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Evaluating HEART: Student Engagement and Health System Impact in a Person-Centered Learning Health System Initiative. 评估心脏:学生参与和卫生系统在以人为本的学习卫生系统倡议的影响。
IF 2.3 Q2 HEALTH POLICY & SERVICES Pub Date : 2026-10-18 eCollection Date: 2026-10-01 DOI: 10.1002/lrh2.70124
Tracey Carr, Stefanie Foster, Phoebe Stobart, Carson Squair, Taylor Spock, Candace Skrapek, Margaret King, Brenda Andreas, Noelle Rohatinsky, Christine Stobart, Caitlin Ward, Tina Zheng, Gerald Farthing

Background: Healthcare Education and Research Training (HEART) is a cocurricular, engaged learning initiative that supported undergraduate students in acquiring and applying healthcare research skills. The project was guided by a learning health system (LHS)-aligned model focused on the collection, synthesis, and rapid translation of patient-reported experience data into actionable recommendations. In the 2023/2024 academic year, a cohort of 28 students completed the pilot project to report LHS-based recommendations to healthcare directors. This paper reports the qualitative evaluation conducted in August 2024 following the pilot to assess the initiative's implementation, participant experience, and healthcare system impacts.

Methods: Virtual, semi-structured interviews were conducted with students who participated in HEART and health system directors from a provincial health authority. Interview guides were developed by the research team in collaboration with Patient Partners. Inductive content analysis (ICA) was used to categorize information significant to the research questions. Final themes were established using a team-based approach.

Results: Student interviews indicated that participants found HEART to be a meaningful learning experience that strengthened their understanding of the healthcare system and patient experiences and helped them build applied research skills. Health system directors also expressed strong satisfaction with the project, noting that student-collected qualitative data identified service gaps, supported patient and community engagement, and contributed to measurable care improvements in at least one clinic. Suggested areas for project improvement included adjusting length of training sessions, increasing clarity around expectations and timelines, streamlining final reporting, and refining the patient interview process to gather more detailed information about specific patient experiences.

Conclusion: While various opportunities for improvement were identified, overall, HEART was determined to be a valuable opportunity for developing student healthcare research skills and was of direct benefit to health system partners as an LHS-aligned initiative providing actionable data used to identify healthcare gaps and improve patient care. Feedback and recommendations drawn from the evaluation were used to adapt and improve HEART for the following academic year.

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引用次数: 0
Electronic Health Record Integration of a Calculator for Cesarean Risk During Labor Induction 电子健康记录集成在引产过程中剖宫产风险的计算器。
IF 2.3 Q2 HEALTH POLICY & SERVICES Pub Date : 2026-10-12 DOI: 10.1002/lrh2.70120
Rebecca F. Hamm, M. Corinne Steele, Sameh Saleh, Mika Epps, E. Madeline Grenader, Lisa D. Levine, M. Kit Delgado

Introduction

Our group developed a calculator to predict individualized likelihood of cesarean delivery for patients undergoing labor induction. We aimed to determine whether nudge theory informed EHR integration of the cesarean risk calculator would increase (1) calculator utilization, and (2) documentation of patient counseling on the result.

Methods

This was a prospective cohort comparing 6 months pre (10/2022–4/2023) versus 6 months post EHR-release of the cesarean risk calculator (4/2023–10/2023) in two labor units. Prior to EHR-integration, Site #1 had a 2018 focused effort towards calculator website use, while Site #2 had no previous use. EHR-integration was automated to recognize eligible patients and allowed clinicians to confirm and utilize EHR variables for score automation, visible on electronic display. Counseling recommendations, specific to the patient's cesarean risk level, were then available for insertion into an EHR-note. The primary outcomes were (1) calculator utilization measured as a score generated in the EHR and (2) risk counseling defined as documentation of score discussion with the patient. The primary outcomes were also analyzed stratified by site.

Results

A total of 2018 patients met eligibility criteria for the cesarean risk calculator (pre:998; post:1010). Clinician calculator utilization significantly increased POST-EHR implementation from 13.4% to 77.4% (p < 0.001). Site #2, without a prior effort towards calculator use, had greater increase in use with EHR integration compared to Site #1 (Site#1 pre: 28.8% vs. post: 62.3%, p < 0.001; Site#2 pre: 0.4% vs. post: 91.8%, p < 0.001). Documentation of patient counseling also increased overall (4.0% vs. 9.9%, p < 0.001); when stratified by site, this difference was only seen at Site #2.

Conclusion

Behaviorally designed EHR integration of a cesarean risk calculator for labor induction was associated with significant increases in calculator utilization and documentation of patient counseling. This model could be applied to other evidence-based health-related risk calculators.

