Learning Health Systems最新文献

{"title":"Multi-site research using electronic health record data: Lessons learned from a case study","authors":"Brittany Garcia,&nbsp;Michael Hogarth,&nbsp;Yu Wang,&nbsp;Xi Zhu,&nbsp;Shin-Ping Tu","doi":"10.1002/lrh2.70039","DOIUrl":"https://doi.org/10.1002/lrh2.70039","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Multi-site research collaboration is necessary to increase generalizability, diversity, and innovation; however, there are complexities and challenges surrounding research processes, including regulatory oversight, data management, and data sharing activities. This report highlights the specific challenges of collaborative research identified in the conduct of a federally funded multi-site study and presents lessons learned to inform ways to overcome these challenges. The purpose of our current research project is to determine how interprofessional teamwork affects quality outcomes and develop tools to improve teamwork in cancer care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Our research team is comprised of 23 members across five academic institutions. Our study cohort includes approximately 20 000 adult patients with breast, colorectal, and non-small cell lung cancers diagnosed at the respective sites between January 1, 2016, and December 31, 2021. Electronic health record (EHR) access log data was extracted 12 months pre- and 24 months post-diagnosis for each patient, and outcome data of potentially preventable emergency department visits and unplanned hospitalizations was extracted from the California state All-Payer Claims database.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Major challenges experienced related to single institutional review board processes, establishment of contract agreements, and data management, analysis, acquisition, and transfer. Lessons learned included: (1) start research planning as early as possible, including engaging with information technology and compliance teams to identify processes and develop and share data dictionaries; (2) work closely with the institution contracting team to identify the most optimal timing and ordering for multiple data use agreement (DUA) contracts; and (3) ensure that research team members are abreast of current Health Insurance Portability and Accountability Act and institutional guidelines as they pertain to research and data practices.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Multi-site research involving big data from the EHR requires ample planning and execution time. Adopting a single standardized DUA and developing data dictionaries that can be shared for research will improve the data acquisition phase of multi-site research studies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":43916,"journal":{"name":"Learning Health Systems","volume":"9 4","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lrh2.70039","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145375260","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":"Co-creating an everyday language illustration of learning health systems alongside patient, caregiver, and community partners","authors":"Shelley Vanderhout,&nbsp;Maureen Smith,&nbsp;Nakia Lee-Foon,&nbsp;Amanda Doherty-Kirby,&nbsp;Rona Fleming,&nbsp;Don Grant,&nbsp;Annie-Danielle Grenier,&nbsp;John Grogan,&nbsp;Roger Farley,&nbsp;Margaret King,&nbsp;Chris Johnston,&nbsp;Virgil Luca,&nbsp;Lisa Ridgway,&nbsp;Donna Rubenstein,&nbsp;Candace Skrapek,&nbsp;Kerry Kuluski","doi":"10.1002/lrh2.70033","DOIUrl":"https://doi.org/10.1002/lrh2.70033","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Patients, caregivers, and community partners (PCC) can have a variety of roles in learning health systems (LHS), such as contributing their data from healthcare encounters to embedded, continuous engagement where they identify health system priorities, guide operational, research, and quality improvement decisions, and facilitate knowledge sharing and implementation. Despite many LHS models placing emphasis on PCC, little has been done to help members of the public understand what a LHS is or initiate dialogue about how they can learn more and become engaged. We brought together a national network of PCC to co-create an everyday language, arts-based resource for the public to learn what a LHS is and how it relates to patient care journeys.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Thirteen PCC with LHS experience from across Canada attended two 2-h virtual workshops to generate ideas on how to better define LHS using everyday language, determine accessible ways to share this information, and co-design a comic strip that can be widely shared across diverse settings and communities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We co-created a six-panel comic strip that depicts a relatable patient experience of waiting in an emergency department. The comic shows that in a LHS, patients are invited to contribute their perspectives about improving healthcare and support implementing and testing new ideas in clinical settings. Creating this comic was considered important for various reasons: to promote a common language around LHS, to build trust between health systems and the public, and to widen the community of PCC who are engaged in LHS activities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This comic is intended to build capacity for LHS culture, where the public can understand how continuous learning and improvement fit within health care, and learn about opportunities for engagement in LHS.