Learning Health Systems最新文献

{"title":"Exploring Factors That Impact Genetic Counseling Referral and Uptake Using Learning Health Approaches","authors":"Samantha Greenberg,&nbsp;Bob Wong,&nbsp;Katherine A. Sward,&nbsp;Kathleen A. Cooney,&nbsp;Jonathan Tward,&nbsp;Andrew Post,&nbsp;Mollie R. Cummins","doi":"10.1002/lrh2.70049","DOIUrl":"https://doi.org/10.1002/lrh2.70049","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Germline testing and pretest genetic counseling are advised for many cancer patients, yet not all receive these services. Electronic Health Records (EHRs) offer a valuable resource to measure referral to genetic counseling (referral receipt) and uptake (completion of counseling). This study uses EHR data to assess demographic factors influencing genetic counseling referral and uptake among prostate cancer patients, serving as a learning health system model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We included prostate cancer patients who met germline testing and counseling criteria at an NCI-designated cancer center from January 1, 2018, to June 30, 2022. Demographic factors—age at diagnosis, race, employment, insurance, and geographic region—were assessed for associations with genetic counseling referral and uptake. Analyses involved descriptive statistics, two-group comparisons, and regression models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 356 prostate cancer patients, only 34.2% received genetic counseling referrals, and of these, 73% completed a counseling visit. Older patients were less likely to receive referrals (OR = 0.93, 95% CI [0.89–0.97]) and complete visits (OR = 0.92, 95% CI [0.87–0.96]). Patients employed full-time were more likely to receive referrals (39.2% vs. 23.1%; <i>p</i> = 0.01), while White (93% vs. 81%; <i>p</i> = 0.047) and rural patients (42.7% vs. 6.1%; <i>p</i> = 0.02) had higher uptake. Insurance status did not significantly affect referral or uptake.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study demonstrates the potential of EHRs to identify demographic disparities in genetic counseling services. Using a learning health system approach, healthcare institutions can leverage EHR data to design targeted interventions aimed at improving access and reducing disparities in genetic services, ultimately enhancing patient outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":43916,"journal":{"name":"Learning Health Systems","volume":"10 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lrh2.70049","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146002115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2024 Healthcare Delivery Science: Innovation and Partnerships for Health Equity Research (DESCIPHER) Symposium","authors":"Amytis Towfighi,&nbsp;Allison Z. Orechwa","doi":"10.1002/lrh2.70042","DOIUrl":"https://doi.org/10.1002/lrh2.70042","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The Southern California Healthcare Delivery Science Center organizes an annual symposium for a broad audience interested in health innovation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The 2024 symposium convened healthcare professionals, researchers, policymakers, and advocates to explore innovative strategies for advancing health equity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials &amp; Methods</h3>\u0000 \u0000 <p>Organizers assembled panels of patients, health system leaders, and researchers to present their perspectives on four primary themes: (1) conceptual frameworks for social determinants of health, (2) community-engaged healthcare delivery interventions, (3) healthcare system-based strategies and innovations, and (4) the ethical use of emerging technologies. The agenda also included poster presentations and interactive break-out sessions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty presenters and facilitators engaged attendees in discussions throughout the day-long symposium. A common theme was understanding social determinants as fundamental, intermediate, and proximate drivers of health inequities. Strategies to bridge these gaps included interdisciplinary collaboration, engaging individuals with lived experience, healthcare system-based and community-centered interventions, ethical use of artificial intelligence, and policy reform.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Presentations emphasized the importance of interdisciplinary collaboration, innovation, and policy reform in addressing social determinants of health and achieving equity. They also highlighted the significance of lived experience, community involvement, and data-driven strategies in advancing healthcare delivery science.