The science of learning health systems: A scoping review of the empirical research (Preprint)

Abstract

The development and adoption of a Learning Health System (LHS) has been proposed as a means to address key challenges facing current and future healthcare systems. The first review of the LHS literature was conducted five years ago, identifying only a small number of published articles had empirically examined the implementation or testing of an LHS. It is timely to look more closely at the published empirical research and to ask the question “where are we now?”, five years on from that early LHS review.

A scoping review of empirical research within the LHS domain. Taking an implementation science lens, the review aimed to map out the empirical research that has been conducted to date, identify limitations and future directions for the field.

Two academic databases (PubMed and Scopus) were searched using the terms “learning health* system*” for articles published between 1st January 2016–31st January 2021 that had an explicit empirical focus on LHSs. Article information was extracted relevant to the review objective including each study’s: publication details; primary concern or focus; context; design; data type; implementation framework, model or theory used; and implementation determinants or outcomes examined.

A total of 76 studies were included in this review. Over two-thirds of the studies were concerned with implementing a particular program, system, or platform (n=53/76, 69.7%) designed to contribute to achieving an LHS. Most of these studies focused on a particular clinical context or patient population (n=37/53, 69.8%), with far fewer studies focusing on whole hospital systems (n = 4/53, 7.5%) or on other broad healthcare systems encompassing multiple facilities (n=12/53, 22.6%). Over two-thirds of the program-specific studies utilised quantitative methods (n=37/53, 69.8%), with a smaller number utilising qualitative methods (n=10/53, 18.9%) or mixed-methods designs (n=6/53, 11.3%). The remaining 23 studies were classified into one of three key areas: ethics, policies, and governance (n=10/76, 13.2%); stakeholder perspectives of LHSs (n=5/76, 6.6%); or LHS-specific research strategies and tools (n=8/76, 10.5%). Overall, relatively few studies were identified that incorporated an implementation science framework.

Although there has been considerable growth in empirical applications of LHSs within the last five years, paralleling the recent emergence of LHS-specific research strategies and tools, there are few high-quality studies. Comprehensive reporting of implementation and evaluation efforts is an important step to moving the LHS field forward. In particular, the routine use of implementation determinant and outcome frameworks will improve the assessment and reporting of barriers, enablers and implementation outcomes in this field and will enable comparison and identification of trends across studies.