</p>\u0000 </section>\u0000 </div>","PeriodicalId":43916,"journal":{"name":"Learning Health Systems","volume":"9 4","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lrh2.70033","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145375117","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":"Achieving an Intelligent HealthScience System: Aligning science, health, business, policy and technology for patients and society","authors":"SYNERGY Forum","doi":"10.1002/lrh2.70020","DOIUrl":"https://doi.org/10.1002/lrh2.70020","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>All societies benefit from a healthy population, and access to affordable, quality, evidence-based medical care can improve health, productivity, and prosperity for all. Two decades ago, experts and stakeholders met at the Institute of Medicine and called for a “new health system for the 21st century.” More recently, efforts have been made to achieve a Learning Health System (LHS). Still, reform efforts in the United States have only marginally succeeded in improving the situation despite innovation, technology, enormous economic resources, and one of the strongest medical research endeavors in the world.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To bring together diverse stakeholders in healthcare, science, technology, business, government and patient advocacy, to envision what lies beyond the so-called Learning Health System approach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In December 2022, the SYNERGY Forum was hosted by the National Academy of Medicine, convened in Washington, DC. This envisioning exercise, the first in a planned series of such events, was proposed and organized by the global non-profit Alliance for Clinical Research Excellence and Safety (ACRES). The two-day exercise combined didactic lectures on systems thinking, focused working-groups, and interactive discussion, to create a vision for an integrated Intelligent HealthScience System (IHSS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The participants proposed creation of a platform and an engine of People, Processes, Policy, and Technology to design and realize this vision through an effective hard and soft systems approach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This report captures what the multi-stakeholder collaboration recommends toward achieving such a System and a proposal for continuation of a SYNERGY Forum to further advance needed change and a design process.</p>\u0000 </section>\u0000 </div>","PeriodicalId":43916,"journal":{"name":"Learning Health Systems","volume":"9 4","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lrh2.70020","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145375118","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":"Increasing physician-perceived comfort about ostomies in pediatric inflammatory bowel disease: An interprofessional quality improvement project","authors":"Jennie G. David,&nbsp;Hannah McKillop,&nbsp;Meghan Fisher,&nbsp;Ashley M. Kroon Van Diest","doi":"10.1002/lrh2.70034","DOIUrl":"https://doi.org/10.1002/lrh2.70034","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Pediatric inflammatory bowel disease (IBD) is a chronic disease with various treatments, including ostomy surgery, which is associated with stigma. Physicians' known discomfort in discussing ostomies can impact medical decision-making and the timing of clinical conversation. This quality improvement (QI) work developed and tested interprofessional tools to increase physician-perceived comfort in ostomy-related discussions at pediatric-IBD focused Learning Health Network site.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A multidisciplinary team of GI/IBD psychologists, ostomy nurses, and child life specialists developed tools designed to increase physician-perceived comfort in ostomy discussions at an institution that participates in ImproveCareNow, a pediatric-IBD Learning Health Network. Two Plan Do Study Act (PDSA) cycles were completed. PDSA Cycle 1 involved IBD attending physicians (<i>n</i> = 4) for 8 weeks and PDSA Cycle 2 involved GI medical fellows (<i>n</i> = 7) for 12 weeks. Each PDSA cycle involved (1) baseline information, (2) resource education, and (3) tracking of physician-perceived comfort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>For IBD attendings, average physician-perceived comfort talking about ostomies increased from 68.8% to 83.3%. For GI medical fellows, average physician-perceived comfort increased from 41.4% to 62%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Ostomy surgery in pediatric IBD is a complex medical decision with notable stigma, demonstrating a pressing need to facilitate non-stigmatizing and psychosocially mindful clinical discussions. This QI project demonstrated how interprofessional education and resources increased physician-perceived comfort in ostomy discussions among IBD attendings and GI medical fellows at an ImproveCareNow site.