The journey to a learning health system in primary care : a qualitative case study utilising an embedded research approach

Journal article


Dammery, Genevieve, Ellis, Louise A., Churruca, Kate, Mahadeva, Janani, Lopez, Francisco, Carrigan, Ann, Halim, Nicole, Willcock, Simon and Braithwaite, Jeffrey. (2023). The journey to a learning health system in primary care : a qualitative case study utilising an embedded research approach. BMC Primary Care. 24(22), pp. 1-10. https://doi.org/10.1186/s12875-022-01955-w
AuthorsDammery, Genevieve, Ellis, Louise A., Churruca, Kate, Mahadeva, Janani, Lopez, Francisco, Carrigan, Ann, Halim, Nicole, Willcock, Simon and Braithwaite, Jeffrey
Abstract

Background: Healthcare systems may be resilient and adaptive, but they are not fit for purpose in their current state. Increasing threats to health system sustainability have underscored the need to move towards a learning health system in which research and data are used routinely in clinical practice to facilitate system improvement. This study aimed to establish which elements of the learning health system were being realised within a university-based general practice and determine acceptability from staff to embrace further the transition towards a learning health system.

Methods: Semi-structured interviews were conducted with practice staff, including clinical and administrative staff, to determine the current state of the learning health system in the practice. An embedded researcher was placed within the general practice on a part-time basis to investigate the learning health system model. Interviews were transcribed and thematically analysed based on the National Academy of Medicine’s framework of learning health systems.

Results: In total, 32 (91%) practice staff were interviewed, comprising general practitioners (n = 15), nurses (n = 3), administrative staff (n = 13), and a psychologist (n = 1). Participants indicated that the practice was operating with several characteristics of a learning health system (e.g., emphasising science and informatics; focusing on patient-clinician partnerships; applying incentives; supporting a continuous learning culture; and establishing structures and governance for learning). These measures were supported by the university-based setting, and resultant culture of learning. Nevertheless, there were areas of the practice where the learning health system could be strengthened, specifically relating to the use of patient data and informatics. Staff generally expressed willingness to engage with the process of strengthening the learning health system within their practice.

Conclusion: Although the idea of a learning health system has been gaining traction in recent years, there are comparatively few empirical studies presented in the literature. This research presents a case study of a general practice that is operating as a learning health system and highlights the utility of using the learning health system framework.

KeywordsLearning health system; General practice; Primary care; Quadruple aim
Year01 Jan 2023
JournalBMC Primary Care
Journal citation24 (22), pp. 1-10
PublisherBMC (BioMed Central) Springer
ISSN2731-4553
Digital Object Identifier (DOI)https://doi.org/10.1186/s12875-022-01955-w
Web address (URL)https://bmcprimcare.biomedcentral.com/articles/10.1186/s12875-022-01955-w
Open accessOpen access
Research or scholarlyResearch
Page range1-10
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online19 Jan 2023
Publication process dates
Accepted23 Dec 2022
Deposited20 Sep 2024
Additional information

© The Author(s) 2023.

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco
mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Place of publicationUnited Kingdom
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