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引用次数: 0
From Challenge to Studio: A Prototype Frontline AI Innovation Mechanism to Address the AI Embedding Deficit in Healthcare and Educational Institutions 从挑战到工作室:解决医疗和教育机构人工智能嵌入赤字的原型前线人工智能创新机制
IF 2.3 Q2 HEALTH POLICY & SERVICES Pub Date : 2026-10-09 DOI: 10.1002/lrh2.70126
Bo Xie
<div> <section> <h3> Introduction</h3> <p>Health systems are expanding access to artificial intelligence (AI), yet frontline integration into teaching, clinical workflows, and research practice remains uneven. We frame this gap as the “AI embedding deficit,” reflecting limited organizational pathways that enable frontline professionals to translate local needs into legitimate, supported, and sustainable AI-enabled tools and workflows. This Experience Report describes a prototype intervention mechanism implemented at an academic nursing school: a rapid-cycle Nursing-AI Challenge followed by a year-round Nursing-AI Studio (NAIS) designed to stabilize and scale embedding.</p> </section> <section> <h3> Methods</h3> <p>We implemented the Nursing-AI Challenge as a structured, time-bounded mechanism to solicit real-world challenges from nursing faculty, translate and curate submissions through an interdisciplinary facilitation role, match challenges to AI trainees and mentors, and support rapid proposal development culminating in a public showcase. We then developed NAIS to address continuity and embedding barriers revealed in the Challenge, incorporating continuous intake, environmental scanning, supported co-development, year-round coordination, formalized interdisciplinary partnerships, and a strategic memorandum of understanding with the Chief Information Officer's office to support legitimate integration pathways.</p> </section> <section> <h3> Results</h3> <p>In the inaugural Challenge cycle (Spring 2025), nursing faculty identified 17 challenges spanning education, clinical practice, and research, and students in AI-related fields submitted eight proposals, followed by team formation, co-design of the AI prototypes, and a public showcase event. Implementation reflections identified key sustainability barriers including semester-bounded participation, summer momentum gaps, and intellectual property ambiguity. NAIS was established (Fall 2025 onward) to mitigate these barriers and support ongoing embedding. In early Spring 2026, NAIS launched “Teaching with AI,” a clinical faculty innovation initiative piloting an AI-powered teaching tool fully deployed within the university's information technology infrastructure.</p> </section> <section> <h3> Conclusions</h3> <p>A Challenge-to-Studio pathway may function as a practical prototype mechanism for learning health systems seeking to reduce embedding barriers and convert decentralized frontline innovation into durable, governable, and evaluable practice change.</p> </section> </di
卫生系统正在扩大人工智能(AI)的使用范围,但一线融入教学、临床工作流程和研究实践的情况仍然不均衡。我们将这一差距定义为“人工智能嵌入赤字”,反映了一线专业人员能够将当地需求转化为合法、受支持和可持续的人工智能工具和工作流程的组织途径有限。本经验报告描述了在一所学术护理学校实施的一个原型干预机制:一个快速周期的护理人工智能挑战,随后是一个旨在稳定和扩大嵌入的全年护理人工智能工作室(NAIS)。我们将护理人工智能挑战作为一种结构化的、有时间限制的机制来实施,以征求护理教师提出的现实世界的挑战,通过跨学科的促进作用翻译和策划提交的内容,将挑战与人工智能学员和导师相匹配,并支持快速的提案发展,最终形成公开展示。然后,我们开发了NAIS,以解决挑战中暴露的连续性和嵌入障碍,包括持续吸收、环境扫描、支持的共同开发、全年协调、正式的跨学科伙伴关系,以及与首席信息官办公室签署的战略谅解备忘录,以支持合法的整合途径。在首届挑战赛周期(2025年春季)中,护理学院确定了17项挑战,涵盖教育、临床实践和研究,人工智能相关领域的学生提交了8份提案,随后组建团队,共同设计人工智能原型,并举行了公开展示活动。实施反思确定了主要的可持续性障碍,包括学期参与、夏季动力差距和知识产权模糊性。NAIS成立于2025年秋季,旨在缓解这些障碍并支持正在进行的嵌入。在2026年早春,NAIS推出了“人工智能教学”,这是一项临床教师创新计划,试点在大学的信息技术基础设施中全面部署人工智能教学工具。从挑战到工作室的途径可以作为一种实用的原型机制,用于学习卫生系统,寻求减少嵌入障碍,并将分散的一线创新转化为持久、可治理和可评估的实践变化。
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引用次数: 0
Moving Person-Centered Care Planning From Theory Into Practice: Patient Perspectives 以人为本的护理计划从理论到实践:病人的观点。
IF 2.3 Q2 HEALTH POLICY & SERVICES Pub Date : 2026-10-01 DOI: 10.1002/lrh2.70122
Claire Sachs, Mary F. Henningfield, Sarina Schrager, Meagan Sulikowski, Michelle Robinson
<div> <section> <h3> Introduction</h3> <p>Persons with multiple chronic conditions often receive care from a complicated network of multiple providers across multiple health systems unique to their conditions, needs, available resources, and insurance. Patients must navigate this healthcare system, which is a difficult and complicated process with just one provider or system, let alone multiple. Developing new solutions to overcome the systemic challenges within healthcare systems to provide high-quality, comprehensive, person-centered care for persons living with, or at risk for, multiple chronic conditions is critical. Person-centered care is needed, not only because it is the right and just approach to supporting patients, but because of the profound implications of the increasing prevalence of multiple chronic conditions on healthcare costs, caregiver burden, workforce productivity, and the broader social fabric. In this commentary, we present patient perspectives on a project that brought together diverse groups to identify potential solutions to challenges in implementation of person-centered care.</p> </section> <section> <h3> Methods</h3> <p>Patients, families, and family caregivers are essential to the design and implementation of person-centered care planning for people with multiple chronic conditions. The Agency for Healthcare Research and Quality (AHRQ) funded a project aimed at compiling best practices and discussing barriers. The project used a learning system approach to engage policy experts, clinicians, researchers, and persons with multiple chronic conditions, their families, and family caregivers. Four main activities included a technical expert panel, an environmental scan, a partner roundtable, and a learning collaborative. An in-person/hybrid summit held in March 2025 summarized activities and provided a forum for presentations to share activities of the project and conduct small group discussions on select topics.