J.L. Anderson is a predoctoral trainee, Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama.
M.J. Mugavero is professor, Division of Infectious Diseases, Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Acad Med. 2022 Oct 1;97(10):1564-1572. doi: 10.1097/ACM.0000000000004712. Epub 2022 Jun 7.
Learning health systems (LHSs), defined as a systematic process for aligning science, informatics, and clinical practice to integrate providers, researchers, and patients as active participants in an evidence-based care continuum, can provide an ideal environment for academic health centers to rapidly adopt evidence-based guidelines and translate research into practice. However, few LHS frameworks are specifically adapted for academic health centers. The authors wanted to identify the definitions, components, and other features of LHSs to develop an interdisciplinary LHS framework for use within academic health centers.
The authors conducted a scoping review of the literature to identify definitions, components, and other features of LHSs that are useful to academic health centers. In January 2021, they searched PubMed, Academic Search Premier, and Scopus databases and identified English-language, peer-reviewed articles pertaining to LHS, LHS frameworks, organization, components, and models. Since the phrase learning health system is relatively new terminology, they conducted a supplemental review with alternative phrases, including embedded research and coordinated or collaborative research network . They used the Knowledge to Action (KTA) Framework to integrate the generation and flow of research into practice.
The primary review retrieved 719 articles and the supplemental review retrieved 209; of these, 49 articles were retained to synthesize common definitions, components, and other features of LHS frameworks. Seven structural components of LHSs were identified: organization and collaborations, performance, ethics and security, scientific approaches, data, information technology, and patient outcomes. An adapted interdisciplinary LHS framework was developed that incorporated research and learning engines derived from the KTA and adaptations of common components and other features within the reviewed articles to fit the interests of providers, researchers, and patients within academic health centers.
The adapted LHS framework can be used as a dynamic foundation for development and organization of interdisciplinary LHSs within academic health centers.
学习型卫生系统(LHS)被定义为一个系统的过程,旨在将科学、信息学和临床实践相结合,使提供者、研究人员和患者作为积极参与者融入循证护理连续体,为学术医疗中心提供了一个理想的环境,可以快速采用循证指南,并将研究转化为实践。然而,很少有 LHS 框架专门针对学术医疗中心进行调整。作者希望确定 LHS 的定义、组成部分和其他特征,以开发一个用于学术医疗中心的跨学科 LHS 框架。
作者对文献进行了范围综述,以确定对学术医疗中心有用的 LHS 的定义、组成部分和其他特征。在 2021 年 1 月,他们搜索了 PubMed、Academic Search Premier 和 Scopus 数据库,并确定了与 LHS、LHS 框架、组织、组成部分和模型相关的英文同行评审文章。由于学习卫生系统这个短语是相对较新的术语,他们还进行了补充检索,使用了替代短语,包括嵌入式研究和协调或合作研究网络。他们使用知识转化行动(KTA)框架将研究的产生和流动整合到实践中。
主要检索共检索到 719 篇文章,补充检索共检索到 209 篇文章,其中 49 篇文章被保留下来,以综合 LHS 框架的常见定义、组成部分和其他特征。确定了 LHS 的七个结构组成部分:组织和合作、绩效、道德和安全、科学方法、数据、信息技术和患者结果。还开发了一个适应性的跨学科 LHS 框架,该框架纳入了 KTA 衍生的研究和学习引擎,以及对综述文章中常见组成部分和其他特征的改编,以适应学术医疗中心中提供者、研究人员和患者的利益。
适应性 LHS 框架可以作为学术医疗中心内跨学科 LHS 发展和组织的动态基础。