The science of learning health systems: A scoping review of the empirical research (Preprint)

BACKGROUND The development and adoption of a Learning Health System (LHS) has been proposed as a means to address key challenges facing current and future healthcare systems. The first review of the LHS literature was conducted five years ago, identifying only a small number of published articles had empirically examined the implementation or testing of an LHS. It is timely to look more closely at the published empirical research and to ask the question “where are we now?”, five years on from that early LHS review. OBJECTIVE A scoping review of empirical research within the LHS domain. Taking an implementation science lens, the review aimed to map out the empirical research that has been conducted to date, identify limitations and future directions for the field. METHODS Two academic databases (PubMed and Scopus) were searched using the terms “learning health* system*” for articles published between 1st January 2016–31st January 2021 that had an explicit empirical focus on LHSs. Article information was extracted relevant to the review objective including each study’s: publication details; primary concern or focus; context; design; data type; implementation framework, model or theory used; and implementation determinants or outcomes examined. RESULTS A total of 76 studies were included in this review. Over two-thirds of the studies were concerned with implementing a particular program, system, or platform (n=53/76, 69.7%) designed to contribute to achieving an LHS. Most of these studies focused on a particular clinical context or patient population (n=37/53, 69.8%), with far fewer studies focusing on whole hospital systems (n = 4/53, 7.5%) or on other broad healthcare systems encompassing multiple facilities (n=12/53, 22.6%). Over two-thirds of the program-specific studies utilised quantitative methods (n=37/53, 69.8%), with a smaller number utilising qualitative methods (n=10/53, 18.9%) or mixed-methods designs (n=6/53, 11.3%). The remaining 23 studies were classified into one of three key areas: ethics, policies, and governance (n=10/76, 13.2%); stakeholder perspectives of LHSs (n=5/76, 6.6%); or LHS-specific research strategies and tools (n=8/76, 10.5%). Overall, relatively few studies were identified that incorporated an implementation science framework. CONCLUSIONS Although there has been considerable growth in empirical applications of LHSs within the last five years, paralleling the recent emergence of LHS-specific research strategies and tools, there are few high-quality studies. Comprehensive reporting of implementation and evaluation efforts is an important step to moving the LHS field forward. In particular, the routine use of implementation determinant and outcome frameworks will improve the assessment and reporting of barriers, enablers and implementation outcomes in this field and will enable comparison and identification of trends across studies.

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An Analysis of the Learning Health System in Its First Decade in Practice: Scoping Review (Preprint)

10.2196/preprints.17026 ◽

2019 ◽

Author(s):

Jodyn E Platt ◽

Minakshi Raj ◽

Matthias Wienroth

Keyword(s):

Health Care ◽

Health System ◽

Thematic Analysis ◽

Scoping Review ◽

Rapid Learning ◽

The Past ◽

Learning From Data ◽

Learning Health System ◽

Over Time ◽

Value Of Health

BACKGROUND In the past decade, Lynn Etheredge presented a vision for the Learning Health System (LHS) as an opportunity for increasing the value of health care via rapid learning from data and immediate translation to practice and policy. An LHS is defined in the literature as a system that seeks to continuously generate and apply evidence, innovation, quality, and value in health care. OBJECTIVE This review aimed to examine themes in the literature and rhetoric on the LHS in the past decade to understand efforts to realize the LHS in practice and to identify gaps and opportunities to continue to take the LHS forward. METHODS We conducted a thematic analysis in 2018 to analyze progress and opportunities over time as compared with the initial <i>Knowledge Gaps and Uncertainties</i> proposed in 2007. RESULTS We found that the literature on the LHS has increased over the past decade, with most articles focused on theory and implementation; articles have been increasingly concerned with policy. CONCLUSIONS There is a need for attention to understanding the ethical and social implications of the LHS and for exploring opportunities to ensure that these implications are salient in implementation, practice, and policy efforts.