</p> </section> <section> <h3> Results/Framework</h3> <p>We present patient narratives to complement content provided by the partner roundtables and other AHRQ-funded activities that provided foundational knowledge and diverse perspectives to promote person-centered care planning as standard practice for persons with multiple chronic conditions. Although many challenges to implementation of person-centered care were identified and discussed, learning from successful models and customization of models using components as appropriate may help overcome barriers. In particular, the need for culture change, use of meaningful measures, scalability, and other concepts must be addressed. Alignment of payment structures and
患有多种慢性疾病的人往往从一个复杂的网络中获得护理,该网络由多个卫生系统中的多个提供者组成,这些卫生系统对他们的病情、需求、可用资源和保险都是独特的。患者必须浏览这个医疗保健系统,这是一个困难而复杂的过程,只有一个提供者或系统,更不用说多个了。制定新的解决方案,克服卫生保健系统内的系统性挑战,为患有多种慢性病或面临多种慢性病风险的人提供高质量、全面、以人为本的护理,这一点至关重要。以人为中心的护理是必要的,不仅因为这是支持患者的正确和公正的方法,而且还因为多种慢性疾病日益流行对医疗保健成本、护理人员负担、劳动力生产力和更广泛的社会结构产生了深远影响。在这篇评论中,我们提出了患者对一个项目的看法,该项目汇集了不同的群体,以确定实施以人为本的护理挑战的潜在解决方案。方法:患者、家庭和家庭照顾者对于设计和实施以人为本的多种慢性疾病患者护理计划至关重要。卫生保健研究和质量局资助了一个旨在汇编最佳做法和讨论障碍的项目。该项目采用了一种学习系统方法,让政策专家、临床医生、研究人员、多种慢性病患者、他们的家人和家庭照顾者参与进来。四项主要活动包括技术专家小组、环境扫描、合作伙伴圆桌会议和学习协作。2025年3月举行的面对面/混合首脑会议总结了各项活动,并提供了一个论坛,供介绍项目的活动,并就选定的主题进行小组讨论。结果/框架:我们提出患者叙述,以补充合作伙伴圆桌会议和其他ahrq资助的活动提供的内容,这些活动提供了基础知识和不同的观点,以促进以人为本的护理计划作为多种慢性疾病患者的标准实践。虽然确定和讨论了实施以人为中心的护理的许多挑战,但从成功的模式中学习并使用适当的组件定制模式可能有助于克服障碍。特别是,必须解决文化变革、使用有意义的度量、可伸缩性和其他概念的需求。协调支付结构和政策支持对于确保以人为本的护理作为常规护理的一个组成部分得到推进至关重要。结论/下一步:已经确定了采用以人为本的护理计划的多重挑战。未来需要多学科团队(必须包括患者、护理人员、政策制定者和临床医生)开展工作,以制定基于证据的可行解决方案,以尊重患者、家属和护理人员的价值观和偏好的方式克服这些障碍。
{"title":"Moving Person-Centered Care Planning From Theory Into Practice: Patient Perspectives","authors":"Claire Sachs,&nbsp;Mary F. Henningfield,&nbsp;Sarina Schrager,&nbsp;Meagan Sulikowski,&nbsp;Michelle Robinson","doi":"10.1002/lrh2.70122","DOIUrl":"10.1002/lrh2.70122","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Persons with multiple chronic conditions often receive care from a complicated network of multiple providers across multiple health systems unique to their conditions, needs, available resources, and insurance. Patients must navigate this healthcare system, which is a difficult and complicated process with just one provider or system, let alone multiple. Developing new solutions to overcome the systemic challenges within healthcare systems to provide high-quality, comprehensive, person-centered care for persons living with, or at risk for, multiple chronic conditions is critical. Person-centered care is needed, not only because it is the right and just approach to supporting patients, but because of the profound implications of the increasing prevalence of multiple chronic conditions on healthcare costs, caregiver burden, workforce productivity, and the broader social fabric. In this commentary, we present patient perspectives on a project that brought together diverse groups to identify potential solutions to challenges in implementation of person-centered care.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Patients, families, and family caregivers are essential to the design and implementation of person-centered care planning for people with multiple chronic conditions. The Agency for Healthcare Research and Quality (AHRQ) funded a project aimed at compiling best practices and discussing barriers. The project used a learning system approach to engage policy experts, clinicians, researchers, and persons with multiple chronic conditions, their families, and family caregivers. Four main activities included a technical expert panel, an environmental scan, a partner roundtable, and a learning collaborative. An in-person/hybrid summit held in March 2025 summarized activities and provided a forum for presentations to share activities of the project and conduct small group discussions on select topics.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results/Framework&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We present patient narratives to complement content provided by the partner roundtables and other AHRQ-funded activities that provided foundational knowledge and diverse perspectives to promote person-centered care planning as standard practice for persons with multiple chronic conditions. Although many challenges to implementation of person-centered care were identified and discussed, learning from successful models and customization of models using components as appropriate may help overcome barriers. In particular, the need for culture change, use of meaningful measures, scalability, and other concepts must be addressed. Alignment of payment structures and ","PeriodicalId":43916,"journal":{"name":"Learning Health Systems","volume":"10 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Harnessing Potential: A Systematic Investigation of How and Why Learning Happens in a Health System 利用潜力:对卫生系统中如何以及为什么会发生学习的系统调查
IF 2.3 Q2 HEALTH POLICY & SERVICES Pub Date : 2026-09-25 DOI: 10.1002/lrh2.70116
Marissa Bird, Ruoxi Wang, Jayshree Joshi, Jaason Geerts, Farah Khan, Balpreet Panesar, Laura Desveaux

