Implementation strategies and outcome measures for advancing learning health systems: a mixed methods systematic review

Somerville, Mari; Cassidy, Christine; Curran, Janet A.; Johnson, Catie; Sinclair, Douglas; Elliott Rose, Annette

doi:10.1186/s12961-023-01071-w

Table 1 Study characteristics and quality score of included papers

From: Implementation strategies and outcome measures for advancing learning health systems: a mixed methods systematic review

Name of LHS	Author, Year (n = 35)	Country	Study design	Objective	Health setting	Population/Health condition	CA score
Peds-CHOIR	Bhandari 2016	USA	Cross-sectional Study	To describe the application of CHOIR in a pediatric pain clinic	Pediatric tertiary care pain clinic	Children aged 8–17 years with chronic pain	75%
SPS Network; ICN; NPCQIC; OPQC	Britto, 2018	USA	Case Study	To describe how the LHS organizational framework has been replicated in four conditions, leading to improved outcomes	Multi-institutional network	Various pediatric conditions within 4 LHS	n/a
RCLS-CF	Dixon-Woods 2021	UK	Qualitative	To examine perspectives of health professionals on how to implement a LHS	Multi-institutional network	Providers working with cystic fibrosis patients (n = 19)	90%
n/a	Enticott 2020	Australia	Qualitative	To explore features of a LHS	National health organization	Variety of health system stakeholders (n = 26)	90%
VA-ESP	Floyd 2019	USA	Cross-sectional Study	To build on previous work, describing LHS needs	Veteran Affairs Health System	Variety of decision-makers (n = 66)	25%
PEDSnet & ICN	Forrest 2014	USA	Case Study	To describe a model for a pediatric LHS	Health Network	Inflammatory bowel disease health centres (n = 8)	n/a
PEDSnet & ICN	Porcaro, 2022	International	Case Study	To describe a strategic governance review of ICN	Health Network	Children and adolescents with IBD across various network sites (n = 106)	n/a
The Ottawa Hospital	Fung-Kee-Fung 2018	Canada	Case Study	To describe an approach to improved lung cancer care	Hospital	Patients with lung cancer, providers and caregivers (n = 68)	n/a
Neotree	Heys, 2022	International	Case Study	To describe conceptualization, development and implementation experience of Neotree	Multi-institutional network	Newborn care in low-resource settings (n = 18 000 babies; n = 400 HCPs)	n/a
n/a	Jeffries 2018	UK	Qualitative	To explore how an LHS intervention was implemented in practice	Primary Care	General practice staff & pharmacists (n = 22)	70%
SHOnet	Koscielniak, 2022	USA	Case Study	To describe the development of an LHS for a pediatric specialty care rehabilitation network	Multi-institutional Network	Data for over 2 million patient encounters	n/a
MSQC	Krapohl 2020	USA	Case Study	Describe how to implement and sustain a LHS	Multi-institutional Network	Michigan hospitals performing major surgeries (n = 70)	n/a
PC-ICCN	Levin, 2022	Canada	Case Study	To describe the PC-ICCN LHS	Multi-institutional Network	Patients living with long COVID (n = 5364)	n/a
TRANSFoRm	Lim, 2015	Europe	Case Study	To describe the TRANSFoRm project and the GERD use case	Primary Care	Patients with GERD	n/a
LFEP	Lowes 2017	USA	Cohort Study	To describe the implementation of a LHS for children with cerebral palsy	Hospital	Children with cerebral palsy (n = 131)	91%
LFEP	Noritz 2018	USA	Cross-sectional Study	To describe the process of screening patients with cerebral palsy for hip displacement	Hospital	Children with cerebral palsy (n = 132)	63%
SCK	Miller 2020	USA	Cross-sectional Study	Develop a data dictionary to standardize bedside data entry in real time	Hospital	Patients with sickle cell disease (n = 285)	75%
IDEA4PS	Moffat-Bruce 2018	USA	Case Study	Describe the experience of an academic medical center in developing an LHS	Hospital	Stakeholders from more than 8 investigators (n = 23)	n/a
MS PATHS	Mowry 2020	International	Cohort Study	To describe initial implementation of MS PATHS	Multi-institutional Network	Patients with multiple sclerosis from 10 institutions (n = 16 568)	55%
ATN/AIR-P	Murray 2019	USA	Case Study	To describe the transition to a learning network, including lessons learned	Multi-institutional Network	Network sites providing autism care (n = 12)	n/a
The Alliance for Healthier Communities	Nash, 2022^a	Canada	Qualitative	Provide guidance for health systems to develop a LHS	Primary Care	Stakeholders (n = 29) from 6 community health centres	60%
The Alliance for Healthier Communities	Nash, 2022^b	Canada	Case Study	To describe the process of developing a province-wide LHS in primary care	Multi-institutional Network (Primary Care)	Community-governed primary care organizations (n = 109)	n/a
SNEPT	Perito 2021	USA	Case Study	To describe the creation of a multicenter LHS for pediatric liver transplantation	Multi-institutional Network	Health care sites providing pediatric liver transplant care (n = 10)	n/a
myAva	Satveit 2018	USA	Case Study	To describe the myAva program as a LHS for women with polycystic ovarian syndrome	Health Network	Patients living with polycystic ovarian syndrome (PCOS) (n = 55)	n/a
ClaudicatioNet Quality System	Sinnige, 2021	Netherlands	Case Study	To describe the transformation of ClaudicatioNet into an LHS which aims to improve physical therapy care for patients with intermittent claudication	Multi-institutional Network	Patients with intermittent claudication	n/a
CHC	Steels 2021	UK	Qualitative	To present preliminary findings of implementing the CHC LHS across the north of England	Multi-institutional Network	CHC program staff and external partners (n = 59)	60%
CORE	Taylor 2021	USA	Case Study	To describe the health system transformation to a LHS	Multi-institutional Network	Various health system concerns	n/a
EQUIPPED	Vandenberg 2020	USA	Case Study	To describe the implementation of the EQUIPPED medication safety program	Multi-institutional Network	Team members from three implementation emergency department sites (n = 18)	n/a
EQUIPPED	Vaughan 2021	USA	Quasi-experimental Study	To describe prescribing behaviours following implementation of the EQUIPPED medication safety program	Multi-institutional Network	Adults aged 65 years and over being discharged from emergency department sites	56%
n/a	Varnell, 2022	USA	Case Study	To describe how building improved health systems with integrated clinical care as part of an LHS can improve pediatric nephrology care	Hospital	Kidney transplant patients from one clinical department	n/a
Grey Literature Sources
Baylor Scott and White Health	AHRQ, 2019	USA	Case Study	To describe the transition of the Baylor Scott & White Health system to an LHS	Multi-institutional network	Multiple healthcare institutions (n = 967)	n/a
Denver Health	AHRQ, 2019	USA	Case Study	To describe the transition of the Denver Health system to an LHS	Multi-institutional network	Multiple healthcare institutions (n = 29)	n/a
HCA Healthcare	AHRQ, 2019	International	Case Study	To describe the transition of HCA Healthcare to an LHS	Multi-institutional network	Multiple healthcare institutions (n = 304)	n/a
University of Utah Health	AHRQ, 2019	USA	Case Study	To describe the transition of the University of Utah Health system to an LHS	Multi-institutional network	Multiple healthcare institutions (n = 42)	n/a
Geisinger Health System	Foley, 2015	USA	Case Study	To describe GHS and its approach to becoming an LHS	Multi-institutional network	Integrated health services organization serving general public (n = 2.6 million patients)	n/a

