Seid Michael, Hartley David M, Dellal George, Myers Sarah, Margolis Peter A
Pulmonary Medicine Cincinnati Children's Hospital Medical Center Cincinnati Ohio.
James M Anderson Center for Health Systems Excellence Cincinnati Children's Hospital Medical Center Cincinnati Ohio.
Learn Health Syst. 2019 Nov 13;4(1):e10205. doi: 10.1002/lrh2.10205. eCollection 2020.
Collaborative learning health systems (CLHSs) enable patients, clinicians, researchers, and others to collaborate at scale to improve outcomes and generate new knowledge. An organizational framework to facilitate this collaboration is the actor-oriented architecture, composed of (a) actors (people, organizations, and databases) with the values and abilities to self-organize; (b) a commons where they create and share resources; and (c) structures, protocols, and processes that facilitate multiactor collaboration. CLHSs may implement a variety of changes to strengthen the actor-oriented architecture and enable more actors to create and share resources.
To describe and measure implementation of elements of the actor-oriented architecture in an existing Collaborative Learning Health System.
We used the case of ImproveCareNow, a CLHS improving outcomes in pediatric inflammatory bowel disease, founded in 2006. We traced several network-level indicators of actor-oriented architecture between 2010 and 2016.
We identified measures of actors, the commons, and ways that have made it easier for network member sites to participate. These indicators show ImproveCareNow has made changes in the three elements of the actor-oriented architecture over time.
It is possible to measure the implementation of an actor-oriented architecture in a CLHS. The elements of the actor-oriented architecture may provide a conceptual framework for their development and optimization. Metrics such as those described here may be actionable indicators of the "health of the system."
协作式学习健康系统（CLHSs）使患者、临床医生、研究人员及其他人员能够大规模协作，以改善治疗效果并产生新知识。促进这种协作的一个组织框架是面向参与者的架构，它由以下部分组成：（a）具有自我组织价值观和能力的参与者（个人、组织和数据库）；（b）他们创建和共享资源的公共区域；以及（c）促进多参与者协作的结构、协议和流程。CLHSs可能会实施各种变革，以强化面向参与者的架构，并使更多参与者能够创建和共享资源。
描述并衡量现有协作式学习健康系统中面向参与者架构各要素的实施情况。
我们以2006年创立的ImproveCareNow为例，这是一个旨在改善儿科炎症性肠病治疗效果的CLHS。我们追踪了2010年至2016年间面向参与者架构的几个网络层面指标。
我们确定了参与者、公共区域的衡量标准，以及使网络成员站点更易于参与的方式。这些指标表明，随着时间推移，ImproveCareNow在面向参与者架构的三个要素方面都发生了变化。
在CLHS中衡量面向参与者架构的实施情况是可行的。面向参与者架构的要素可能为其发展和优化提供一个概念框架。此处描述的此类指标可能是“系统健康状况”的可操作指标。