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The 2024 Healthcare Delivery Science Symposium successfully convened broad stakeholders to exchange ideas and proven strategies for advancing health equity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":43916,"journal":{"name":"Learning Health Systems","volume":"10 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lrh2.70042","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145983464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Patient Engaged Research Center's Sustainable Funding Framework: A Path Towards Sustainable Patient Engagement in Care and Research Within a Health System","authors":"Paige Coyne,&nbsp;Leah Copeland,&nbsp;Dana Murphy,&nbsp;Ashley Redding,&nbsp;Christine C. Johnson,&nbsp;Karen E. Kippen,&nbsp;Sara Santarossa","doi":"10.1002/lrh2.70047","DOIUrl":"https://doi.org/10.1002/lrh2.70047","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Despite growing acknowledgement that patient engagement (PE) in research, quality improvement, and clinical care is important, models showcasing how learning health systems (LHSs) can sustain long-term PE across endeavors remain scant. Henry Ford Health's (HFH) Patient Engaged Research Center (PERC) provides a replicable example by which other LHSs can feasibly sustain/grow PE across research, quality improvement, and clinical care in a more efficient and cohesive manner.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>To support its current infrastructure, PERC obtains financial support from an array of sources, including internal health system funding, external grant funding, and philanthropic support. In addition, PERC has created a Sustainable Funding Framework (SFF) and offers à la carte patient-centered services to further diversify its funding and ensure the sustainability of PE throughout the system. PERC utilizes a four-step SFF to offer expertise in conducting patient-centered research, as well as operational and programming support for PE-related initiatives at HFH and within the broader community. The steps are as follows: awareness/need recognition, intake process (intake form, intake meeting, and invoice), project status (approval or not), and project details/start date. Example services include, but are not limited to, instrument development (surveys, moderator guides for interviews/focus groups), facilitation/transcription (surveys/interviews/focus groups), data analysis and reporting (mixed methods and qualitative), Patient Advisor recruitment and training, development/maintenance of Patient and Family Advisory Councils, placement of patient advisors on committees/councils/projects, and grant writing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>PE in research, quality improvement, and clinical care within most health systems is often siloed and disjointed, lacking a sustainable financial or work process model. PERC's SFF provides a promising and replicable example by which LHSs can feasibly sustain and grow PE across research, quality improvement, and clinical care delivery, as well as incorporate this data in a feedback loop to improve all three.</p>\u0000 </section>\u0000 </div>","PeriodicalId":43916,"journal":{"name":"Learning Health Systems","volume":"10 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lrh2.70047","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146002570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thanks to our peer reviewers","authors":"","doi":"10.1002/lrh2.70046","DOIUrl":"https://doi.org/10.1002/lrh2.70046","url":null,"abstract":"&lt;p&gt;The publication of Issue 4 marks the completion of Volume 9 of &lt;i&gt;Learning Health Systems&lt;/i&gt;. An international, trans-disciplinary, open access publication, the journal has advanced research and scholarship on learning health systems in partnership with our reviewers. With indexing in multiple major sources and an Impact Factor of 2.6, we have achieved a publication milestone that signals a sustainable, positive trajectory. Articles from the journal had more than 142,000 full-text views in 2024. We continue to diversify the offerings of the journal through special issues and special collections, and through the supplemental issue published each year in collaboration with Academy Health.&lt;/p&gt;&lt;p&gt;We are keenly aware that these achievements would not have happened without the dedicated efforts and insightful comments of all those individuals who accepted invitations to review submitted articles. With busy schedules and full commitments, these individuals found the time and energy to contribute their expertise to our authors to help ensure that their papers met (and often exceeded) the journal's high standards for publication.