Acad Med. 2024 Feb 1;99(2):215-220. doi: 10.1097/ACM.0000000000005540. Epub 2023 Nov 17.
Over the past 2 decades, many academic health centers (AHCs) have implemented learning health systems (LHSs). However, the LHS has been defined with limited input from AHC leaders. This has implications because these individuals play a critical role in LHS implementation and sustainability. This study aims to demonstrate how an international group of AHC leaders defines the LHS, and to identify key considerations they would pose to their leadership teams to implement and sustain the LHS.
A semistructured survey was developed and administered in 2022 to members of the Association of Academic Health Centers President's Council on the Learning Health System to explore how AHC leaders define the LHS in relation to their leadership roles. The authors then conducted a focus group, informed by the survey, with these leaders. The focus group was structured using the nominal group technique to facilitate consensus on an LHS definition and key considerations. The authors mapped the findings to an existing LHS framework, which includes 7 components: organizational, performance, ethics and security, scientific, information technology, data, and patient outcomes.
Thirteen AHC leaders (100%) completed the survey and 10 participated in the focus group. The AHC leaders developed the following LHS definition: "A learning health system is a health care system in which clinical and care-related data are systematically integrated to catalyze discovery and implementation of new knowledge that benefits patients, the community, and the organization through improved outcomes." The key considerations mapped to all LHS framework components, but participants also described as important the ability to communicate the LHS concept and be able to rapidly adjust to unforeseen circumstances.
The LHS definition and considerations developed in this study provide a shared foundation and road map for future discussions among leaders of AHCs interested in implementing and sustaining an LHS.
在过去的 20 年里，许多学术医疗中心（AHC）已经实施了学习型医疗系统（LHS）。然而，这个概念的定义主要来自于 AHC 领导者的有限投入。这是有影响的，因为这些人在 LHS 的实施和可持续性方面起着至关重要的作用。本研究旨在展示一组国际 AHC 领导者如何定义 LHS，并确定他们将向领导团队提出的实施和维持 LHS 的关键考虑因素。
2022 年，我们向学术医疗中心协会主席理事会学习健康系统委员会的成员开发并管理了一项半结构式调查，以探讨 AHC 领导者如何根据其领导角色来定义 LHS。然后，我们根据调查结果与这些领导者进行了一次重点小组讨论。该重点小组使用名义小组技术进行组织，以促进对 LHS 定义和关键考虑因素的共识。作者将这些发现映射到现有的 LHS 框架上，该框架包括 7 个组成部分：组织、绩效、伦理和安全、科学、信息技术、数据和患者结果。
13 名 AHC 领导者（100%）完成了调查，其中 10 名参加了重点小组讨论。AHC 领导者制定了以下 LHS 定义：“学习医疗系统是一种医疗保健系统，通过系统地整合临床和护理相关数据，促进新知识的发现和实施，从而通过改善结果使患者、社区和组织受益。”关键考虑因素映射到所有 LHS 框架组件，但参与者还描述了沟通 LHS 概念的能力和能够快速适应意外情况的重要性。
本研究中制定的 LHS 定义和考虑因素为有兴趣实施和维持 LHS 的 AHC 领导者提供了一个共同的基础和路线图，以供未来的讨论。