</p>\u0000 </section>\u0000 </div>","PeriodicalId":43916,"journal":{"name":"Learning Health Systems","volume":"9 4","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lrh2.70034","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145375065","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":"Learning about learning health systems: Strengthening theory through continuous evaluation and improvement","authors":"Andreas Gremyr,&nbsp;Michael Seid,&nbsp;Peter A. Margolis,&nbsp;Rohit Ramaswamy","doi":"10.1002/lrh2.70038","DOIUrl":"https://doi.org/10.1002/lrh2.70038","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Learning Health Systems (LHSs) offer potential for transforming healthcare through continuous learning and improvement. However, the current literature lacks a robust connection between theory and practice, limiting knowledge transferability across diverse healthcare environments. This article proposes a novel framework for integrating theorizing and continuous evaluation into LHSs, illustrated through the case of the Bipolar Action Network (The Network).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We use a process of theorizing to structure how mid-range theory, program theory and LHS design, development and evaluation can support improved practices and theories. We use the Conceptual Framework for Value-Creating Learning Health Systems as our initial mid-range theory, and the Bipolar Action Network serves as an illustrative case.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The framework emphasizes continuous multi-level LHS theory refinement based on real-world data, ensuring that both the system and its theoretical underpinnings evolve in response to new insights and challenges by connecting four steps: (1) Selecting an initial mid-range theory, (2) Creating a program theory for a specific LHS, (3) Evaluating LHS performance using operational data, and (4) Using evaluation findings to refine both the LHS program and mid-range theory.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This article contributes to the field by offering a practical methodology for bridging the gap between LHS theory and practice. By promoting ongoing theorizing and evaluation, our framework aims to both enhance the effectiveness and adaptability of LHSs, as well as inform theory development. Challenges remain, including resource intensity for data infrastructure and potential limitations in data quality or accessibility, which must be addressed to realize the full potential of LHSs as adaptive, theory-driven systems.</p>\u0000 </section>\u0000 </div>","PeriodicalId":43916,"journal":{"name":"Learning Health Systems","volume":"9 4","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lrh2.70038","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145375061","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 PaTH from discovery to implementation: Using a PCORnet® Clinical Research Network's own research to prioritize topics for collaborative health improvement activities","authors":"Autumn R. Boyer,&nbsp;Charles P. Friedman,&nbsp;Cynthia H. Chuang,&nbsp;Megan E. Hamm,&nbsp;April Wyncott,&nbsp;James Gregory Merritt,&nbsp;Michael J. Becich,&nbsp;Soledad A. Fernandez,&nbsp;Daniel E. Ford,&nbsp;Henry Lester Kirchner,&nbsp;Anuradha Paranjape,&nbsp;David A. Williams,&nbsp;Kathleen M. McTigue","doi":"10.1002/lrh2.70037","DOIUrl":"https://doi.org/10.1002/lrh2.70037","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Applying research findings to health care practice has typically been a prolonged process, resulting in frustration to patients, providers, and other health system constituents. The PaTH Clinical Research Network developed the Discovery to Implementation (D2I) Initiative, rooted in Learning Health Systems principles, to engage constituents across seven academic sites/affiliated health systems in a process of identifying and prioritizing topics for future health improvement activities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To develop a consensus process to prioritize topics derived from the network's own research for future implementation efforts conducted by network-based Learning Communities. To apply this process to identify priority topics based on the network's recently published research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We developed a multi-institutional process for engaging a broad variety of perspectives to systematically review and evaluate PaTH-affiliated, patient-focused health research published between 2020 and 2022. Each site invited local constituents including patients, caregivers, clinicians, researchers, funders, health plan representatives, and health system leaders to help prioritize research topics and identify potential Learning Community areas of focus. D2I activities included brief surveys, review of data from the PCORnet® Common Data Model, and a multi-step deliberative process during two virtual events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The D2I Initiative included the participation of nearly 90 constituents in its iterative process to prioritize research topics. From 21 publications of patient-focused PaTH-affiliated research, three topics emerged as the highest priority for potential quality improvement work: back pain, hypertension, and frailty. Furthermore, the D2I Initiative mobilized interest in three potential Learning Communities to work toward implementing health care innovations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The D2I format is an innovative, engaging, and scalable model for involving constituents throughout our health systems to prioritize topics for future improvement activities. The process aims, ultimately, to reduce the time from research discovery to health systems improvements while maintaining a focus on the needs and priorities of those involved at multiple system levels.