&lt;/p&gt;&lt;p&gt;Please accept our sincere gratitude for your outstanding efforts!&lt;/p&gt;&lt;p&gt;Charles P. Friedman, Editor in Chief&lt;/p&gt;&lt;p&gt;Nancy Allee, Senior Associate Editor&lt;/p&gt;&lt;p&gt;Linda Novak, Managing Editor&lt;/p&gt;&lt;p&gt;\u0000 &lt;b&gt;&lt;i&gt;Learning Health Systems&lt;/i&gt; Peer Reviewers&lt;/b&gt;\u0000 &lt;/p&gt;&lt;p&gt;Note: These are the reviewers for articles published in all four issues of Volume 9 and for all articles currently published and posted online in Early View through September 30, 2025. Reviewers of manuscripts that were not ultimately published are also included in this list.&lt;/p&gt;&lt;p&gt;Julia Adler-Milstein (United States)&lt;/p&gt;&lt;p&gt;Aneel Advani (United States)&lt;/p&gt;&lt;p&gt;Holt Anderson (United States)&lt;/p&gt;&lt;p&gt;Nate Apathy (United States)&lt;/p&gt;&lt;p&gt;Cristina Ardura-Garcia (Cambodia)&lt;/p&gt;&lt;p&gt;Amir Reza Azizian (United States)&lt;/p&gt;&lt;p&gt;Ross Bailie (Australia)&lt;/p&gt;&lt;p&gt;Rebecca Baker (United States)&lt;/p&gt;&lt;p&gt;Timothy Beebe (United States)&lt;/p&gt;&lt;p&gt;Peter Bower (United Kingdom of Great Britain and Northern Ireland)&lt;/p&gt;&lt;p&gt;Jeffrey Brown (United States)&lt;/p&gt;&lt;p&gt;Michael Bushey (United States)&lt;/p&gt;&lt;p&gt;Michael Cantor (United States)&lt;/p&gt;&lt;p&gt;Yidan Cao (United States)&lt;/p&gt;&lt;p&gt;Harold Collard (United States)&lt;/p&gt;&lt;p&gt;Marisa Conte (United States)&lt;/p&gt;&lt;p&gt;Theresa Cullen (United States)&lt;/p&gt;&lt;p&gt;Jennie David (United States)&lt;/p&gt;&lt;p&gt;Josie Dickerson (United Kingdom of Great Britain and Northern Ireland)&lt;/p&gt;&lt;p&gt;Anne Douglass (United States)&lt;/p&gt;&lt;p&gt;Douglas Easterling (United States)&lt;/p&gt;&lt;p&gt;Davide Ferrari (United Kingdom of Great Britain and Northern Ireland)&lt;/p&gt;&lt;p&gt;Stephan Fihn (United States)&lt;/p&gt;&lt;p&gt;Karen Fisher (Australia)&lt;/p&gt;&lt;p&gt;Allen Flynn (United States)&lt;/p&gt;&lt;p&gt;Tom Foley (United Kingdom of Great Britain and Northern Ireland)&lt;/p&gt;&lt;p&gt;Kelly Foltz-Ramos (United States)&lt;/p&gt;&lt;p&gt;Rachel Forcino (United States)&lt;/p&gt;&lt;p&gt;Patricia Franklin (United States)&lt;/p&gt;&lt;p&gt;Nicholas Fusco (United States)&lt;/p&gt;&lt;p&gt;Melissa Garrido (United States)&lt;/p&gt;&lt;p&gt;Cheryl G","PeriodicalId":43916,"journal":{"name":"Learning Health Systems","volume":"9 4","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lrh2.70046","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145375198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ten Reasons Why Learning Health Systems Will Have a Transformational Effect on Health and Health Care","authors":"Charles P. Friedman,&nbsp;Sarah M. Greene,&nbsp;Joshua C. Rubin","doi":"10.1002/lrh2.70044","DOIUrl":"https://doi.org/10.1002/lrh2.70044","url":null,"abstract":"&lt;p&gt;The description of each feature, to follow, is accompanied by at least one citation, out of multitudes that are eligible to be referenced. A fully referenced paper goes beyond the scope of this commentary; but in almost every case, the works referenced below point to a more complete set of citations supporting the assertions offered here.&lt;/p&gt;&lt;p&gt;There are many reasons why innovations are adopted, but the process typically begins when the idea behind the innovation attracts the attention of potential adopters [&lt;span&gt;2&lt;/span&gt;]. Beginning with the 2007 seminal workshop report from the (then) Institute of Medicine [&lt;span&gt;3&lt;/span&gt;] with 574 citations and later with the Friedman et al. 2010 article cited 622 times [&lt;span&gt;4&lt;/span&gt;] and Greene et al. cited 430 times [&lt;span&gt;5&lt;/span&gt;], the concepts and methods associated with Learning Health Systems have garnered significant attention. Gro wth of the LHS, both as a concept and set of methods, is difficult to quantify, but the two indices presented in Figure 1 offer evidence of steadily increasing attention. The first is the number of retrievals through a PubMed search for articles with the title or abstract containing “Learning Health Systems” or “Learning Healthcare Systems.” (The actual number of relevant publications is likely much higher since the search as conducted retrieved only 52% of the articles published in this journal.) The second is the number of full-text downloads of articles published in &lt;i&gt;Learning Health Systems&lt;/i&gt;, which is fully online.