Background

The ability to learn is central to innovation and performance across industries, and it is the hallmark feature of the rapidly growing movement toward Learning Health Systems. While learning drivers—such as experimentation, risk-taking, participative decision-making, dialogue, and interaction with the external environment—are well defined, they have received little attention in healthcare contexts.

Aim

This study explored the nature of organizational learning within Trillium Health Partners (THP), one of Canada's largest community-based teaching hospital systems.

Methods

Formal leaders at THP completed the Organizational Learning Capability instrument. A latent profile analysis identified the number and nature of distinct learning profiles. Semi-structured interviews were conducted to develop an empirically grounded explanation of how organizational learning drivers interact to enable—or constrain—learning within the organization.

Results

Of 334 eligible leaders, 231 responded to the survey, and 141 provided sufficient data for inclusion in the analyses. Latent Profile Analysis identified two distinct learning profiles: one with relatively higher perceived learning capability and another with relatively lower perceived capability. Interviews with leaders (n = 12) from both groups described how theoretical factors that influence organizational learning manifest to drive (or derail) learning in practice.

Conclusion

Our systematic investigation into how and why learning occurs within a large community hospital system may support other healthcare systems in developing programs that foster the learning necessary to develop and implement innovative delivery models at scale.

学习能力是各行各业创新和绩效的核心,也是快速发展的学习型卫生系统运动的标志性特征。虽然学习驱动因素(如实验、冒险、参与性决策、对话和与外部环境的互动)得到了很好的定义,但它们在医疗保健环境中很少受到关注。目的本研究探讨了加拿大最大的社区教学医院系统之一——Trillium Health Partners (THP)的组织学习本质。方法完成组织学习能力量表。潜在特征分析确定了不同学习特征的数量和性质。进行了半结构化访谈,以开发一个基于经验的解释,说明组织学习驱动因素如何相互作用,以实现或限制组织内的学习。结果在334名合格的领导中,231人回应了调查,141人提供了足够的数据纳入分析。潜在特征分析发现两种不同的学习特征:一种是相对较高的感知学习能力,另一种是相对较低的感知学习能力。对两组领导人(n = 12)的访谈描述了影响组织学习的理论因素如何在实践中驱动(或破坏)学习。我们对大型社区医院系统中学习发生的方式和原因的系统调查可能会支持其他医疗保健系统开发项目,促进大规模开发和实施创新交付模式所需的学习。
{"title":"Harnessing Potential: A Systematic Investigation of How and Why Learning Happens in a Health System","authors":"Marissa Bird,&nbsp;Ruoxi Wang,&nbsp;Jayshree Joshi,&nbsp;Jaason Geerts,&nbsp;Farah Khan,&nbsp;Balpreet Panesar,&nbsp;Laura Desveaux","doi":"10.1002/lrh2.70116","DOIUrl":"https://doi.org/10.1002/lrh2.70116","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The ability to learn is central to innovation and performance across industries, and it is the hallmark feature of the rapidly growing movement toward Learning Health Systems. While learning drivers—such as experimentation, risk-taking, participative decision-making, dialogue, and interaction with the external environment—are well defined, they have received little attention in healthcare contexts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This study explored the nature of organizational learning within Trillium Health Partners (THP), one of Canada's largest community-based teaching hospital systems.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Formal leaders at THP completed the Organizational Learning Capability instrument. A latent profile analysis identified the number and nature of distinct learning profiles. Semi-structured interviews were conducted to develop an empirically grounded explanation of how organizational learning drivers interact to enable—or constrain—learning within the organization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 334 eligible leaders, 231 responded to the survey, and 141 provided sufficient data for inclusion in the analyses. Latent Profile Analysis identified two distinct learning profiles: one with relatively higher perceived learning capability and another with relatively lower perceived capability. Interviews with leaders (<i>n</i> = 12) from both groups described how theoretical factors that influence organizational learning manifest to drive (or derail) learning in practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our systematic investigation into how and why learning occurs within a large community hospital system may support other healthcare systems in developing programs that foster the learning necessary to develop and implement innovative delivery models at scale.</p>\u0000 </section>\u0000 </div>","PeriodicalId":43916,"journal":{"name":"Learning Health Systems","volume":"10 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lrh2.70116","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149048332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Leveraging a Locally Anchored Learning Health Care System Toward Equitable Telehealth: Assessing Broadband Access and Supporting Use of Federal Internet Subsidies in a Safety-Net Setting 利用本地锚定的学习医疗保健系统实现公平的远程医疗:评估宽带接入并支持在安全网设置中使用联邦互联网补贴。