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Reimagining community relationships for organizational learning: a scoping review with implications for a learning health system

BMC Health Services Research ◽

10.1186/s12913-021-06640-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Crystal Milligan ◽

Whitney Berta

Keyword(s):

Organizational Learning ◽

Transformative Learning ◽

Health System ◽

Health Systems ◽

Scoping Review ◽

English Language ◽

Explicit Knowledge ◽

Grey Literature ◽

Specific Patient ◽

Learning Health System

Abstract Background Communities represent a highly relevant source of knowledge with regard to not only healthcare performance but also sociocultural context, yet their role in learning health systems has not been studied. Situating the learning health system as an organization, this paper explores the phenomenon of organizational learning from or with communities (defined as one of ‘the people,’ such as a town, a specific patient group or another group directly receiving a healthcare service). Methods We conducted a scoping review to determine what is known about organizational learning from or with communities that the organization serves, and to contribute to a more comprehensive evidence base for building and operating learning health systems. In March 2019, we systematically searched six academic databases and grey literature, applying no date limits, for English language materials that described organizational learning in relation to knowledge transfer between an organization and a community. Numerous variables were charted in Excel and synthesized using frequencies and thematic analysis. We updated this search in August 2020. Results In total, 42 documents were included in our analysis. We found a disproportionate emphasis on learning explicit knowledge from community rather than on tacit knowledge or learning in equal partnership with community. Our review also revealed inconsistently defined concepts, tenuously linked with their theoretical and empirical foundations. Our findings provide insight to understand the organization-community learning relationship, including motives and power differentials; types of knowledge to be learned; structures and processes for learning; and transformative learning outcomes. Conclusions Our review makes a singular contribution to organizational learning literatures by drawing from diverse research disciplines such as health services, business and education to map what is known about learning from or with community. Broadly speaking, learning health systems literature would benefit from additional research and theory-building within a sociological paradigm so as to establish key concepts and associations to understand the nature of learning with community, as well as the practices that make it happen.

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Leveraging Disruptions to Create an Equitable, Age-Friendly, Learning Health System

Innovation in Aging ◽

10.1093/geroni/igab046.1124 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 291-291

Author(s):

Eric Lenze ◽

Brian Carpenter ◽

Nancy Morrow-Howell ◽

Beth Prusaczyk

Keyword(s):

Mental Health ◽

Older Adults ◽

Health System ◽

Health Equity ◽

Healthcare Workers ◽

Healthcare Systems ◽

Learning Health System ◽

External Evidence ◽

Rapid Changes ◽

Innovative Solutions

Abstract In a learning health system, the system’s own data and the experiences of its workforce are integrated with external evidence to provide better care. In an age-friendly health system, core principles of age-friendly care are integrated into every point in the system. Disruptions caused by the COVID-19 pandemic, and the innovations that addressed them, present an opportunity to discuss how these two frameworks may be combined and leveraged to transform care for older adults. We will present examples of pandemic-related disruptions, including rapid changes in how patients and providers move within and between facilities and the significant toll on healthcare workers’ mental health. We will also highlight innovative solutions to these disruptions that could transform healthcare systems. Critical to these points is a discussion of how these disruptions have disproportionately impacted healthcare workers and patients of color and how the innovations must be implemented using an anti-racist, health equity lens.

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Reimagining Community Relationships for Organizational Learning: a Scoping Review With Implications for a Learning Health System

10.21203/rs.3.rs-135727/v1 ◽

2020 ◽

Author(s):

Crystal Milligan ◽

Dorothy Wong ◽

Whitney Berta

Keyword(s):