&lt;/p&gt;&lt;p&gt;In the authors' own subjective experience with LHS, dating back to 2009, no one has said that LHS is a bad idea. One conjecture about the appeal of the idea goes to its name: very few people oppose “learning” and almost no one opposes “health.” While “system” is a somewhat more controversial concept, when combined with the other two terms, “system” takes on a more positive connotation. Indeed, the challenge and the corresponding opportunity associated with realizing learning and transformation at the system level can attract diverse thinkers who recognize that system problems demand system solutions.&lt;/p&gt;&lt;p&gt;There are many descriptions of “improvement cycles” in LHS; but, to a reasonable approximation, all such models include transitional elements of practice to data, data to knowledge (evidence), and knowledge (evidence) back to practice. While cyclical activity to drive improvement is hardly a new concept, the LHS brings inclusion and co-creation—similarly referred to as co-production—to the level of imperatives. An extensive literature describes the hyper-collaborative nature of Learning Health Systems [&lt;span&gt;11&lt;/span&gt;], and a scoping review [&lt;span&gt;12&lt;/span&gt;] offers examples of how LHS models incorporate the related concept of co-production. The imperative for inclusion, however, derives primarily from common sense. It is intuitively obvious that including everyone with a stake in a health problem in learning communities that are dedicated to ","PeriodicalId":43916,"journal":{"name":"Learning Health Systems","volume":"9 4","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lrh2.70044","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145375077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging Health Equity, Quality Improvement, and Patient Safety: A Framework for Medical Student Education","authors":"Joyce R. Javier,&nbsp;Anne T. Vo,&nbsp;Gery W. Ryan,&nbsp;Craig W. Robbins,&nbsp;Heidi D. Nelson,&nbsp;Ashwini Lakshmanan","doi":"10.1002/lrh2.70045","DOIUrl":"https://doi.org/10.1002/lrh2.70045","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Ensuring patient safety (PS) and implementing quality improvement (QI) are well-recognized functions of healthcare delivery systems and fall within physicians' scope of practice. How to effectively introduce equity-centered PS and QI concepts into an already overloaded undergraduate medical education curriculum is a challenge.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This report describes our experiences at the Kaiser Permanente Bernard J. Tyson School of Medicine (KPSOM), a new medical school, and how we have developed our Quality Improvement and Patient Safety curriculum within a larger institutional environment where equity and social justice are highly valued.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Integrating health systems science into undergraduate medical education and concepts related to health equity requires intentional curricular design and ongoing adaptation. Lessons learned include: (1) importance of using the Basic Improvement Framework as an educational anchor; (2) understanding the value of integration across curricular phases; and (3) creating a dedicated space for curricular refinement over time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Medical schools and health systems aiming to strengthen their health systems science curricula may find value in implementing structured approaches—such as the Basic Improvement Framework utilized at KPSOM—to promote early and meaningful engagement with systems-based concepts, especially health equity, throughout learners’ training.</p>\u0000 </section>\u0000 </div>","PeriodicalId":43916,"journal":{"name":"Learning Health Systems","volume":"10 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lrh2.70045","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145983751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Data-Driven Implementation Trials: Realizing Their Full Potential in Achieving the Promise of Learning Health Systems","authors":"Charis X. Xie,&nbsp;Patricia D. Franklin,&nbsp;Theresa L. Walunas,&nbsp;Rinad S. Beidas","doi":"10.1002/lrh2.70043","DOIUrl":"https://doi.org/10.1002/lrh2.70043","url":null,"abstract":"<p>The digital transformation of healthcare has generated unprecedented volumes of routine clinical data, enabling health system leaders, including quality improvement (QI) efforts, to optimize care using real-time analytics. However, health system QI typically focuses on changes within localized environments; it is often limited in its ability to address systemic barriers or scale evidence-based strategies across diverse settings. Thoughtful integration of implementation science (IS) approaches addresses this gap by systematically integrating interventions into diverse