AHRQ Agency of Healthcare Research and Quality, ATN/AIR-P Autism Treatment Network & Autism Intervention and Research Network on Physical Health, CA Critical Appraisal, CHC Connected Health Cities, CHOIR Collaborative Health Outcomes Information Registry, CORE Center for Outcomes Research and Evaluation, COVID Coronavirus Disease, EQUIPPED Enhancing Quality of Prescribing Practices for Older Adults in the Emergency Department, GERD Gastroesophageal reflux disease, GHS Geisinger Health System, HCA Hospital Corporation of America, IBD Inflammatory bowel disease, ICN Improve Care Now, IDEA4PS Institute for the Design of Environments Aligned for Patient Safety, LFEP learn from every patient, LHS Learning Health System, MS PATHS Multiple Sclerosis Partners Advancing Technology and Health Solutions, MSQC Michigan Surgical Quality Collaborative, NPCQIC National Pediatric Cardiology Quality Improvement Collaborative, PCICCN Post COVID-19 Interdisciplinary Clinical Care Network, OPQC Ohio Perinatal Quality Collaborative, Peds-CHOIR Pediatric adaptation of the Collaborative Health Outcomes Information Registry, RCLS-CF Registry-enabled Care and Learning System for Cystic Fibrosis, SCK Sickle cell knowledge base, SHOnet Shriners Hospitals for Children (SHC) Health Outcomes Network, SPS Solutions for Patient Safety, SNEPT Starzl Network for Excellence in Pediatric Transplantation, UK United Kingdom, USA United States of America, VA-ESP Veterans Affairs Evidence Synthesis Program

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ISSN: 1478-4505

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