Health for people and planet: building bridges to a sustainable future

Introduction: A key component of building sustainable health systems is strengthening the front lines of care, especially emergency departments and primary care settings. Globally, these settings are challenged, amongst other factors, by ageing populations, a burnt-out workforce, future pandemics, and worsening climate change effects. Learning Health Systems (LHSs) have been advocated as a solution to improve care quality and patient safety by continuously embedding research and data into routine practice, thereby enabling the front lines to learn and improve on-the-go1,2. So: how far have the front lines of care progressed in adopting LHSs principles? Many experts think progress is critical in delivering better care and being prepared for looming threats to the system. This rapid literature review investigated the breadth of LHS approaches adopted in primary care and emergency settings and the factors influencing their adoption Methods: To comprehensively consider this question, three databases (Embase, Scopus, PubMed) were searched from January 2018 to March 2023 for literature reporting on LHSs in primary care or emergency settings. Articles with a key focus on LHSs in primary care (general practice, allied health, multidisciplinary primary care, and community-based care) and/or emergency settings were screened to assess their eligibility. Data from included articles were extracted into a purpose-designed Excel spreadsheet and catalogued according to the five components of the Zurynski-Braithwaite 2020 LHS model3 : science and informatics, patient-clinician partnerships, incentives, continuous learning culture and structure and governance.
Results: Of the 37 articles included and analysed, the vast majority (86%) were focussed on primary care and conducted in North America (68%). Science and informatics was the most commonly employed LHS component, in which 92% of articles examined technological tools, systems, or measures that had been implemented to improve care quality (e.g., electronic health records to improve adherence to guideline-directed care). Continuous learning culture was a focus of 84% of articles, most frequently centred on the creation of teams or collaboratives to share quality improvement learnings. Structure and governance, the third most common component (76%), focused primarily on partnership structures to strengthen research and leadership engagement. Less of a focus were incentives (e.g., compensation to encourage staff training) and patient-clinician relationships (e.g., intervention co-design). Further, patient satisfaction and health outcomes in the context of LHSs were rarely explored. Barriers to adopting LHSs at the front lines of care included data infrastructure that was too complex, communication challenges between healthcare professionals, and limited resources to support improvement. Facilitators included stakeholder buy-in, positive relationships, and forward-planning for interventions.
Conclusion: This study found a breadth and range of LHS approaches adopted in primary care and emergency settings internationally. Many care settings are providing clinicians with actionable data and tools to learn from patient encounters; are facilitating a culture of continual quality improvement; and are effectively managing their learning environment. Less progress than we would prefer is being made along LHS lines to provide incentives and take patient preferences into account in decision-making processes. Becoming an LHS requires good policy to support resource commitment, and funding models that enable partnerships within and across organisations. Multidisciplinary learning and patient co-design must be a core focus to facilitate empowered, informed, and enabled individuals and teams at the front lines of care.
References: 1. Braithwaite J, Glasziou P, Westbrook J. The three numbers you need to know about healthcare: the 60-
30-10 challenge. BMC medicine 2020;18:1-8.
2. Pomare C, Mahmoud Z, Vedovi A, et al. Learning health systems: a review of key topic areas and bibliometric trends.
Learning Health Systems 2022;6(1):e10265.
3. Zurynski Y, Smith CL, Vedovi A, et al. Mapping the learning health system: a scoping review of current evidence. A
white paper. 2020