</p>\u0000 </section>\u0000 </","PeriodicalId":43916,"journal":{"name":"Learning Health Systems","volume":"9 4","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lrh2.70037","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145375107","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":"Clinical quality registries: Establishing the socio-technical infrastructure for learning health systems","authors":"Rob G. Stirling,&nbsp;Susannah Ahern,&nbsp;Jeremy Millar,&nbsp;Sue Evans,&nbsp;Paul Dawkins,&nbsp;John Zalcberg","doi":"10.1002/lrh2.70036","DOIUrl":"https://doi.org/10.1002/lrh2.70036","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Clinical quality registries (CQR) systematically monitor and provide feedback on the appropriateness and effectiveness of health care within specific clinical domains, collecting data about medical care processes and outcomes, and providing benchmarked performance reports to health care providers for the purpose of driving improvements in safety and quality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The successful development of a learning infrastructure requires the alignment of people, technologies, policies, and processes, brought together by shared needs and a culture of continuous quality improvement. The creation and description of such infrastructure is likely to successfully support the delivery of services critical to continuous quality improvement initiatives.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>We aimed to describe the construction and impacts of healthcare improvement infrastructure within CQRs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Socio-technical infrastructure comprises participants that contribute to the design, evaluation, reporting and dissemination of quality improvement activities: employing effective and timely data acquisition, describing healthcare processes and outcomes; supported by directed policy process and supportive organisations. Review of CQR function identifies positive impacts on healthcare utilisation, improved clinical outcomes and significant improvement in survival supported by cost effective investment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Quality improvement frameworks and strategies have been developed to drive CQRs towards international best practice in learning health system structure for data collection and reporting; delivering efficiency and interoperability in data collection and exchange; promoting standardised approaches to CQR design.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Clinical quality registries have demonstrated significant national impacts in quality improvement in high burden disease domains. These registries rely on the construction and resourcing of socio-technical infrastructures that support quality improvement.</p>\u0000 </section>\u0000 </div>","PeriodicalId":43916,"journal":{"name":"Learning Health Systems","volume":"9 4","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lrh2.70036","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145375025","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":"Evaluation of four learning collaboratives for improving diagnostic excellence in radiology","authors":"Laura M. Holdsworth,&nbsp;Heather Z. Mui,&nbsp;Kandice Garcia Tomkins,&nbsp;Kay Zacharias-Andrews,&nbsp;Mythreyi Bhargavan-Chatfield,&nbsp;Marcy Winget,&nbsp;David Larson","doi":"10.1002/lrh2.70035","DOIUrl":"https://doi.org/10.1002/lrh2.70035","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Learning collaboratives are frequently used within healthcare to facilitate practice improvement through collaboration among clinical teams across multiple organizations. The aim of this study was to use the Agency for Healthcare Research and Quality (AHRQ) collaborative taxonomy to identify collaborative elements that influence successful implementation of clinical practices and sustain improvements in four radiology learning collaboratives.