Training the next generation of learning health system scientists

Abstract

Introduction The learning health system (LHS) aligns science, informatics, incentives, stakeholders, and culture for continuous improvement and innovation. The Agency for Healthcare Research and Quality and the Patient‐Centered Outcomes Research Institute designed a K12 initiative to grow the number of LHS scientists. We describe approaches developed by 11 funded centers of excellence (COEs) to promote partnerships between scholars and health system leaders and to provide mentored research training. Methods Since 2018, the COEs have enlisted faculty, secured institutional resources, partnered with health systems, developed and implemented curricula, recruited scholars, and provided mentored training. Program directors for each COE provided descriptive data on program context, scholar characteristics, stakeholder engagement, scholar experiences with health system partnerships, roles following program completion, and key training challenges. Results To date, the 11 COEs have partnered with health systems to train 110 scholars. Nine (82%) programs partner with a Veterans Affairs health system and 9 (82%) partner with safety net providers. Clinically trained scholars (n = 87; 79%) include 70 physicians and 17 scholars in other clinical disciplines. Non‐clinicians (n = 29; 26%) represent diverse fields, dominated by population health sciences. Stakeholder engagement helps scholars understand health system and patient/family needs and priorities, enabling opportunities to conduct embedded research, improve outcomes, and grow skills in translating research methods and findings into practice. Challenges include supporting scholars through roadblocks that threaten to derail projects during their limited program time, ranging from delays in access to data to COVID‐19‐related impediments and shifts in organizational priorities. Conclusions Four years into this novel training program, there is evidence of scholars' accomplishments, both in traditional academic terms and in terms of moving along career trajectories that hold the potential to lead and accelerate transformational health system change. Future LHS training efforts should focus on sustainability, including organizational support for scholar activities.

Developing ahighly‐reliablelearning health system

“…Key strategies are to: (1) Integrate individuals with informatics expertise into operational teams, (2) Align QI projects with health system priorities; (3) Utilize incentives to promote clinician engagement; (4) Make QI priorities, efforts and successes visible enterprise‐wide; (5) Provide QI training for all team members. These strategies align well with recently published recommendations by AHRQ and PCORI‐funded Learning Health Systems Centers of Excellence 16 . These efforts to develop a highly‐reliable learning health system have created a system that incentivizes and reinforces a culture of quality among a wide range of team members, and amplifies our tripartite mission of high‐quality care, education of trainees, and dissemination of important innovations.…”

Advancing healthcare equity through dissemination and implementation science

“…Advancing the use of D&I science by these groups will promote equity in healthcare practice and research. However, to achieve this goal, there needs to be a workforce able to generate and apply knowledge that is responsive to community needs, accelerates the implementation of EBIs, and promotes the delivery and monitoring of equitable healthcare 235 …”

“…However, to achieve this goal, there needs to be a workforce able to generate and apply knowledge that is responsive to community needs, accelerates the implementation of EBIs, and promotes the delivery and monitoring of equitable healthcare. 235 It is important for researchers to be embedded within and knowledgeable of the healthcare system to collaborate and co-create insights and evidence to improve healthcare delivery. 236 AHRQ has recommended a series of competencies for healthcare scientists, 236 which include knowledge and skills about D&I science.…”

Development and use of a novel tool for assessing and improving researcher embeddedness in learning health systems and applied system improvements

“…Embeddedness is widely acknowledged as a core piece of LHS research and training [5]. Embeddedness represents being located in, connected to, and responsively oriented toward the systems that researchers are trying to improve [6][7][8].…”