Gremyr Andreas, Andersson Gäre Boel, Thor Johan, Elwyn Glyn, Batalden Paul, Andersson Ann-Christine
Department of Schizophrenia Spectrum Disorders, Sahlgrenska University Hospital, Sahlgrenska Universitetssjukhuset Psykiatri Psykos, Göteborgsvägen 31, Mölndal, Västragötalandsregionen 431 80, Sweden.
Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Barnarpsgatan 39, Jönköping, Jönköpings län 55111, Sweden.
Int J Qual Health Care. 2021 Nov 29;33(Supplement_2):ii26-ii32. doi: 10.1093/intqhc/mzab072.
Co-production of health is defined as 'the interdependent work of users and professionals who are creating, designing, producing, delivering, assessing, and evaluating the relationships and actions that contribute to the health of individuals and populations'. It can assume many forms and include multiple stakeholders in pursuit of continuous improvement, as in Learning Health Systems (LHSs). There is increasing interest in how the LHS concept allows integration of different knowledge domains to support and achieve better health. Even if definitions of LHSs include engaging users and their family as active participants in aspects of enabling better health for individuals and populations, LHS descriptions emphasize technological solutions, such as the use of information systems. Fewer LHS texts address how interpersonal interactions contribute to the design and improvement of healthcare services.
We examined the literature on LHS to clarify the role and contributions of co-production in LHS conceptualizations and applications.
First, we undertook a scoping review of LHS conceptualizations. Second, we compared those conceptualizations to the characteristics of LHSs first described by the US Institute of Medicine. Third, we examined the LHS conceptualizations to assess how they bring four types of value co-creation in public services into play: co-production, co-design, co-construction and co-innovation. These were used to describe core ideas, as principles, to guide development.
Among 17 identified LHS conceptualizations, 3 qualified as most comprehensive regarding fidelity to LHS characteristics and their use in multiple settings: (i) the Cincinnati Collaborative LHS Model, (ii) the Dartmouth Coproduction LHS Model and (iii) the Michigan Learning Cycle Model. These conceptualizations exhibit all four types of value co-creation, provide examples of how LHSs can harness co-production and are used to identify principles that can enhance value co-creation: (i) use a shared aim, (ii) navigate towards improved outcomes, (iii) tailor feedback with and for users, (iv) distribute leadership, (v) facilitate interactions, (vi) co-design services and (vii) support self-organization.
The LHS conceptualizations have common features and harness co-production to generate value for individual patients as well as for health systems. They facilitate learning and improvement by integrating supportive technologies into the sociotechnical systems that make up healthcare. Further research on LHS applications in real-world complex settings is needed to unpack how LHSs are grown through coproduction and other types of value co-creation.
健康共同生产被定义为“用户和专业人员的相互依存工作，他们共同创造、设计、生产、提供、评估和评价有助于个人和人群健康的关系及行动”。它可以有多种形式，包括多个利益相关者追求持续改进，就像学习型健康系统（LHS）那样。人们越来越关注LHS概念如何整合不同知识领域以支持并实现更好的健康。即使LHS的定义包括让用户及其家人作为积极参与者，在为个人和人群促进更好健康的各个方面发挥作用，但LHS的描述强调技术解决方案，比如信息系统的使用。较少有LHS文本探讨人际互动如何有助于医疗服务的设计和改进。
我们研究了关于LHS的文献，以阐明共同生产在LHS概念化和应用中的作用及贡献。
首先，我们对LHS概念化进行了范围综述。其次，我们将这些概念化与美国医学研究所首次描述的LHS特征进行了比较。第三，我们研究LHS概念化，以评估它们如何发挥公共服务中四种价值共创类型的作用：共同生产、共同设计、共同构建和共同创新。这些被用作描述核心思想的原则，以指导发展。
在确定的17种LHS概念化中，有3种在忠实于LHS特征及其在多种环境中的应用方面被认为是最全面的：（i）辛辛那提协作LHS模型，（ii）达特茅斯共同生产LHS模型，以及（iii）密歇根学习周期模型。这些概念化展示了所有四种价值共创类型，提供了LHS如何利用共同生产的示例，并被用于确定可以增强价值共创的原则：（i）使用共同目标，（ii）朝着改善结果前进，（iii）为用户并与用户一起定制反馈，（iv）分散领导力，（v）促进互动，（vi）共同设计服务，以及（vii）支持自我组织。
LHS概念化具有共同特征，并利用共同生产为个体患者以及卫生系统创造价值。它们通过将支持性技术整合到构成医疗保健的社会技术系统中来促进学习和改进。需要对LHS在现实世界复杂环境中的应用进行进一步研究，以深入了解LHS如何通过共同生产和其他类型的价值共创得以发展。