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used an ethnographic approach to evaluate a learning collaborative network using the AHRQ collaborative taxonomy. Data collection included observations, interviews, and review of site performance metrics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified four themes that spanned the four AHRQ taxonomy primary elements (innovation, time, communication, social system) that explained the influence of the collaborative structure on site improvements and sustained success: (1) structured education in quality improvement and access to quality improvement tools provides a framework for quality improvement; (2) an expert-guided, structured improvement process sets the pace of improvement; (3) intentional participant interaction and contribution in meetings reinforces accountability; and (4) credible leadership and facilitation sustains participation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>While we identified all four primary elements of the AHRQ framework as important for a successful learning collaborative, social system elements were particularly dominant in their influence on sites' success. In particular, expert, credible leaders who provided the right tools, at the right time and pace, with constructive guidance were critical for maintaining site engagement and driving problem-solving.</p>\u0000 </section>\u0000 </div>","PeriodicalId":43916,"journal":{"name":"Learning Health Systems","volume":"9 4","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lrh2.70035","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145375345","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":"It takes a village: Evolving from learning health system to learning community for health equity","authors":"Sally A. Kraft,&nbsp;Chelsey R. Canavan,&nbsp;Gregory A. Norman,&nbsp;Rudolph Fedrizzi,&nbsp;Tina C. Foster","doi":"10.1002/lrh2.70031","DOIUrl":"10.1002/lrh2.70031","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Improving health equity requires engagement with partners outside of the clinical health system to address the socio-political-economic and structural drivers that shape health equity. Health systems need to focus on learning with communities to impact these conditions. The learning health system will need to evolve to a learning community to advance health equity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We describe the experience of researchers, educators, clinicians, and community members (“four pillars”) working together to develop the Dartmouth Health Center for Advancing Rural Health Equity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Structures and processes were co-designed to create an infrastructure that supports partnerships dedicated to improving rural health equity through community-based projects, education and training, and advocacy efforts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Co-designing an infrastructure to support enduring partnerships between research, education, clinical service, and community can support learning and improvement activities focused on improving health equity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":43916,"journal":{"name":"Learning Health Systems","volume":"10 2","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12900615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146203280","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":"Improving information sharing in Medicaid home and community-based services with learning health systems: Implications for older adults and individuals living with disabilities and dementia","authors":"Chanee D. Fabius,&nbsp;Christin Diehl,&nbsp;Quincy M. Samus,&nbsp;Joseph J. Gallo,&nbsp;Jennifer L. Wolff","doi":"10.1002/lrh2.70029","DOIUrl":"https://doi.org/10.1002/lrh2.70029","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Medicaid home and community-based services (HCBS) support community living for older adults and individuals living with disabilities. Information sharing and effective communication among home care team members are critical to HCBS care coordination but are often fragmented, resulting in potentially avoidable consequences, particularly for persons living with complex health conditions, like dementia. Medicaid HCBS programs collect a range of data that could be leveraged in a learning health system (LHS) model to strengthen coordination between home care team members to improve outcomes and equity in HCBS care delivery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We leverage Friedman's Socio-technical Infrastructure for LHS to consider information sharing capabilities and needs within Medicaid HCBS in Maryland.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Given longitudinal care complexities, significant costs, and data collection protocols, Medicaid HCBS is promising for LHS efforts. Recommendations for implementing an LHS in Medicaid HCBS highlight a socio-technical infrastructure (i.e., people, technology, policies, processes), information cycles (e.g., existing research relationships and opportunities for expansion), and governance (e.g., ensuring ethical LHS implementation). Additional considerations for persons living with dementia should be made, such as the integration of dementia-related policies into care delivery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Integrating LHS strategies into Medicaid HCBS holds promise for strengthening efficiency and equity in information sharing across state agencies, care teams (e.g., direct care workers, nurses), and families.</p>\u0000 </section>\u0000 </div>","PeriodicalId":43916,"journal":{"name":"Learning Health Systems","volume":"9 4","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lrh2.70029","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145375049","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}