practice settings and defining generalizable implementation strategies. These attributes position IS as a cornerstone of learning health systems (LHS), which strive for population-wide improvements through continuous, data-driven learning. Within this paradigm, randomized implementation trials provide the gold standard for comparing and optimizing implementation strategies. By leveraging routine data, these trials generate causal evidence on the effectiveness of different approaches and offer rigorous insights for health system decision-makers. In this viewpoint, we highlight data-driven implementation trials as catalysts for rigorous and scalable health system transformation. Specifically, we articulate the value proposition of data-driven implementation trials, examine their transformative potential toward learning health systems, and outline persistent challenges. Drawing on experiences from the UK and the US in large health systems, we propose actionable recommendations to optimize infrastructure, foster collaboration, secure health system-level commitments, and cultivate a culture that is grounded in IS while augmenting the impact of QI—critical steps toward realizing scalable, equitable healthcare innovation.</p>","PeriodicalId":43916,"journal":{"name":"Learning Health Systems","volume":"10 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lrh2.70043","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145983890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Empirical research related to the ethics of pragmatic clinical trials: A scoping review","authors":"Kayla R. Mehl,&nbsp;Stephanie R. Morain,&nbsp;Jeremy Sugarman","doi":"10.1002/lrh2.70041","DOIUrl":"https://doi.org/10.1002/lrh2.70041","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pragmatic clinical trials (PCTs) offer insights into real-world intervention effectiveness, but they may involve challenging ethical issues. Empirical ethics research may inform deliberations about them.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a scoping review of empirical ethics research related to PCTs. This involved searching in PubMed and Embase, charting findings, and analyzing themes to identify trends and gaps.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eighty-two publications were included, which examined a vast number of issues encompassing 22 themes. The five most prominent were: consent/disclosure; risk assessment; trust and transparency; burdens, barriers, and costs; and engagement. Written consent is often impractical, prompting interest in opt-out or general notification approaches. Challenges in risk assessment include variability in defining minimal risk, thereby complicating regulatory determinations for the appropriateness of particular participant protections and communicating research risks. Trust-building practices, such as result-sharing and data-use disclosure, can foster confidence. Stakeholder engagement can address logistical barriers, improve recruitment, and align research with participant needs. Time, financial, and regulatory burdens are significant obstacles to implementing PCTs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>There has been progress in understanding many ethical issues encountered in PCTs, including appropriately navigating alternatives to obtaining written informed consent, trust-building, and the operational role of stakeholder engagement. However, critical gaps remain, with research concentrated in Western contexts and reliant on surveys and hypothetical scenarios, limiting generalizability and real-world insights. Addressing these gaps with geographically inclusive studies, innovative methods, and nested empirical work will be important for more comprehensively understanding the ethical issues in PCTs and developing appropriate approaches to mitigating them.</p>\u0000 </section>\u0000 </div>","PeriodicalId":43916,"journal":{"name":"Learning Health Systems","volume":"10 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lrh2.70041","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146002077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enriched core competencies for health services and policy research—An update","authors":"Meghan McMahon,&nbsp;Rhonda Boateng,&nbsp;Richard H. Glazier,&nbsp;Stephen Bornstein,&nbsp;Shanthi Johnson,&nbsp;Carl-Ardy Dubois,&nbsp;Matthew Menear,&nbsp;Tara Sampalli,&nbsp;Tracy Wasylak,&nbsp;Deborah Marshall,&nbsp;Denis Roy,&nbsp;Deepa Singal,&nbsp;Adalsteinn Brown","doi":"10.1002/lrh2.70032","DOIUrl":"https://doi.org/10.1002/lrh2.70032","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Doctoral and postdoctoral training in health services and policy