Organizational Learning ◽

Transformative Learning ◽

Health System ◽

Health Systems ◽

Scoping Review ◽

English Language ◽

Explicit Knowledge ◽

Grey Literature ◽

Specific Patient ◽

Learning Health System

Abstract Background: Communities represent a highly relevant source of knowledge with regard to not only healthcare performance but also sociocultural context, yet their role in learning health systems has not been studied. Situating the learning health system as an organization, this paper explores the phenomenon of organizational learning from or with communities (defined as one of ‘the people,’ such as a town, a specific patient group or another group directly receiving a healthcare service).Methods: We conducted a scoping review to determine what is known about organizational learning from or with communities that the organization serves, and to contribute to a more comprehensive evidence base for building and operating learning health systems. In March 2019, we systematically searched six academic databases and grey literature, applying no date limits, for English language materials that described organizational learning in relation to knowledge transfer between an organization and a community. Numerous variables were charted in Excel and synthesized using frequencies and thematic analysis. We updated this search in August 2020. Results: In total, 42 documents were included in our analysis. We found a disproportionate emphasis on learning explicit knowledge from community rather than on tacit knowledge or learning in equal partnership with community. Our review also revealed inconsistently defined concepts, tenuously linked with their theoretical and empirical foundations. Our findings provide insight to understand the organization-community learning relationship, including motives and power differentials; types of knowledge to be learned; structures and processes for learning; and transformative learning outcomes.Conclusions: Our review makes a singular contribution to organizational learning literatures by drawing from diverse research disciplines such as health services, business and education to map what is known about learning from or with community. Broadly speaking, learning health systems literature would benefit from additional research and theory-building within a sociological paradigm so as to establish key concepts and associations to understand the nature of learning with community, as well as the practices that make it happen.

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Informed consent within a learning health system: A scoping review

Learning Health Systems ◽

10.1002/lrh2.10206 ◽

2020 ◽

Vol 4 (2) ◽

Cited By ~ 1

Author(s):

Annabelle Cumyn ◽

Adrien Barton ◽

Roxanne Dault ◽

Anne‐Marie Cloutier ◽

Rosalie Jalbert ◽

...

Keyword(s):

Informed Consent ◽

Health System ◽

Scoping Review ◽

System A ◽

Learning Health System

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The COVID-19 pandemic and healthcare systems in Africa: a scoping review of preparedness, impact and response

BMJ Global Health ◽

10.1136/bmjgh-2021-007179 ◽

2021 ◽

Vol 6 (12) ◽

pp. e007179

Author(s):

Gizachew A Tessema ◽

Yohannes Kinfu ◽

Berihun Assefa Dachew ◽

Azeb Gebresilassie Tesema ◽

Yibeltal Assefa ◽

...

Keyword(s):

Health Services ◽

Health System ◽

Health Systems ◽

Scoping Review ◽

Grey Literature ◽

Healthcare Systems ◽

Strengthen Health System ◽

Global Engagement ◽

Scoping Reviews ◽

Meta Analyses

BackgroundThe COVID-19 pandemic has overwhelmed health systems in both developed and developing nations alike. Africa has one of the weakest health systems globally, but there is limited evidence on how the region is prepared for, impacted by and responded to the pandemic.MethodsWe conducted a scoping review of PubMed, Scopus, CINAHL to search peer-reviewed articles and Google, Google Scholar and preprint sites for grey literature. The scoping review captured studies on either preparedness or impacts or responses associated with COVID-19 or covering one or more of the three topics and guided by Arksey and O’Malley’s methodological framework. The extracted information was documented following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension checklist for scoping reviews. Finally, the resulting data were thematically analysed.ResultsTwenty-two eligible studies, of which 6 reported on health system preparedness, 19 described the impacts of COVID-19 on access to general and essential health services and 7 focused on responses taken by the healthcare systems were included. The main setbacks in health system preparation included lack of available health services needed for the pandemic, inadequate resources and equipment, and limited testing ability and surge capacity for COVID-19. Reduced flow of patients and missing scheduled appointments were among the most common impacts of the COVID-19 pandemic. Health system responses identified in this review included the availability of telephone consultations, re-purposing of available services and establishment of isolation centres, and provisions of COVID-19 guidelines in some settings.ConclusionsThe health systems in Africa were inadequately prepared for the pandemic, and its impact was substantial. Responses were slow and did not match the magnitude of the problem. Interventions that will improve and strengthen health system resilience and financing through local, national and global engagement should be prioritised.

