Learning health systems in primary care: a systematic scoping review

Abstract

Background Learning health systems have been gaining traction over the past decade. The purpose of this study was to understand the spread of learning health systems in primary care, including where they have been implemented, how they are operating, and potential challenges and solutions. Methods We completed a scoping review by systematically searching OVID Medline®, Embase®, IEEE Xplore®, and reviewing specific journals from 2007 to 2020. We also completed a Google search to identify gray literature. Results We reviewed 1924 articles through our database search and 51 articles from other sources, from which we identified 21 unique learning health systems based on 62 data sources. Only one of these learning health systems was implemented exclusively in a primary care setting, where all others were integrated health systems or networks that also included other care settings. Eighteen of the 21 were in the United States. Examples of how these learning health systems were being used included real-time clinical surveillance, quality improvement initiatives, pragmatic trials at the point of care, and decision support. Many challenges and potential solutions were identified regarding data, sustainability, promoting a learning culture, prioritization processes, involvement of community, and balancing quality improvement versus research. Conclusions We identified 21 learning health systems, which all appear at an early stage of development, and only one was primary care only. We summarized and provided examples of integrated health systems and data networks that can be considered early models in the growing global movement to advance learning health systems in primary care.

Describing a complex primary health care population in a learning health system to support future decision support and artificial intelligence initiatives

“…1,2 LHS initiatives target quality improvement, research, or decision support; and usually rely on EHR data from the same population that the findings or end-product are intended to benefit. [2][3][4][5] These initiatives can support populations who have historically been excluded from medical research and clinical guideline development, such as those with complex health needs or barriers to participation. [6][7][8][9] Primary care (PC), first contact care provided in a community setting over the life course, is inherently complex.…”

“…[12][13][14] The Alliance officially adopted a LHS model in October 2020, 15,16 making them one of few documented PC LHSs in North America. 5 A LHS may pursue multiple initiatives to inform and improve care delivery. A first step towards any initiative is identifying needs of clients and providers, which is often driven by internal stakeholders.…”

“…12–14 The Alliance officially adopted a LHS model in October 2020, 15,16 making them one of few documented PC LHSs in North America. 5…”

“…The recognized potential for analysis of electronic health record (EHR) data to inform health care delivery led to the formalization of the concept of a Learning Health System (LHS) in 2007: a socio-technical system characterized by iterative cycles of data-to-knowledge-to-practice feedback [1,2]. LHS initiatives target quality improvement, research, or decision support; and usually rely on EHR data from the same population that the findings or end-product are intended to benefit [2][3][4][5]. These initiatives can support populations who have historically been excluded from medical research and clinical guideline development, such as those with complex health needs or barriers to participation [6][7][8][9].…”

“…The Alliance for Healthier Communities provides team-based primary health care through 72 Community Health Centres (CHCs) across Ontario to clients who face barriers to care and challenges, such as poverty and mental illness, that increase their risk for poor health [12][13][14]. Population health is a central element of their care model, and the Alliance officially adopted a LHS model in October 2020 [15,16], making them one of few documented primary care LHSs in North America [5]. A LHS may pursue multiple initiatives to inform and improve care delivery.…”