Learning Health Systems最新文献_第2页

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

Learning Health Systems

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

Learning Health Systems

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

Operationalizing Patient Experience Data as a System Feedback Asset in Learning Health Systems: Learnings From Model of Care Redesign at Trillium Health Partners 将患者体验数据作为学习卫生系统的系统反馈资产进行操作：从Trillium健康合作伙伴的护理重新设计模型中学习

IF 2.3 Q2 HEALTH POLICY & SERVICES

Learning Health Systems

Pub Date : 2026-08-17 DOI: 10.1002/lrh2.70113

Umair Majid, Arija Birze, Danielle Jacobson, Michelle Marcinow, Natalie Murray, Wanyue Chen, Marissa Bird, Adam Gdyczynski, Kerry Kuluski

Introduction

Learning Health Systems (LHS) offer a pathway to continuously improve care by integrating data and lived experience, yet few practical examples demonstrate how LHS can be operationalized in hospital settings in ways that embed the voices of patients and families. This manuscript describes how patient experience (PX) data are integrated into the design of a new model of care (MoC) that responds to both system demands and the realities of patients and families.

Methods

Researchers partnered with clinical leaders to integrate patient and family voices into the design of a new MoC using PX survey data, interviews with patients and families admitted to medicine units, and naturalistic walk-throughs of each medicine unit. Data collection explored care priorities, interactions with staff, physical environments, and reflections on positive and challenging aspects of care. Analysis followed a three-step iterative process: unit-level synthesis, cross-unit thematic comparison, and data integration.

Results

In total, 390 patients participated in the PX survey and 19 patients/families participated in interviews. Patients situated their experiences within a health care system under strain, highlighting both strengths and gaps. Many expressed appreciation for nurses' compassion, but emotional support for fears, anxieties, and worries was inconsistent, particularly when staff were overstretched or transient. Long wait times for transport, procedures, or basic care needs were reported as sources of anxiety and diminished dignity. Naturalistic walk-throughs documented how crowding, noise, lighting, and wayfinding shaped patients' comfort and privacy.

Conclusions

This work provides a practical example of how an LHS approach can be operationalized by embedding the voices of patients and families into care redesign. Findings from the PX survey and interviews are directly shaping a new MoC at Trillium Health Partners (THP) that is evidence-informed and co-designed with patients and families, providing a practical example of how PX data can drive continuous, system-level learning.

学习型卫生系统（LHS）提供了一条通过整合数据和生活经验来持续改善护理的途径，但很少有实际例子表明，LHS如何在医院环境中以嵌入患者和家庭声音的方式运作。这篇手稿描述了病人的经验（PX）数据是如何整合到一个新的护理模式（MoC）的设计，以响应系统的需求和病人和家庭的现实。方法研究人员与临床领导合作，利用PX调查数据、对住院患者和家属的访谈以及对每个医疗单元的自然走查，将患者和家属的声音整合到新的MoC设计中。数据收集探讨了护理重点、与工作人员的互动、物理环境以及对护理积极和具有挑战性方面的反思。分析遵循三步迭代过程：单位级综合、跨单位专题比较和数据集成。结果共有390名患者参与PX调查，19名患者/家庭参与访谈。患者将他们在医疗保健系统中的经历置于压力之下，突出了优势和差距。许多人对护士的同情心表示赞赏，但对恐惧、焦虑和担忧的情感支持是不一致的，特别是当工作人员过度劳累或短暂的时候。据报告，等待运输、程序或基本护理需求的时间过长是焦虑和尊严受损的根源。自然主义的演练记录了拥挤、噪音、照明和寻路如何影响患者的舒适度和隐私。这项工作提供了一个实际的例子，说明如何通过将患者和家庭的声音嵌入到护理重新设计中来实现LHS方法的操作。PX调查和访谈的结果直接塑造了Trillium Health Partners （THP）的一个新的MoC，该MoC是基于证据的，与患者和家属共同设计的，为PX数据如何推动持续的系统级学习提供了一个实际的例子。

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引用次数: 0

Long-Term, Low-Maintenance, and Impactful: Lessons Learned From Sustaining the NOHARM Pragmatic Clinical Trial 长期、低维护和有效：维持NOHARM实用临床试验的经验教训

IF 2.3 Q2 HEALTH POLICY & SERVICES

Learning Health Systems

Pub Date : 2026-08-17 DOI: 10.1002/lrh2.70075

Shritha Gayathri, Amanda Courtright-Lim, Alexandra Wicker, Jane Hein, Amanda Nelson, Sue Cutshall, Sarah A. Minteer, Andrea Cheville, Jon Tilburt