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3428 Adopting a learning health system architecture: a scoping review and pre-implementation framework to reduce readmissions within academic hospitals

Journal of Clinical and Translational Science ◽

10.1017/cts.2019.312 ◽

2019 ◽

Vol 3 (s1) ◽

pp. 138-138

Author(s):

Jami Anderson ◽

Becky Reamy ◽

Michael Mugavero

Keyword(s):

Knowledge Translation ◽

Health System ◽

Health Systems ◽

Scoping Review ◽

Outcomes Research ◽

Academic Hospital ◽

Patient Centered ◽

Implementation Framework ◽

Learning Health System ◽

Academic Hospitals

OBJECTIVES/SPECIFIC AIMS: Of the six Centers for Medicare and Medicaid Services (CMS) monitored diagnoses targeted for readmissions reductions, reasons for readmissions within academic hospitals are poorly understood and reflect complex interactions between the patient, provider and organizational-level responses to initial hospitalization. Learning health systems (the organizational and orchestrated integration of research into evidence-based practice) can address the complexities of readmissions through an innovative approach to knowledge translation and patient-centered outcomes research. The objective of this review is to define and optimize the architecture of learning health systems to produce a dynamic pre-implementation framework of knowledge translation and patient-centered outcomes research, leveraging two engines (research and learning) within the academic and clinical settings for reducing readmissions. METHODS/STUDY POPULATION: Three databases were utilized for this scoping review (PubMed, Academic Search Premier, and Scopus) focusing on 1.) learning health systems and the methods of defining and building these systems within an academic hospital setting and 2.) the use of learning health systems in reducing readmissions within academic hospitals. Empirical articles and reviews pertaining to the architecture, development, conceptualization, definition, and translation of learning health systems were identified and compiled into a scoping review and proposed framework. RESULTS/ANTICIPATED RESULTS: The scoping review yielded 139 articles; from which 28 articles were retained. No articles were found utilizing learning health systems to address readmissions. Thus, a new architectural framework was developed incorporating common architectural themes from the literature with adaptations to fit the interests of patients, providers, and researchers in reducing readmissions within academic hospitals (Figure 1). DISCUSSION/SIGNIFICANCE OF IMPACT: Given the dearth of information applying learning health systems to readmissions, the proposed architecture for an integrative learning health system can be utilized as a dynamic foundation for adoption and pre-implementation planning for reducing readmissions within academic hospital settings. Additionally, the authors expect this model to be tested and continually refined to address historical and emerging issues for clinically-relevant and clinically-effective approaches to patient-centered practice and research.

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Small sided games: a scoping review of literature 2006-2016

International Sports Studies ◽

10.30819/iss.41-2.02 ◽

2019 ◽

Vol 41 (2) ◽

pp. 5-31

Author(s):

Shane Pill ◽

Deboraha Agnew

Keyword(s):

Empirical Research ◽

Scoping Review ◽

Selection Criteria ◽

Physiological Responses ◽

Training Effect ◽

Review Of Literature ◽

Academic Journal ◽

Practice Activity ◽

Thematic Approach ◽

Determining Factor

This article reports the findings of a scoping review of the use of small-sided games (SSGs) as a teaching or coaching pedagogy across four game categories. The selection criteria included empirical research available online, published after January 1 2006 and prior to December 31, 2016, in an academic journal. The data were analysed through an inductive thematic approach which generated two themes: Development and Practical considerations. This review found that SSGs can be used as a deliberate pedagogy to elicit physiological responses for a training effect. Given that the variables associated with SSGs include pitch size, game intensity, and number of players, a key determining factor in the implementation of SSGs includes the objective of the practice activity.

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