Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, VIC, Australia.
Monash Partners Academic Health Sciences Centre, Melbourne, VIC, Australia.
Health Res Policy Syst. 2024 Aug 6;22(1):95. doi: 10.1186/s12961-024-01179-7.
Despite increased interest in learning health systems (LHS), a paucity of guidance and tools for evaluating LHS implementation exists. To address this, we aim to undertake a scoping review on existing tools and evaluation of exemplars of LHS implementation.
We conducted a scoping review of peer-reviewed studies within Scopus, EMBASE, MEDLINE, and MEDLINE in-process that described (1) the evaluation of the implementation of an operating LHS or (2) the development of a framework or tool to facilitate this evaluation. Anima, basic research, abstracts, non-English language articles, and publications before 2018 were excluded. All study designs were considered.
From 1300 studies initially identified, 4 were eligible, revealing three tools with nine implementation evaluation examples. The identified tools shared constructs which were evaluated, including: Stakeholders, Data, Research Evidence, Implementation, and Sociotechnical Infrastructure. However, there was divergence in evaluation methodology. Tools ranged from a five-point numerical rating system for process maturity with a radar chart called the Network Maturity Grid (NMG); the Kaiser Permanente Washington (KPWA) LHS Logic Model, which provides a broad list of constructs and sample measures relevant to LHS operations; and finally LADDERS, a simple tool or form-based template designed for consistent evaluation over time. The NMG tool was the most mature in terms of adaptation and adoption. Notably, two (NMG and the KPWA LHS Logic Model) out of three tools conceptualized the LHS as a suite of processes and devised tools were processes that linked these constructs.
The evaluation of LHS implementation remains an under explored area of investigation, as this scoping review found only three tools for LHS implementation evaluation. Our findings indicate a need for further empirical research in this area and suggest early consensus in constructs that need to be considered during evaluation.
尽管人们对学习卫生系统（LHS）越来越感兴趣，但对于评估 LHS 实施的指导和工具却很少。为了解决这个问题，我们旨在对现有的工具进行范围界定审查，并对 LHS 实施的范例进行评估。
我们在 Scopus、EMBASE、MEDLINE 和 MEDLINE 进行了范围界定审查，其中包括：（1）评估现有 LHS 的实施情况；（2）开发框架或工具以促进这种评估。排除了动物学、基础研究、摘要、非英语语言文章和 2018 年以前的出版物。考虑了所有研究设计。
从最初确定的 1300 项研究中，有 4 项符合条件，揭示了 3 种工具和 9 个实施评估示例。确定的工具具有共同的评估结构，包括：利益相关者、数据、研究证据、实施和社会技术基础设施。然而，评估方法存在分歧。工具范围从一个名为网络成熟度网格（NMG）的五分量表评分系统，用于评估流程成熟度的雷达图；凯撒永久华盛顿（KPWA）LHS 逻辑模型，它提供了一个广泛的与 LHS 操作相关的构建和样本措施列表；最后是 LADDERS，一个简单的工具或基于表单的模板，旨在随着时间的推移进行一致的评估。在适应和采用方面，NMG 工具是最成熟的。值得注意的是，三个工具中的两个（NMG 和 KPWA LHS 逻辑模型）将 LHS 概念化为一系列流程，并设计了将这些构建联系起来的工具。
LHS 实施的评估仍然是一个探索较少的研究领域，因为本次范围界定审查仅发现了三个用于 LHS 实施评估的工具。我们的研究结果表明，在这个领域需要进一步进行实证研究，并建议在评估过程中考虑需要考虑的早期共识的构建。
