Abstract
Background: Learning health systems (LHS) are designed to generate and apply evidence, innovation and quality to improve the provision of care. By leveraging technology and data-driven strategies, organizations can enhance the coordination, efficiency, and effectiveness of care. Implementing the LHS approach fosters integrated and patient-centered healthcare delivery, resulting in enhanced outcomes, greater efficiency, and improved care quality for individuals throughout the care continuum. While the concept has been studied in acute healthcare settings, its application in non-acute healthcare settings remains underexplored. Addressing this gap in research, our scoping review aimed to explore how have “learning health systems” and “learning organisations” (LO) been conceptualised and operationalised in the field of rehabilitation.
Methods: The review followed Joanna Briggs Institute (JBI) and Arksey & O’Malley frameworks, employing a three-step search strategy: (1) initial keyword search in two databases (OVID MEDLINE & CINAHL), (2) comprehensive search across five databases (OVID MEDLINE; EMBASE, CINAHL; APA PsycINFO; COCHRANE) using the developed search-string, and (3) hand-search of reference lists. Inclusion criteria considered studies defining or describing LOs or LHSs and translating research evidence into healthcare improvement with relevance to rehabilitation context. Descriptive statistical analysis, qualitative content analysis and thematic mapping were utilized to explore selected studies and address the research question.
Results: The searches identified 407 records, 82 full texts were retained for review and 27 studies were finally included in the analysis. The distribution of papers indicated a growing interest in the application of the LHS concept in the field of rehabilitation, with two publications before 2014, ten between 2015-2019, and 15 between 2020 - June 2023. Studies conceptualised LHS in rehabilitation as an organizational infrastructure that supports continuous learning by integrating clinical care and research. It aims to generate new knowledge by capturing data from every clinical encounter and applying it to practice through iterative learning cycles, characterized by three phases : 1. Data to Knowledge, 2. Knowledge to Performance, and 3. Performance to Data. The analysis of the application of the LHSs in rehabilitation yielded four key themes : 1. Creating a Functioning Data Infrastructure involved the development of a robust database, ensuring data quality and security, and integrating data into clinical practice. 2. Quality of Collected Data emphasized effective collection mechanisms, discrete data collection, and standardized terminology. 3. Assembling a Multidisciplinary Team focused on engaging stakeholders with diverse expertise and various specialized skills, fostering collaboration, and actively involving patients and their families. 4. Institutional Strategies and Characteristics highlighted key organizational strategies for successful LHS operation, emphasizing effective internal communication, collaboration among stakeholders, and organizational measures to reduce fragmentation, ensure compliance, engage, and educate clinicians, manage workloads efficiently, monitor operations and enable organisational learning.
Conclusion: This study is the first scoping review on LHSs in the context of rehabilitation, employing a systematic and rigorous process to capture the relevant literature. The review identified multiple areas that need to be addressed to transform an organisation into a LHS, and its findings can be applied across other non-acute health settings.