Learning Health Systems Research: Continued Progress and Ongoing Challenges.

Background: Learning health systems research (LHSR) builds on concepts of systems-based participatory research to form a new paradigm for partnered research.

Objective: Defines LHSR and its ongoing challenges and future directions.

Research design: Qualitative description of relevant dimensions of LHSR.

Results: In LHSR, researchers and health system stakeholders co-create research with dual aims of producing internal quality improvement and generalizable, disseminable knowledge. This approach aligns research priorities with community and health system needs, resulting in interventions that are both feasible and acceptable in real-world settings and effective. LHSR methods and outcomes reflect elements of implementation science, particularly participatory implementation science and the use of mixed methods, but the field is distinct in its emphasis on co-creation with health system leaders and the use of theory to inform rather than drive the work. Practitioners of LHSR face challenges related to the complex and multi-stakeholder nature of the field, including the time-intensive nature of building partnerships, conflicting project time horizons, imprecision inherent in real-world data, and barriers to publication of the smaller studies that typically result from LHSR.

Conclusions: Continued advancement of the field requires confronting these challenges with a variety of interventions, including explicit institutional support and incentives for this type of work, training and career development opportunities, a diversity of funding sources, investment in data resources and expertise, and inclusive research governance structures.