IF 2.3 Q2 HEALTH POLICY & SERVICES Pub Date : 2026-09-21 DOI: 10.1002/lrh2.70121
Samantha M. R. Kling, Jonathan G. Shaw, Aaron A. Tierney, Mayra Reyes, Kalijah Terilli, Louis Mckinnon, Noha Aboelata, Temesgen Woldeyesus
<div> <section> <h3> Objective</h3> <p>To understand patients' access to telehealth and broadband and interest in the <i>Affordable</i> Connectivity Program (ACP) in an urban, safety-net setting, using community-engaged iterative learning cycles to improve patient-centered care.</p> </section> <section> <h3> Data Sources and Study Setting</h3> <p>Roots Community Health, a health center focused on uplifting those impacted by systemic inequities, functions as a community-anchored learning health system (LHS). Community was engaged in data collection and intervention development through Roots' Telehealth Patient Advisory Council. A cross-sectional survey was administered to adult patients.</p> </section> <section> <h3> Study Design</h3> <p>Roots designed and implemented an intervention to connect patients to digital access resources, including a 66-item questionnaire capturing patients' telehealth experience and barriers, device and broadband access, and awareness of ACP—a federal benefit providing up to $30 monthly toward internet for low-income households. Patients interested in ACP were offered enrollment support.</p> </section> <section> <h3> Data Collection Methods</h3> <p>Patients were screened for ACP interest and eligibility and offered survey participation, in-person or by phone by trained clinic staff and volunteers.</p> </section> <section> <h3> Principal Findings</h3> <p>One hundred nine patients were screened for ACP eligibility and interest; 99 completed the survey. Two-thirds (65/99) had experience with telehealth and 53% (52/99) were interested in future telehealth appointments. Patients reported several notable barriers: slow internet (46/98), no Internet access (40/99), mobile data plan issues (31/98), and downloading/using the telehealth software (31/98). Surveyed patients frequently reported utilizing the Internet for resources categorizable as Social Drivers of Health (SDOH). Most screened patients (65/109) had not heard of ACP, but over half (60/109) reported interest in applying.</p> </section> <section> <h3> Conclusions</h3> <p>Using a community-embedded LHS approach, we found that broadband connectivity is crucial for equitable telehealth access, an essential part of healthcare in clinics that aim to remedy persistent health inequities affecting people of African descent. Policy and advocacy should prioritize this SDOH, while
目的:了解在城市安全网环境下,患者对远程医疗和宽带的使用情况以及对平价连接计划(ACP)的兴趣,利用社区参与的迭代学习周期来改善以患者为中心的护理。数据来源和研究环境:根社区卫生是一个卫生中心,致力于帮助那些受到系统性不平等影响的人,是一个以社区为基础的学习型卫生系统(LHS)。社区通过根的远程保健病人咨询委员会参与数据收集和干预发展。对成年患者进行了横断面调查。研究设计:Roots设计并实施了一项干预措施,将患者与数字访问资源联系起来,包括一份66项调查问卷,记录患者的远程医疗体验和障碍,设备和宽带访问,以及对acp的认识,acp是一项联邦福利,每月为低收入家庭提供高达30美元的互联网服务。对ACP感兴趣的患者提供入组支持。数据收集方法:筛选患者对ACP的兴趣和资格,并由训练有素的临床工作人员和志愿者亲自或通过电话参与调查。主要发现:109例患者进行了ACP资格和兴趣筛选;99人完成了调查。三分之二(65/99)的人有远程医疗的经验,53%(52/99)的人对未来的远程医疗预约感兴趣。患者报告了几个明显的障碍:网速慢(46/98),无法上网(40/99),移动数据计划问题(31/98),以及下载/使用远程医疗软件(31/98)。接受调查的患者经常报告利用互联网获取可归类为健康社会驱动因素(SDOH)的资源。大多数接受筛查的患者(65/109)没有听说过ACP,但超过一半(60/109)表示有兴趣申请ACP。结论:使用社区嵌入式LHS方法,我们发现宽带连接对于公平的远程医疗访问至关重要,远程医疗访问是诊所医疗保健的重要组成部分,旨在纠正影响非洲人后裔的持续健康不平等现象。政策和宣传应优先考虑这种SDOH,而医疗保健组织应评估其在宽带政策中的作用,以提高公平性。
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引用次数: 0
Promising Patient-Engagement Practices Used by National Research Networks at the US Veterans Health Administration: Perspectives of Veterans, Staff, and Research Leaders 美国退伍军人健康管理局国家研究网络使用的有前途的患者参与实践:退伍军人,工作人员和研究领导者的观点。
IF 2.3 Q2 HEALTH POLICY & SERVICES Pub Date : 2026-09-16 DOI: 10.1002/lrh2.70119
Tracy L. Sides, Jennifer Wisdom, Malloree M. Argust, Erin C. Amundson, Diana Burgess, Laura A. Meis, Agnes C. Jensen, Erin E. Krebs

Introduction

Active involvement of patients is an essential feature of learning health systems and patient-centered research. Research networks and healthcare organizations lack guidance on best practices for developing and sustaining patient engagement infrastructure. We sought to examine perspectives on promising Veteran-engagement infrastructure and practices used by US Veterans Affairs (VA) research networks.

Methods

We solicited expert opinion from three separate panels of Veterans, VA engagement staff, and VA research leaders using a modified Delphi process comprising two rounds of online surveys and a set of virtual group meetings or individual interviews. In a prior study, we identified promising engagement practices in use by VA national research networks. We analyzed survey data with predefined rating categories to determine which practices the three expert panels consistently endorsed. We used thematic analysis to compare experts' perspectives across panels and to identify emergent cross-cutting themes.