Introduction

Sustaining interventions implemented as part of pragmatic clinical trials requires proactive planning, but how to approach this process remains understudied. The Non-pharmacological Options in Hospital-based and Rehabilitation pain Management stepped-wedge cluster-randomized pragmatic trial tested an electronic health record-based educational bundle (known as the Healing After Surgery [HAS] initiative) that encouraged the incorporation of non-pharmacological pain care in perioperative pain management. The HAS initiative was implemented in multiple surgical practices and hospital sites. One year prior to trial completion, a sustainment committee was established to support the transition of intervention components to clinical ownership and to support posttrial sustainment of the HAS initiative.

Methods

We reviewed meeting minutes from biweekly sustainment committee meetings and conducted debriefing sessions with committee members (informed by the Clinical Sustainability Assessment Tool) to identify sustainment strategies and challenges, which were then organized into meaningful themes.

Results

The following six themes emerged from meeting minutes and debriefings: (1) automation of low-touch components, (2) reliance on internal champions, (3) intentional handoff communication, (4) institutional attention, (5) relaxed fidelity, and (6) continuous evaluation. Together, they highlight the importance of early, structured planning and adaptable implementation strategies.

Conclusions

Sustainment of the HAS initiative required extensive communication, adaptation, and stakeholder engagement across diverse institutional contexts. Proactive sustainment planning during trial design may help ensure interventions are successfully integrated into routine clinical practice posttrial.

作为实用临床试验的一部分，维持干预措施的实施需要积极的计划，但如何处理这一过程仍未得到充分研究。基于医院和康复疼痛管理的非药物选择楔形聚类随机实用试验测试了一种基于电子健康记录的教育包（称为手术后愈合[HAS]倡议），鼓励将非药物疼痛护理纳入围手术期疼痛管理。HAS倡议已在多个外科诊所和医院实施。在试验完成前一年，成立了一个维持委员会，以支持将干预组成部分移交给临床所有，并支持HAS倡议的试验后维持。我们回顾了两周一次的可持续委员会会议纪要，并与委员会成员进行了汇报会议（由临床可持续性评估工具告知），以确定可持续战略和挑战，然后将其组织成有意义的主题。结果从会议纪要和述职报告中可以得出以下六个主题：(1)低接触组件的自动化，(2)对内部冠军的依赖，(3)有意的交接沟通，(4)机构关注，(5)放松保真度，(6)持续评估。它们共同强调了早期、有组织的规划和适应性强的实施战略的重要性。维持HAS倡议需要在不同的制度背景下进行广泛的沟通、适应和利益相关者的参与。试验设计期间的前瞻性维持计划可能有助于确保干预措施成功地纳入试验后的常规临床实践。

{"title":"Long-Term, Low-Maintenance, and Impactful: Lessons Learned From Sustaining the NOHARM Pragmatic Clinical Trial","authors":"Shritha Gayathri, Amanda Courtright-Lim, Alexandra Wicker, Jane Hein, Amanda Nelson, Sue Cutshall, Sarah A. Minteer, Andrea Cheville, Jon Tilburt","doi":"10.1002/lrh2.70075","DOIUrl":"https://doi.org/10.1002/lrh2.70075","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Sustaining interventions implemented as part of pragmatic clinical trials requires proactive planning, but how to approach this process remains understudied. The Non-pharmacological Options in Hospital-based and Rehabilitation pain Management stepped-wedge cluster-randomized pragmatic trial tested an electronic health record-based educational bundle (known as the Healing After Surgery [HAS] initiative) that encouraged the incorporation of non-pharmacological pain care in perioperative pain management. The HAS initiative was implemented in multiple surgical practices and hospital sites. One year prior to trial completion, a sustainment committee was established to support the transition of intervention components to clinical ownership and to support posttrial sustainment of the HAS initiative.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We reviewed meeting minutes from biweekly sustainment committee meetings and conducted debriefing sessions with committee members (informed by the Clinical Sustainability Assessment Tool) to identify sustainment strategies and challenges, which were then organized into meaningful themes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The following six themes emerged from meeting minutes and debriefings: (1) automation of low-touch components, (2) reliance on internal champions, (3) intentional handoff communication, (4) institutional attention, (5) relaxed fidelity, and (6) continuous evaluation. Together, they highlight the importance of early, structured planning and adaptable implementation strategies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Sustainment of the HAS initiative required extensive communication, adaptation, and stakeholder engagement across diverse institutional contexts. Proactive sustainment planning during trial design may help ensure interventions are successfully integrated into routine clinical practice posttrial.</p>\u0000 </section>\u0000 </div>","PeriodicalId":43916,"journal":{"name":"Learning Health Systems","volume":"10 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lrh2.70075","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148783797","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

