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学习型医疗保健系统:我们目前处于什么阶段?一项系统综述。

The Learning Healthcare System: Where are we now? A systematic review.

作者信息

Budrionis Andrius, Bellika Johan Gustav

机构信息

Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway.

Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway.

出版信息

J Biomed Inform. 2016 Dec;64:87-92. doi: 10.1016/j.jbi.2016.09.018. Epub 2016 Sep 28.

Abstract

BACKGROUND AND OBJECTIVE

The Learning Healthcare System paradigm has attracted the attention of researchers worldwide. The great potential originating from high-scale health data reuse and the inclusion of patient perspectives into care models promises personalized care, lower costs of health services and minimized consumption of resources. The aim of this review is to summarize the attempts to adopt the novel paradigm, putting emphasis on implementations and evaluating the impact on current medical practices.

METHOD

PRISMA methodology was followed for structuring the review process. Three major research databases (PubMed, IEEE Xplore and ACM DL) were queried with the predefined search terms "learning healthcare" and "learning health". Publications containing specific theoretical or empirical results were considered.

RESULTS

Three hundred and fifty-eight publications were identified; however, only 32 met the inclusion criteria. Nineteen papers were characterized as theoretical contributions, while the rest presented empirical achievements. Only one paper described the initial estimates of impact and economy.

DISCUSSION

Individualistic communication of studies ignoring popular frameworks for assessing and reporting research achievements prevents the systematic generation of knowledge. Evaluating the impact of the Learning Healthcare System instances where it is implemented could work as a catalyst in reaching higher acceptance and adoption of the proposed ideas by healthcare worldwide; however, it mostly remains described in theory.

CONCLUSIONS

The review demonstrated the interest of researchers in exploring the Learning Healthcare System ideas. However, it also revealed minimal focus on evaluating the impact of the novel paradigm on both healthcare service delivery and patient outcome.

摘要

背景与目的

学习型医疗系统范式已引起全球研究人员的关注。大规模健康数据再利用以及将患者观点纳入护理模式所带来的巨大潜力有望实现个性化医疗、降低医疗服务成本并减少资源消耗。本综述的目的是总结采用这一新范式的尝试,重点关注实施情况并评估其对当前医疗实践的影响。

方法

采用PRISMA方法构建综述过程。使用预定义的搜索词“学习型医疗”和“学习健康”查询三个主要研究数据库(PubMed、IEEE Xplore和ACM DL)。纳入包含特定理论或实证结果的出版物。

结果

共识别出358篇出版物;然而,只有32篇符合纳入标准。19篇论文被归类为理论贡献,其余论文展示了实证成果。只有一篇论文描述了对影响和经济性的初步评估。

讨论

研究的个体化交流忽视了评估和报告研究成果的通用框架,阻碍了知识的系统生成。评估学习型医疗系统在实施过程中的影响,可能会促使全球医疗界更高程度地接受和采用所提出的理念;然而,目前大多仍停留在理论描述层面。

结论

本综述表明研究人员对探索学习型医疗系统理念感兴趣。然而,也揭示出对评估这一新范式对医疗服务提供和患者结局的影响关注较少。

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