Results

Veterans, VA engagement staff, and VA research leaders consistently endorsed 66% (29/44) of the research networks' promising Veteran-engagement practices. Summarized, these practices formed five recommended engagement-related responsibilities for VA research networks. Some network engagement practices were inconsistently endorsed (13/44, 30%), and two practices (4%) received overall ratings of neutral or unsure by at least one expert panel. Network practices not consistently endorsed varied by expert panel, but panelists' comments reflected three overarching themes: constraint of resource availability, commitment to respectful and meaningful engagement processes, and concern for potential burden on partners.

Conclusions

Panelists' perspectives highlight challenges regarding how to best invest limited patient-engagement resources within research and learning health system organizations. Research network engagement infrastructure can help expand the capacity and culture of patient-centered research and care. Organizations seeking to function as learning health systems need to devote planning time, skilled staff, and funds to develop and sustain patient-engagement infrastructure tailored to their context.

患者的积极参与是学习型卫生系统和以患者为中心的研究的基本特征。研究网络和医疗保健组织缺乏关于开发和维持患者参与基础设施的最佳实践的指导。我们试图研究美国退伍军人事务(VA)研究网络使用的有前途的退伍军人参与基础设施和实践的观点。方法:我们使用一种改进的德尔菲过程,包括两轮在线调查和一组虚拟小组会议或个人访谈,从三个独立的退伍军人小组、退伍军人事务部工作人员和退伍军人事务部研究负责人中征求专家意见。在之前的一项研究中,我们确定了VA国家研究网络正在使用的有前途的参与实践。我们用预定义的评级类别分析调查数据,以确定三个专家小组一致认可的做法。我们使用主题分析来比较各小组专家的观点,并确定新兴的跨领域主题。结果:退伍军人、退伍军人事务部员工和退伍军人事务部研究负责人一致认可66%(29/44)的研究网络有前途的退伍军人参与实践。总结起来,这些实践为VA研究网络形成了五种推荐的参与相关责任。一些网络参与实践得到了不一致的认可(13/ 44,30 %),两个实践(4%)被至少一个专家小组评为中性或不确定。专家小组并不一致赞同网络实践,但专家小组成员的意见反映了三个主要主题:资源可用性的限制、对尊重和有意义的参与过程的承诺以及对合作伙伴潜在负担的关注。结论:小组成员的观点强调了如何在研究和学习卫生系统组织中最好地投资有限的患者参与资源的挑战。研究网络参与基础设施可以帮助扩大以患者为中心的研究和护理的能力和文化。寻求作为学习型卫生系统运作的组织需要投入规划时间、熟练的员工和资金,以发展和维持适合其情况的患者参与基础设施。
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引用次数: 0
Beyond Blind Trust in Hospital Data Warehouses: Evaluating Real-World Data Accountability 超越医院数据仓库的盲目信任:评估真实世界的数据问责制。
IF 2.3 Q2 HEALTH POLICY & SERVICES Pub Date : 2026-09-06 DOI: 10.1002/lrh2.70118
Akemi Morohashi, Satoshi Yamashita, Takahiro Imaizumi, Takuto Sano, Yachiyo Kuwatsuka, Masahiko Ando, Yoshimune Shiratori

Introduction

The reliability of real-world evidence (RWE) depends on data accuracy and secondary users' ability to evaluate how data are generated and transformed. Although recent frameworks emphasize provenance, transparency, and auditability, their practical assessment in routine hospital settings remains unclear. This study examines the practical evaluability of real-world data (RWD) and explores operational boundaries limiting data quality assessment within learning health systems.

Methods

An empirical case study was conducted at a tertiary-care university hospital in Japan. Data extracted from electronic health records and a clinical data warehouse were compared using 15 quality indicators derived from the Data Quality Management Guidebook of the Digital Agency of Japan (based on ISO/IEC 25012). Evaluability was assessed using a two-step framework comprising empirical verification and contextual explanation from the perspective of research support personnel operating under routine institutional access permissions.

Results

Evaluability varied substantially across clinical domains. Diagnosis records were generally verifiable and explainable, whereas medication-related domains contained observations that could be verified but not fully explained by secondary users. Indicators including currentness and efficiency faced additional operational constraints, revealing boundaries between observable data characteristics and available explanatory information.

Conclusions

Practical RWD use depends not only on observable data characteristics but also on the accessibility of information needed to interpret them. Evaluability boundaries reflect operational constraints rather than poor data quality. Rendering these boundaries visible may support more transparent and accountable RWD governance and inform future improvements through system design and data governance practices.

