how AI may related to provider burnout.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We find that it is premature to assert that AI tools will reduce physician burnout. Considering the integration of AI scribes into Learning Health Systems healthcare delivery becomes a starting point for understanding the challenges faced in safely adopting AI tools more generally, with attention to the healthcare workforce and patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>It is not a foregone conclusion that AI-enabled healthcare technologies, in their current state and application, will lead to improved healthcare delivery and reduced burnout. Instead, this is an open question that demands rigorous evaluation and high standards of evidence before we restructure the work of physicians and redefine the care of our patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":43916,"journal":{"name":"Learning Health Systems","volume":"9 4","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lrh2.70013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145375024","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}

{"title":"How senior leaders support innovations in large learning health systems: Insights from United States Veterans Health Administration national program office leaders","authors":"Jaifred Christian F. Lopez,&nbsp;Sallie Allgood,&nbsp;Kate Sheahan,&nbsp;Brandolyn White,&nbsp;M. Amy Kirshner,&nbsp;Suzanne Shirley,&nbsp;Madison Coffey,&nbsp;Amanda Milo,&nbsp;Sarah L. Cutrona,&nbsp;Laura Damschroder,&nbsp;Gemmae M. Fix,&nbsp;Andrea L. Nevedal,&nbsp;Caitlin M. Reardon,&nbsp;Marilla A. Opra Widerquist,&nbsp;Maria Arasim,&nbsp;Allen L. Gifford,&nbsp;Kathryn DeLaughter,&nbsp;George L. Jackson","doi":"10.1002/lrh2.70012","DOIUrl":"https://doi.org/10.1002/lrh2.70012","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The U.S. Veterans Health Administration (VHA) formed an Innovation Ecosystem that develops and disseminates innovative practices to enhance Veterans' health. Support of senior leadership and their perception of the innovation process is key to the Ecosystem's success. We aimed to elicit insights on (1) how national VHA program office leaders define innovation, and (2) important considerations in facilitating the adoption of innovations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>As part of a quality improvement initiative, we conducted 19 semi-structured interviews via teleconference. Interviews involved 4 administration offices, 7 clinical and population health program offices, and 8 policy and quality improvement offices; 12 of these offices reported experience working with the Innovation Ecosystem. Responses were audio recorded, transcribed, and analyzed using constructs from the Consolidated Framework for Implementation Research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Participants generally agreed that innovation within VHA is defined by evidence-based development and implementation of interventions that improve response to Veterans' needs. Considerations in facilitating innovations include: (1) implementation climate that promotes network-building, open communication, and well-executed planning processes; (2) implementation infrastructures that enable engagement with key players and augment existing resources; and (3) innovation evidence strength and responsiveness to patient needs. Individuals working in policy-related offices were more likely to identify complexity, leadership engagement, culture and available resources as factors in choosing innovations to adopt. Individuals who reported experience of working with the Ecosystem emphasized the importance of intra-organizational networks and a favorable implementation climate, while those without experience noted the importance of working with external change agents. CFIR ‘inner setting’ constructs were seen in responses across all categories; meanwhile, emerging constructs highlight how innovation should be balanced by the reality of operations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Among national VHA program office leaders, innovation is pursued to improve Veterans' health. Resources, networks, culture, and processes are considered important factors among program office leaders to support and encourage innovation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":43916,"journal":{"name":"Learning Health Systems","volume":"9 3","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lrh2.70012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144635208","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}

{"title":"Disentangling informing participants from obtaining their consent","authors":"Patricia Pearl O'Rourke,&nbsp;Joseph Ali,&nbsp;Judith Carrithers,&nbsp;David Magnus,&nbsp;Benjamin S. Wilfond,&nbsp;Sheana Bull,&nbsp;Laura M. Dember,&nbsp;Gail D'Onofrio,&nbsp;Julie Goldman,&nbsp;P. Michael Ho,&nbsp;Edward R. Melnick,&nbsp;Karen L. Staman,&nbsp;James A. Tulsky,&nbsp;Miguel A. Vazquez,&nbsp;Angelo Volandes,&nbsp;David Wendler","doi":"10.1002/lrh2.70014","DOIUrl":"https://doi.org/10.1002/lrh2.70014","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Pragmatic clinical trials conducted in the context of routine care frequently satisfy the regulatory criteria for a waiver of research consent. When they do, investigators and Institutional Review Boards might assume that there is no reason to communicate any information regarding the study to participants. Yet, this approach ignores the possibility that there may be value in providing information to participants, even when the study does not pose significant risks and researchers are not obtaining their consent.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Members of the NIH Collaboratory Ethics and Regulatory Core working group used ethical analysis to determine whether there are reasons to provide information to research participants, other than notifying them of significant risks or obtaining their consent. Study team members then provided examples of trials which illustrate the feasibility and different options for providing information to participants in the context of trials conducted with a waiver of research consent.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Communicating information to participants can promote one or more of six goals: respect for persons, participant understanding of the research, participant understanding of their contributions, participant ability to voice any concerns, participant engagement, and trust and trustworthiness. Providing information can also raise potential concerns about feasibility and cost, which need to be balanced against these reasons to inform participants. Depending on the study, a variety of methods can be used to communicate information; for example, letters, email, flyers, posters, as well as brief conversations with clinicians.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Even when researchers are not obtaining participants' consent, communicating information can promote one or more of six important goals. Providing information to participants should thus be the default for trials conducted under a waiver of research consent.</p>\u0000 </section>\u0000 </div>","PeriodicalId":43916,"journal":{"name":"Learning Health Systems","volume":"9 4","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lrh2.70014","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145375279","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}