research (HSPR) needs to evolve to address changing career trajectories, emerging health system challenges, and the advancement of learning health systems. This changing landscape necessitates examination of the core competencies that underpin training. This study presents a refreshed set of core competencies for HSPR to guide the modernization of training and considerations for implementation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Qualitative methods and an iterative development process with extensive community engagement throughout were used. Data were obtained from multiple sources, including literature reviews, surveys, key informant interviews, focus groups, Task Force meetings, a consensus workshop, and a validation process (Fall 2022 to May 2024). The study setting is Canada.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The refreshed core competencies include nine essential domains that maintain an emphasis on rigorous scholarly preparation and prioritize leadership and other professional skills deemed essential to contribute to evidence-informed system improvement and learning health systems. Additionally, the framework features two new transversal domains: Equity, Diversity, Inclusion, Accessibility, and Anti-Oppression; and Indigenous Cultural Safety and Humility. These domains are considered fundamental principles to be embedded into all aspects of HSPR competencies and training, fostering more inclusive and equitable leaders and health systems.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>As health systems continuously evolve, so too should the questions researchers address, the methods they use, and the skills needed to maximize contributions to evidence-informed health system improvement and learning health systems. The refreshed core competencies for HSPR maintain important continuity with the inaugural competency framework while also including several important additions. The framework allows for flexibility in its implementation and us; it can be used to guide the enhancement of existing training programs, the development of new ones, and the growth and development of a HSPR workforce with the skills to lead and contribute within learning health systems.</p>\u0000 </section>\u0000 </div>","PeriodicalId":43916,"journal":{"name":"Learning Health Systems","volume":"10 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lrh2.70032","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146002474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating and reframing tensions within equity-centered learning health systems","authors":"Ibukun-Oluwa Omolade Abejirinde,&nbsp;Brianne Wood","doi":"10.1002/lrh2.70040","DOIUrl":"10.1002/lrh2.70040","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Canada recently joined a growing list of countries that are establishing national collaboratives to exchange knowledge on and scale learning health systems (LHSs) across geographies and sectors. The first symposium of the pan-Canadian Learning Health Hub was held in June 2024 and included a keynote presentation and breakout discussions on how to operationalize equity in LHSs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In preparing for the keynote presentation, we examined the literature, reflected on our experiences building LHSs that have an equity focus, and on discussions we have had with other LHS practitioners on where and how equity manifests within a LHS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Through our preparation, we identified three tensions that are inherent to and result from centering equity in LHSs: (i) Divergent definitions and languages of health equity (the tension of language); (ii) rapid learning versus slow engagement (the tension of pace); and (iii) equity as a driver and an outcome (the tension of dual roles). In this analysis, we present how these tensions manifest in the practice of equity and LHSs alongside strategies for navigating and reframing these tensions to catalyze dynamic learning.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>For individuals and organizations interested in advancing equity-oriented LHSs, in Canada and other jurisdictions, this paper highlights how and why the goal should not be to avoid these tensions, but rather to navigate the push-pull inherent in our contexts with intention and a commitment to transformative action.</p>\u0000 </section>\u0000 </div>","PeriodicalId":43916,"journal":{"name":"Learning Health Systems","volume":"10 2","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12900621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146203245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}