引言:真实世界证据(RWE)的可靠性取决于数据的准确性和次要用户评估数据如何生成和转换的能力。虽然最近的框架强调来源、透明度和可审计性,但它们在常规医院环境中的实际评估仍不清楚。本研究考察了真实世界数据(RWD)的实际可评估性,并探讨了学习型卫生系统中限制数据质量评估的操作边界。方法:以日本某大学三级医院为研究对象进行实证研究。利用日本数字机构的《数据质量管理指南》(基于ISO/IEC 25012)得出的15项质量指标,对从电子健康记录和临床数据仓库提取的数据进行了比较。可评估性采用两步框架进行评估,包括经验验证和情境解释,从研究支持人员在常规机构访问许可下操作的角度进行评估。结果:可评估性在不同的临床领域差异很大。诊断记录通常是可验证和可解释的,而与药物相关的领域包含可验证但不能由次要用户完全解释的观察结果。包括当前和效率在内的指标面临额外的操作限制,揭示了可观察数据特征与可用解释性信息之间的界限。结论:RWD的实际使用不仅取决于可观察到的数据特征,还取决于解释这些数据所需信息的可及性。可评估性边界反映的是操作约束,而不是糟糕的数据质量。呈现这些边界可以支持更透明和负责任的RWD治理,并通过系统设计和数据治理实践为未来的改进提供信息。
{"title":"Beyond Blind Trust in Hospital Data Warehouses: Evaluating Real-World Data Accountability","authors":"Akemi Morohashi,&nbsp;Satoshi Yamashita,&nbsp;Takahiro Imaizumi,&nbsp;Takuto Sano,&nbsp;Yachiyo Kuwatsuka,&nbsp;Masahiko Ando,&nbsp;Yoshimune Shiratori","doi":"10.1002/lrh2.70118","DOIUrl":"10.1002/lrh2.70118","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The reliability of real-world evidence (RWE) depends on data accuracy and secondary users' ability to evaluate how data are generated and transformed. Although recent frameworks emphasize provenance, transparency, and auditability, their practical assessment in routine hospital settings remains unclear. This study examines the practical evaluability of real-world data (RWD) and explores operational boundaries limiting data quality assessment within learning health systems.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>An empirical case study was conducted at a tertiary-care university hospital in Japan. Data extracted from electronic health records and a clinical data warehouse were compared using 15 quality indicators derived from the <i>Data Quality Management Guidebook</i> of the Digital Agency of Japan (based on ISO/IEC 25012). Evaluability was assessed using a two-step framework comprising empirical verification and contextual explanation from the perspective of research support personnel operating under routine institutional access permissions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Evaluability varied substantially across clinical domains. Diagnosis records were generally verifiable and explainable, whereas medication-related domains contained observations that could be verified but not fully explained by secondary users. Indicators including currentness and efficiency faced additional operational constraints, revealing boundaries between observable data characteristics and available explanatory information.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Practical RWD use depends not only on observable data characteristics but also on the accessibility of information needed to interpret them. Evaluability boundaries reflect operational constraints rather than poor data quality. Rendering these boundaries visible may support more transparent and accountable RWD governance and inform future improvements through system design and data governance practices.</p>\u0000 </section>\u0000 </div>","PeriodicalId":43916,"journal":{"name":"Learning Health Systems","volume":"10 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13547741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Evaluation of a Real-Time Knowledge Exchange Network Supporting Syphilis Rapid Testing and Immediate Treatment in Seven Public Health Units in Ontario, Canada 加拿大安大略省7个公共卫生单位支持梅毒快速检测和即时治疗的实时知识交换网络的评价
IF 2.3 Q2 HEALTH POLICY & SERVICES Pub Date : 2026-09-01 DOI: 10.1002/lrh2.70106
Megan Ann Carter, Sara Tryon, Mary Southall, Kandace Belanger, Mary France Caron-Bruneau, Anne Charron, Sandra Dereski, Michael Evans, Natasha Larkin, Kassandra Plante, Melanie St. John, Nicole Szumlanski, Lucy Mackrell, Sahar Saeed

Introduction

The Syphilis Point of care Rapid testing and Immediate Treatment Evaluation (SPRITE) is a collaborative, community-based initiative that strengthens syphilis prevention and control in Ontario, Canada through flexible outreach nursing and point-of-care testing (POCT) and immediate treatment. Seven public health units (PHUs) partnered with 86 community-based organizations (CBOs) to deliver syphilis/HIV POCTs in underserved settings. This study evaluated a real-time knowledge exchange network that supported syphilis POCT implementation and capacity-building across PHUs and CBOs in Ontario.

Methods

The evaluation was a mixed-methods case study using surveys and interviews focusing on the community of practice (CoP), community engagement, and knowledge mobilization. It considers SPRITE CoP activities from beginning of implementation (mid 2023) to the Fall of 2025.

Results

The CoP, consisting of public health nurses, researchers, and knowledge specialists, supported engagement, co-development, and peer learning. Members shared lessons learned, built partnerships, and supported each other in navigating challenges. Flexibility in funding allowed innovation by CoP members in their CBO engagement efforts but also created some uncertainty and possible confusion. CoP members were overall satisfied with CoP functioning, and CBOs surveyed appeared knowledgeable and engaged in SPRITE.

Discussion

The CoP model, while distinct from traditional public health CoPs, proved effective in fostering engagement, resource development, and knowledge mobilization. Lessons learned and tools developed provide guidance for future POCT efforts. Improvements should include clearer goals, stronger facilitation, and structured engagement strategies. Addressing funding stability, particularly for POCT services and CoP management roles, is essential. Strengthening CBO partnerships through incentives and bi-directional information sharing will further enhance POCT and syphilis prevention. This evaluation underscores the importance of flexible yet accountable approaches to knowledge mobilization and POCT implementation in diverse public health contexts. Continued investment in collaborative networks like SPRITE remains critical to advancing syphilis elimination efforts across Ontario.

