de Bruin Josefien, Bos Cheryl, Struijs Jeroen Nathan, Drewes Hanneke Wil-Trees, Baan Caroline Astrid
Department of Quality of Care and Health Economics National Institute for Public Health and the Environment, Center for Nutrition, Prevention and Health Services Bilthoven the Netherlands.
Tranzo, Tilburg School of Social and Behavioral Sciences Tilburg University Tilburg the Netherlands.
Learn Health Syst. 2022 Jun 2;7(1):e10311. doi: 10.1002/lrh2.10311. eCollection 2023 Jan.
Health systems worldwide face the challenge of increasing population health with high-quality care and reducing health care expenditure growth. In pursuit for a solution, regional cross-sectoral partnerships aim to reorganize and integrate services across public health, health care and social care. Although the complexity of regional partnerships demands an incremental strategy, it is yet not known how learning works within these partnerships. To understand learning in regional cross-sectoral partnerships for health, this study aims to map the concept Learning Health System (LHS).
This mapping review used a qualitative text analysis approach. A literature search was conducted in Embase and was limited to English-language papers published in the period 2015-2020. Title-abstract screening was performed using established exclusion criteria. During full-text screening, we combined deductive and inductive coding. The concept LHS was disentangled into aims, design elements, and process of learning. Data extraction and analysis were performed in MAX QDA 2020.
In total, 155 articles were included. All articles used the LHS definition of the Institute of Medicine. The interpretation of the concept LHS varied widely. The description of LHS contained 25 highly connected aims. In addition, we identified nine design elements. Most elements were described similarly, only the interpretation of stakeholders, data infrastructure and data varied. Furthermore, we identified three types of learning: learning as 1) interaction between clinical practice and research; 2) a circular process of converting routine care data to knowledge, knowledge to performance; and performance to data; and 3) recurrent interaction between stakeholders to identify opportunities for change, to reveal underlying values, and to evaluate processes. Typology 3 was underrepresented, and the three types of learning rarely occurred simultaneously.
To understand learning within regional cross-sectoral partnerships for health, we suggest to specify LHS-aim(s), operationalize design elements, and choose deliberately appropriate learning type(s).
全球卫生系统面临着通过高质量医疗服务提升人群健康水平以及降低医疗保健支出增长的挑战。为寻求解决方案，区域跨部门伙伴关系旨在对公共卫生、医疗保健和社会护理服务进行重组与整合。尽管区域伙伴关系的复杂性需要渐进式战略，但目前尚不清楚这些伙伴关系中的学习是如何运作的。为了解区域卫生跨部门伙伴关系中的学习情况，本研究旨在梳理学习型卫生系统（LHS）这一概念。
本梳理性综述采用定性文本分析方法。在Embase数据库中进行文献检索，仅限于2015年至2020年期间发表的英文论文。使用既定的排除标准进行标题-摘要筛选。在全文筛选过程中，我们结合了演绎编码和归纳编码。将LHS概念分解为学习目标、设计要素和学习过程。在MAX QDA 2020中进行数据提取和分析。
共纳入155篇文章。所有文章均采用了医学研究所对LHS给出的定义。对LHS概念的解读差异很大。对LHS的描述包含25个高度相关的目标。此外，我们确定了九个设计要素。大多数要素的描述相似，只是对利益相关者、数据基础设施和数据的解读有所不同。此外，我们确定了三种学习类型：一是临床实践与研究之间的互动；二是将常规护理数据转化为知识、知识转化为绩效、绩效转化为数据的循环过程；三是利益相关者之间反复互动，以识别变革机会、揭示潜在价值观并评估过程。类型3的研究较少，且这三种学习类型很少同时出现。
为了解区域卫生跨部门伙伴关系中的学习情况，我们建议明确LHS目标、落实设计要素并谨慎选择合适的学习类型。