Development of the Learning Health Systems Toolkit: A Collaborative Effort to Bridge Concept and Practice 学习卫生系统工具包的开发：桥梁概念和实践的合作努力

IF 2.3 Q2 HEALTH POLICY & SERVICES

Learning Health Systems

Pub Date : 2026-08-14 DOI: 10.1002/lrh2.70111

Sarah Gilman, Jessica R. Phillips, Tom Foley, Philip J. van der Wees, Jeffrey Braithwaite, Kenneth Harwood, Robert Verheij, Joshua C. Rubin, Remco Benthem de Grave, Eleni Margariti, Paige L. McDonald

Introduction

Learning communities need access to resources to support efforts in building and sustaining learning health systems. This experience report details our development and initial assessments of the Learning Health System (LHS) Toolkit, a menu of resources purpose-designed to support users to build more proactive, responsive, and equitable systems of care by developing, implementing and sustaining LHSs.

Methods

Toolkit development began in 2022, and the current version was completed in 2025. To optimize knowledge translation, we structured our methods to align with the phases of the Knowledge to Action (KTA) Model, including (1) Knowledge Inquiry; (2) Synthesis and Creation; (3) Knowledge Selection; (4) Adapting Knowledge to Local Context; (5) Assessing Barriers and Facilitators to Knowledge Use; (6) Selecting, Tailoring, and Implementing the Intervention, and (7) Monitoring Knowledge Use.

Results

Development of the web-based toolkit and vetting of its contents were achieved over several phases. Feedback from toolkit users was positive overall and was integral to its development and refinement. Users from 72 countries have accessed the toolkit, although most engagement has occurred in high-income countries, chiefly the US, UK, Türkiye, Australia, Canada, The Netherlands, and New Zealand.

Conclusions

The toolkit is uniquely situated to support learning communities. It includes a dynamic design, is regularly updated, and is accessible free of cost. Additionally, unlike a literature search, the toolkit is developed with usability in mind and includes tools beyond peer-reviewed literature, curated by LHS experts. The next steps are to develop and action a dissemination plan based on implementation science principles to increase the reach and adoption of the toolkit.

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引用次数: 0

Automatic Conversion of NICE Guidelines to an Executable Computational Model Using Large Language Models 使用大型语言模型的NICE指南到可执行计算模型的自动转换

IF 2.3 Q2 HEALTH POLICY & SERVICES

Learning Health Systems

Pub Date : 2026-08-14 DOI: 10.1002/lrh2.70114

Ashvin Gupta, Denys Prociuk, Alessandra Russo, Brendan C. Delaney

Introduction

The UK National Institute for Health and Care Excellence (NICE) produce guidelines that provide evidence-based recommendations to support clinical care across England and Wales, but remain available in unstructured natural language form. Converting these guidelines into computable, logically coherent representations is an active area of research yet existing approaches typically focus on individual diseases, require substantial manual encoding, and do not scale. Recent advances in large language models offer an opportunity to automate much of this translation process.

Methods

We present an end-to-end approach that automatically converts textual clinical guidelines into an executable model capable of generating explainable patient-specific recommendations. Our approach uses a stepwise LLM-based transformation with in-context examples that can be customized to the guideline of your choice. Each step generates human-inspectable intermediate artifacts, ensuring full transparency and modifiability. We apply the approach to both pancreatic and lung cancer NICE guidelines and use expert human review to assess the alignment of the produced rules as well as evaluating the executable model over 20 pancreatic cancer patient vignettes.

Results

Human experts review demonstrated strong alignment between the natural language guidelines and the generated executable models, with the majority of guideline recommendations translated correctly. Most discrepancies involved partial omissions of specific details rather than incorrect logic, and instances of hallucinated or fundamentally incorrect rules were rare. When executed on the vignettes, the resulting executable models produced patient-specific recommendations with an F1 score of 82.5%.

Conclusion

This work demonstrates that LLMs can be used to automatically transform natural language NICE guidelines into interpretable and executable models. The models preserve guideline structure, allow transparent inspection and modification, and can be executed to generate patient-specific recommendations. Our findings highlight the feasibility of automated guideline generation, opening the door to scalable computable guidelines.