{"title":"The surprising politics of learning health systems","authors":"Adalsteinn Brown,&nbsp;Robert J. Reid","doi":"10.1002/lrh2.70008","DOIUrl":"https://doi.org/10.1002/lrh2.70008","url":null,"abstract":"<p>Learning Health Systems (LHS) are an increasingly common element of health policy reform efforts in a number of jurisdictions. There is little disagreement around the LHS vision, and early adopters provide some development guidance. Despite the attractiveness of the LHS vision, progress on adoption by systems remains slow. In this commentary, we consider one potential reason, namely politics, or the ways in which government bodies, interest groups, and political ideas shape structures and policies. LHS can change the ways that health systems work and interact with payors and populations and thereby create political challenges. The need for upfront new investment to build capacity for LHS activities, the creation of new partnerships or collaborations, increased transparency, and the direct engagement of populations can all create political risks and subsequent barriers. With a broad population health focus that extends across typical political cycles, politics may create an even greater barrier. We suggest that building strong engagement, clear and transparent accountabilities, communities of practice and other vehicles to promote data sharing and transparency, and careful attention to risk management may all help reduce political challenges. Some sets of policies—like value-based care—can support these sorts of changes and accelerate the adoption of LHS.</p>","PeriodicalId":43916,"journal":{"name":"Learning Health Systems","volume":"9 3","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lrh2.70008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144635503","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}

{"title":"The experience of a learning community to develop a HeartSafe Home intervention to improve survival from out-of-hospital cardiac arrest","authors":"Amanda L. Missel,&nbsp;Noor Khan,&nbsp;Michelle Williams,&nbsp;Emilee I. Coulter-Thompson,&nbsp;Sameer Hameed,&nbsp;James M. Pribble,&nbsp;Theresa Shields,&nbsp;Gwen Fosse,&nbsp;Stephen R. Dowker,&nbsp;Robert W. Neumar,&nbsp;Robert Swor,&nbsp;Jodyn Platt","doi":"10.1002/lrh2.70010","DOIUrl":"https://doi.org/10.1002/lrh2.70010","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>In the United States, only 8.2% of people treated for out-of-hospital cardiac arrest (OHCA) in 2023 survived with good neurological function. The interval from the onset of cardiac arrest to the start of CPR and defibrillation is strongly associated with survival and neurologic recovery. We present our process of conducting stakeholder engagement sessions to engage an OHCA Learning Community to develop an intervention to decrease time to first treatment (CPR and AED) and improve survival from OHCA in Michigan's Washtenaw and Livingston Counties.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a CPR survey, a Community Engagement Studio, and three stakeholder engagement sessions with the OHCA Learning Community in Washtenaw and Livingston Counties in Michigan to achieve three goals: (1) increasing public awareness of OHCA, (2) engaging diverse and underserved communities, and (3) developing an intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>As a result of these sessions, we identified improving in-home OHCA response, addressing disparities in underserved and minority communities, and increasing capacity among families and friends as the key targets for intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Based on these sessions, we developed a HeartSafe Home intervention that aims to prepare household members to respond to a cardiac arrest at home.</p>\u0000 </section>\u0000 </div>","PeriodicalId":43916,"journal":{"name":"Learning Health Systems","volume":"9 4","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lrh2.70010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145375214","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}

{"title":"Four distinct models of learning health systems: Strength through diversity","authors":"Charles P. Friedman,&nbsp;Sarah M. Greene","doi":"10.1002/lrh2.70009","DOIUrl":"https://doi.org/10.1002/lrh2.70009","url":null,"abstract":"<p>The concept of a learning health system (LHS) was established nearly 20 years ago as a unifying commitment to speed the generation and use of evidence primarily by leveraging rapid advances in data and technologies, resulting in optimized care for each patient. In the ensuing decades, vanguard adopters of the LHS who have sought to move the LHS from conceptual to operational have done so in ways that fit with and reflect their organizational structure, mission, and culture—as well as their personal values and experiences. They have also extended the focus from health care to include individual and population health more broadly. This commentary describes four distinctive models that have evolved as learning health system activities have matured. Viewing this diversity as a strength, the features, commonalities, and unique differences of these models are described.</p>","PeriodicalId":43916,"journal":{"name":"Learning Health Systems","volume":"9 2","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lrh2.70009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143835793","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}