Département de management, Faculté des sciences de l'administration, Université Laval, Québec, QC, Canada
Centre de recherche en gestion des services de santé, Université Laval, Québec, QC, Canada.
BMJ Open. 2023 Oct 31;13(10):e073767. doi: 10.1136/bmjopen-2023-073767.
Despite efforts and repeated calls to improve the organisation and quality of healthcare and services, and in view of the many challenges facing health systems, the results and capacity to adapt and integrate innovations and new knowledge remain suboptimal. Learning health systems (LHS) may be an effective model to accelerate the application of research for real quality improvement in healthcare. However, while recognising the enormous potential of LHS, the literature suggests the model remains more of an aspiration than a reality.
To reach a fine understanding of the implementation of the concepts involved in LHS, we will use a hybrid method which combines concept analyses with systematic review methodology. We will use a two-step analysis, a content analysis to analyse the definitions, uses and attributes of the concept and a systematic review to analyse the concept's implementation mechanisms. We will search eight databases and grey literature and present a broad synthesis of the available evidence regarding design, implementation and evaluation of LHS in a multilevel perspective. We will follow the latest Preferred Reporting Items for Systematic Review and Meta-Analysis statement for conducting and reporting a systematic review. Two reviewers will independently screen the titles and abstracts against the eligibility criteria followed by full-text screening of potentially relevant articles for final inclusion decision. Conflicts will be resolved with a senior author. We will include published primary studies that use qualitative, quantitative or mixed methods. The assessment of risk of bias will be made using the Mixed-Methods Appraisal Tool.
This systematic review is exempt from ethics approval. The results formulated will highlight evidence-based interventions that support the implementation of a national LHS. They will be of particular interest to decision makers, researchers, managers, clinicians and patients allowing finally to implement the promising proposal of LHSs at national scale.
CRD42023393565.
尽管为改善医疗保健和服务的组织和质量做出了努力，并反复发出呼吁，但鉴于卫生系统面临的诸多挑战，创新和新知识的应用和整合的结果和能力仍不理想。学习型卫生系统（LHS）可能是加速研究在医疗保健领域实际质量改进应用的有效模式。然而，尽管认识到 LHS 的巨大潜力，但文献表明，该模式仍然更多地是一种愿望，而不是现实。
为了深入了解 LHS 所涉及概念的实施情况，我们将采用一种混合方法，将概念分析与系统评价方法相结合。我们将采用两步分析，内容分析来分析概念的定义、用途和属性，以及系统评价来分析概念的实施机制。我们将搜索八个数据库和灰色文献，并从多层次的角度对学习型卫生系统的设计、实施和评估的现有证据进行广泛综合。我们将遵循最新的系统评价和荟萃分析声明，以进行和报告系统评价。两位评审员将独立筛选标题和摘要，以符合资格标准，然后对潜在相关文章进行全文筛选，以做出最终纳入决定。如有冲突，将由资深作者解决。我们将纳入使用定性、定量或混合方法的已发表的主要研究。使用混合方法评估工具评估偏倚风险。
本系统评价无需伦理批准。制定的结果将突出支持实施国家学习型卫生系统的基于证据的干预措施。它们将特别引起决策者、研究人员、管理人员、临床医生和患者的兴趣，最终将在国家范围内实施有前途的学习型卫生系统提案。
CRD42023393565。