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引用次数: 0

Ambient AI Scribes as Emerging Infrastructure in the Learning Health System 环境人工智能抄写作为学习健康系统的新兴基础设施。

IF 2.3 Q2 HEALTH POLICY & SERVICES

Learning Health Systems

Pub Date : 2026-08-10 DOI: 10.1002/lrh2.70115

Taofeeq Oluwatosin Togunwa, Jodyn Platt

Ambient artificial intelligence (AI) scribes are systems that automatically generate clinical documentation from clinician-patient conversations and are being deployed at accelerating pace across US health systems. Early evaluations report reduced documentation burden, improved clinician well-being, and perceived efficiency gains, reinforcing a narrative of inevitability. Yet this frontline framing understates a more consequential issue: ambient scribes outsource the “first mile” of clinical documentation, thereby reshaping the production of clinical data and the learning health systems (LHSs) that depend on documentation as foundational infrastructure. This paper argues that ambient AI scribes should be understood not merely as workflow tools, but as emerging infrastructure that will materially shape the capacity and capabilities of LHSs. Drawing on infrastructure studies and LHS frameworks, we conceptualize clinical documentation as the epistemic substrate through which encounters are translated into analyzable data that power quality measurement, predictive modeling, clinical decision support, and institutional learning. When this translation is algorithmically mediated by proprietary systems, design choices, training data, and integration pathways can introduce systematic documentation errors that propagate downstream, often invisibly, through analytic pipelines. Synthesizing emerging evidence, we highlight risks including hallucinated clinical details, omission of safety-critical information, and differential performance across patient populations with diverse accents or speech patterns. These risks mirror classic infrastructural properties described by Star: embeddedness, dependence on the installed base, wide propagation, and visibility primarily upon breakdown. From this perspective, ambient scribes may quietly reshape documentation norms, data quality, and learning trajectories well before downstream effects are routinely assessed. We conclude by outlining a governance agenda grounded in LHS principles: documentation-quality metrics, drift monitoring, equity-focused evaluation, transparency, and multi-stakeholder stewardship. Without such oversight, ambient AI scribes risk stabilizing an infrastructural layer that delivers short-term relief while eroding the long-term integrity, equity, and trustworthiness of learning health systems.

环境人工智能（AI）抄写员是一种从临床医生与患者的对话中自动生成临床文档的系统，这种系统正在美国卫生系统中加速部署。早期的评估报告减少了文件负担，改善了临床医生的福利，并提高了效率，加强了必然性的叙述。然而，这种前线框架低估了一个更重要的问题：环境抄写员外包了临床文件的“第一英里”，从而重塑了临床数据的生产和依赖文件作为基础设施的学习型卫生系统（lhs）。本文认为，环境人工智能抄写器不应该仅仅被理解为工作流工具，而且应该被理解为新兴的基础设施，它将从根本上塑造lhs的能力和能力。在基础设施研究和LHS框架的基础上，我们将临床文献概念化为认知基础，通过它，遭遇被转化为可分析的数据，从而为质量测量、预测建模、临床决策支持和机构学习提供动力。当这种转换由专有系统以算法为中介时，设计选择、训练数据和集成路径可能引入系统性文档错误，这些错误通过分析管道向下游传播，通常是不可见的。综合新出现的证据，我们强调的风险包括幻觉的临床细节，安全关键信息的遗漏，以及不同口音或语言模式的患者群体的差异表现。这些风险反映了Star描述的经典基础设施特性：嵌入性、对安装基础的依赖性、广泛的传播以及主要在故障时的可见性。从这个角度来看，在常规评估下游影响之前，环境抄写员可能会悄悄地重塑文档规范、数据质量和学习轨迹。最后，我们概述了基于LHS原则的治理议程：文档质量度量、漂移监测、以股权为中心的评估、透明度和多利益相关者管理。如果没有这样的监督，环境人工智能就有可能稳定基础设施层，从而在短期内提供缓解，同时侵蚀学习型卫生系统的长期完整性、公平性和可信度。

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引用次数: 0

Leading Learning Health Systems in the Asia Pacific: A Mixed-Method Evaluation of Health Professionals' Experiences in a Longitudinal Leadership Program 亚太地区领先的学习卫生系统：纵向领导计划中卫生专业人员经验的混合方法评估。

IF 2.3 Q2 HEALTH POLICY & SERVICES

Learning Health Systems

Pub Date : 2026-08-07 DOI: 10.1002/lrh2.70109

Lichin Lim, Carolyn Van Heerden, Amy Gray

Introduction

The Learning Health System (LHS) concept is gaining traction in high-income countries, yet its implementation in low- and middle-income countries (LMICs) remains limited with few initiatives offering practical strategies tailored to these contexts. The Leading a Learning Health System (LLHS) Program, grounded in LHS principles, aimed to build leadership capacities among health professionals and leaders from five Asia-Pacific LMICs. This study explored participants' learning experiences and applications in their context.

