Diversity in Combating Complex, Chronic, and Costly Conditions Using a Learning Health System Approach: A Scoping Review.

Introduction: The purpose of this scoping review was to investigate in the literature how a learning health system (LHS) can be implemented in cases of complex, costly, chronic (3C) conditions.

Methods: A scoping review of literature published in English since 2007 was conducted using Medline, Cumulative Index to Nursing and Allied Health Literature, and Scopus. Two authors screened the resulting articles and two authors extracted study details on the structure, process, and outcome of each LHS. Eligibility criteria included studies of LHSs that focused on populations experiencing a complex chronic health condition. A narrative synthesis of data was conducted using deductive qualitative methods.

Results: Application of the authors' search strategy resulted in 656 publications that were analyzed for this review. The authors included 17 studies that focused on 13 LHSs. The structure of the LHSs had many components, and many included data from either patient surveys or patient charts. The processes varied widely, from engaging patients in the process to exclusively analyzing the data. The outcomes were largely patient-reported, though several clinical outcomes were also used to benchmark the success of the LHS.

Discussion: Our review shows that LHS definitions, structures, processes, and outcomes in 3C applications vary widely. Many have shown substantial potential to be implemented and improve care in 3C populations. To deliver on this goal, future work will need to focus on better specification, formalization, and definition of LHS approaches, as well as better design of their structures, processes, and outcomes to fit the needs of the intended population.