梅毒护理点快速检测和即时治疗评估(SPRITE)是一项基于社区的合作倡议,旨在通过灵活的外展护理和护理点检测(POCT)和即时治疗加强加拿大安大略省的梅毒预防和控制。7个公共卫生单位与86个社区组织合作,在服务不足的环境中提供梅毒/艾滋病毒poct。本研究评估了一个实时知识交流网络,该网络支持安大略省phu和cbo的梅毒POCT实施和能力建设。方法:评估是一种混合方法的案例研究,使用调查和访谈,重点关注实践社区(CoP),社区参与和知识动员。它考虑了雪碧从实施之初(2023年年中)到2025年秋季的CoP活动。结果:CoP由公共卫生护士、研究人员和知识专家组成,支持参与、共同发展和同伴学习。成员们分享了经验教训,建立了伙伴关系,并在应对挑战时相互支持。资金的灵活性允许缔约方会议成员在其CBO参与工作中进行创新,但也造成了一些不确定性和可能的混乱。CoP成员总体上对CoP的运作感到满意,被调查的cbo对雪碧的了解和投入。讨论:缔约方会议模式虽然不同于传统的公共卫生缔约方会议,但在促进参与、资源开发和知识动员方面证明是有效的。吸取的经验教训和开发的工具为今后POCT工作提供了指导。改进应包括更明确的目标、更有力的促进和有组织的参与战略。解决资金稳定性问题,特别是POCT服务和缔约方会议管理角色的资金稳定性问题至关重要。通过激励和双向信息共享加强CBO伙伴关系将进一步加强POCT和梅毒预防。这一评价强调了在不同的公共卫生环境中采取灵活而负责任的方法来调动知识和实施POCT的重要性。对雪碧等合作网络的持续投资对于推动安大略省消除梅毒的努力仍然至关重要。
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引用次数: 0
Toward a Smart Learning Health System: An Ontology-Based Framework 迈向智能学习健康系统:基于本体的框架
IF 2.3 Q2 HEALTH POLICY & SERVICES Pub Date : 2026-08-19 DOI: 10.1002/lrh2.70117
Meg Ma, Ping Yu, Louise D. Hickman

Background

Learning health system (LHS) frameworks have been presented in multiple forms, but there is no standardized representation that captures both their core concepts and the relationships among them. This limits their practical use by health services seeking to design, implement, and evaluate LHS capabilities in changing sociotechnical environments. This study developed the Smart Learning Health System ontology (SMARTLHS), a formal semantic framework that synthesizes concepts and relationships from published LHS frameworks.

Methods

Relevant literature was identified through a systematic database search. SMARTLHS was developed using an iterative system mapping and ontology engineering approach, comprising five steps: (1) ontology requirements specification, (2) iterative ontology conceptualization, (3) concept and relationship comparison and formalization, (4) ontology evaluation and refinement, and (5) ontology alignment with foundational ontology, to ensure semantic consistency and interoperability. The SMARTLHS ontology was implemented using the Web Ontology Language (OWL) and developed in Protégé.

Results

SMARTLHS contains 447 classes and 134 object properties. Its structure is organized around four high-level groupings: LHSs, supporting pillars, cross-cutting themes, and common reference LHS frameworks. The supporting pillars comprise seven domains: Care delivery and organizational strategies, community and patient engagement, culture and change management, data and technology infrastructure, governance and leadership, research and education, and workforce and capacity building. The cross-cutting themes include ethics and oversight, evaluation and methodology, and value creation and benefits. Together, these classes and relationships provide a computable semantic representation of LHS implementation.

Conclusions

SMARTLHS addresses key limitations of existing LHS frameworks by transforming narrative framework concepts into a formal, extensible semantic knowledge model. By explicitly representing both concepts and relationships, it provides a foundation for organizational assessment, semantic interoperability, and future AI-enabled applications, including ontology-guided retrieval and Retrieval-Augmented Generation (RAG).

学习卫生系统(LHS)框架已经以多种形式呈现,但没有一个标准化的表示来捕捉它们的核心概念和它们之间的关系。这限制了在不断变化的社会技术环境中寻求设计、实施和评估LHS能力的卫生服务的实际使用。本研究开发了智能学习卫生系统本体(SMARTLHS),这是一个正式的语义框架,综合了已发布的LHS框架中的概念和关系。方法通过系统的数据库检索,找到相关文献。SMARTLHS采用迭代系统映射和本体工程方法开发,包括五个步骤:(1)本体需求规范,(2)迭代本体概念化,(3)概念和关系比较和形式化,(4)本体评估和改进,(5)本体与基础本体对齐,以确保语义一致性和互操作性。SMARTLHS本体采用Web本体语言OWL (Web ontology Language)实现,并在proteproteins中开发。结果SMARTLHS包含447个类和134个对象属性。它的结构围绕四个高级组进行组织:LHS、支持支柱、交叉主题和公共参考LHS框架。支持支柱包括七个领域:护理提供和组织战略、社区和患者参与、文化和变革管理、数据和技术基础设施、治理和领导、研究和教育以及劳动力和能力建设。交叉主题包括道德和监督、评估和方法论,以及价值创造和利益。总之,这些类和关系提供了LHS实现的可计算语义表示。SMARTLHS通过将叙事框架概念转化为正式的、可扩展的语义知识模型,解决了现有LHS框架的主要局限性。通过显式表示概念和关系,它为组织评估、语义互操作性和未来支持ai的应用程序(包括本体引导的检索和检索增强生成(RAG))提供了基础。
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引用次数: 0
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Learning Health Systems
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