G.E. Rosenthal is professor and chair, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
D.A. McClain is professor, Department of Internal Medicine, Section on Endocrinology and Metabolism, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
Acad Med. 2023 Sep 1;98(9):1002-1007. doi: 10.1097/ACM.0000000000005259. Epub 2023 Apr 25.
The learning health system (LHS) has emerged over the past 15 years as a concept for improving health care delivery. Core aspects of the LHS concept include: promoting improved patient care through organizational learning, innovation, and continuous quality improvement; identifying, critically assessing, and translating knowledge and evidence into improved practices; building new knowledge and evidence around how to improve health care and health outcomes; analyzing clinical data to support learning, knowledge generation, and improved patient care; and engaging clinicians, patients, and other stakeholders in processes of learning, knowledge generation, and translation. However, the literature has paid less attention to how these LHS aspects may integrate with the multiple missions of academic medical centers (AMCs). The authors define an academic learning health system (aLHS) as an LHS built around a robust academic community and central academic mission, and they propose 6 features that emphasize how an aLHS differs from an LHS. An aLHS capitalizes on embedded academic expertise in health system sciences; engages the full spectrum of translational investigation from mechanistic basic sciences to population health; builds pipelines of experts in LHS sciences and clinicians with fluency in practicing in an LHS; applies core LHS principles to the development of curricula and clinical rotations for medical students, housestaff, and other learners; disseminates knowledge more broadly to advance the evidence for clinical practice and health systems science methods; and addresses social determinants of health, creating community partnerships to mitigate disparities and improve health equity. As AMCs evolve, the authors expect that additional differentiating features and ways to operationalize the aLHS will be identified and hope this article stimulates further discussion around the intersection of the LHS concept and AMCs.
学习型医疗体系（LHS）在过去 15 年中逐渐兴起，成为改善医疗服务的一种理念。LHS 概念的核心方面包括：通过组织学习、创新和持续质量改进来提高患者护理水平；识别、批判性评估和转化知识和证据，以改善实践；围绕如何改善医疗保健和健康结果来构建新知识和证据；分析临床数据以支持学习、知识生成和改善患者护理；并让临床医生、患者和其他利益相关者参与学习、知识生成和转化的过程。然而，文献对这些 LHS 方面如何与学术医疗中心（AMC）的多重使命相整合关注较少。作者将学术学习型医疗体系（aLHS）定义为一个以强大的学术社区和核心学术使命为基础的 LHS，并提出了 6 个特征，强调了 aLHS 与 LHS 的不同之处。aLHS 利用健康系统科学中的嵌入式学术专业知识；从基础的机制科学到人口健康，涵盖转化研究的各个方面；建立 LHS 科学和具有 LHS 实践能力的临床医生的专家库；将核心 LHS 原则应用于医学生、住院医师和其他学习者的课程和临床轮转的发展；更广泛地传播知识，以推进临床实践和卫生系统科学方法的证据；并解决健康的社会决定因素，建立社区伙伴关系，以减轻差异并改善健康公平。随着 AMCs 的发展，作者预计会确定更多具有区分度的特征和运营 aLHS 的方法，并希望本文能激发围绕 LHS 概念和 AMC 交叉点的进一步讨论。
