Morain Stephanie R, Kass Nancy E, Grossmann Claudia
Center for Medical Ethics and Health Policy Baylor College of Medicine Houston Texas.
Johns Hopkins Bloomberg School of Public Health Johns Hopkins Berman Institute of Bioethics and Department of Health Policy and Management Baltimore Maryland.
Learn Health Syst. 2016 Oct 21;1(1):e10015. doi: 10.1002/lrh2.10015. eCollection 2017 Jan.
The US health care system faces pressure to improve quality while managing complexity, curbing costs, and reducing inefficiency. These shortcomings have sparked interest in the Learning Health Care System (LHCS) as an alternate approach to organizing research and clinical care. Although diverse stakeholders have expressed support for moving toward an LHCS model, limited guidance exists for institutions considering such a transition.
Interviews were conducted with institutional leaders from 25 health care systems considered to be at the forefront of LHCS. Interviews focused on the process of transitioning toward an LHCS, including motivations for change, key components, challenges encountered, and strategies for success, and on ethics and regulatory issues encountered. Qualitative analysis identified key themes across institutions.
Respondents described 5 themes related to the origin of their LHCS transformation: (1) visionary leadership or influence of a key individual, (2) adaptation to a changing health care landscape, (3) external funding, (4) regulatory or legislative influence, and (5) mergers or expansions. They described 6 challenges: (1) organizational culture, (2) data systems and data sharing, (3) funding learning activities, (4) limited supply of skilled individuals, (5) managing competing priorities, and (6) regulatory challenges. Finally, they suggested 8 strategies to support transformation: (1) strong leadership, (2) setting a limited number of organizational priorities, (3) building on existing strengths, (4) training programs, (5) "purposeful" design of data systems, (6) internal transparency of quality metrics, (7) payer/provider integration, and, within academic medical centers, (8) academic/clinical integration.
Even institutions at the forefront of LHCS described the transition as difficult. Their experiences provide insight into other institutions considering similar transitions, including elements essential for success and likely challenges.
美国医疗保健系统在管理复杂性、控制成本和减少低效率的同时，面临着提高质量的压力。这些缺陷引发了人们对学习型医疗保健系统（LHCS）的兴趣，它是一种组织研究和临床护理的替代方法。尽管不同的利益相关者都表示支持向LHCS模式转变，但对于考虑这种转变的机构来说，指导却很有限。
对25个被认为处于LHCS前沿的医疗保健系统的机构领导人进行了访谈。访谈集中在向LHCS转变的过程，包括变革的动机、关键组成部分、遇到的挑战和成功策略，以及遇到的伦理和监管问题。定性分析确定了各机构的关键主题。
受访者描述了与他们LHCS转型起源相关的5个主题：（1）有远见的领导或关键人物的影响，（2）适应不断变化的医疗保健格局，（3）外部资金，（4）监管或立法影响，以及（5）合并或扩张。他们描述了6个挑战：（1）组织文化，（2）数据系统和数据共享，（3）为学习活动提供资金，（4）技术人员供应有限，（5）管理相互竞争的优先事项，以及（6）监管挑战。最后，他们提出了8个支持转型的策略：（1）强有力的领导，（2）设定有限数量的组织优先事项，（3）基于现有优势，（4）培训项目，（5）数据系统的“有目的”设计，（6）质量指标的内部透明度，（7）支付方/提供者整合，以及在学术医疗中心内，（8）学术/临床整合。
即使是处于LHCS前沿的机构也表示转型困难。他们的经验为其他考虑类似转型的机构提供了见解，包括成功的关键要素和可能面临的挑战。