Methods

A mixed-method longitudinal study was conducted (13-months), informed by social constructivism and Kirkpatrick's evaluation framework. Surveys and semi-structured interviews were conducted after the intensive course (Survey A and Interview A) and 1 year later (Survey B and Interview B). Quantitative data were analyzed descriptively, and qualitative data were analyzed through inductive content analysis.

Results

Thirteen participants (13/20, 65%) completed Survey A. All (100%) rated the program and cross-country network as “high value.” Eleven participants (11/20, 55%) completed Survey B. All participants reported applying program learnings regularly on most days (6/11, 55%) or most weeks (5/11, 45%). Nine participants (82%) reported influencing team culture and five (45%) reported influencing organizational change. Qualitative analysis of 20 Interview A and 10 Interview B identified four themes: (1) developing a systems leadership identity, (2) translating leadership intent into practice, (3) contextual challenges to applying learnings, (4) resilience via adaptive leadership capacity and programmatic support.

Conclusion

This study demonstrates how a longitudinal leadership program based on the LHS framework supported LMIC health professionals to develop systems leadership identity, foster learning culture, and cultivate adaptive, distributed leadership to build resilience in resource-limited settings. The variability of health information systems in LMICs should not be seen as a barrier to implementing LHS, as improvement can begin with the effective use of locally available data. These findings can inform future capacity-building initiatives to advance LHSs in LMICs.

导读：学习型卫生系统（LHS）概念在高收入国家越来越受欢迎，但其在低收入和中等收入国家（LMICs）的实施仍然有限，几乎没有针对这些情况提供实际战略的举措。领导学习型卫生系统（LLHS）项目以LHS原则为基础，旨在培养来自亚太五个中低收入国家的卫生专业人员和领导人的领导能力。本研究探讨了参与者的学习经历及其在其情境中的应用。方法：采用社会建构主义和Kirkpatrick的评价框架，采用混合方法进行为期13个月的纵向研究。在强化课程结束后（调查A和访谈A）和1年后（调查B和访谈B）分别进行调查和半结构化访谈。定量数据采用描述性分析，定性数据采用归纳性内容分析。结果：13名参与者（13/20,65%）完成了调查a。所有参与者（100%）认为该项目和越野网络具有“高价值”。11名参与者（11/ 20,55%）完成了调查b。所有参与者都报告在大多数天（6/ 11,55%）或大多数周（5/ 11,45%）定期应用程序学习。9名参与者（82%）表示影响了团队文化，5名参与者（45%）表示影响了组织变革。对20次访谈A和10次访谈B的定性分析确定了四个主题：(1)发展系统领导身份，(2)将领导意图转化为实践，(3)应用学习的情境挑战，(4)通过适应性领导能力和计划性支持实现弹性。结论：本研究展示了基于LHS框架的纵向领导力项目如何支持LMIC卫生专业人员发展系统领导力认同，促进学习文化，培养适应性，分布式领导力，以建立资源有限环境下的弹性。中低收入国家卫生信息系统的可变性不应被视为实施低卫生保健的障碍，因为改进可以从有效利用当地现有数据开始。这些研究结果可以为未来的能力建设举措提供信息，以促进中低收入国家的卫生服务。

{"title":"Leading Learning Health Systems in the Asia Pacific: A Mixed-Method Evaluation of Health Professionals' Experiences in a Longitudinal Leadership Program","authors":"Lichin Lim, Carolyn Van Heerden, Amy Gray","doi":"10.1002/lrh2.70109","DOIUrl":"10.1002/lrh2.70109","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The Learning Health System (LHS) concept is gaining traction in high-income countries, yet its implementation in low- and middle-income countries (LMICs) remains limited with few initiatives offering practical strategies tailored to these contexts. The Leading a Learning Health System (LLHS) Program, grounded in LHS principles, aimed to build leadership capacities among health professionals and leaders from five Asia-Pacific LMICs. This study explored participants' learning experiences and applications in their context.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A mixed-method longitudinal study was conducted (13-months), informed by social constructivism and Kirkpatrick's evaluation framework. Surveys and semi-structured interviews were conducted after the intensive course (Survey A and Interview A) and 1 year later (Survey B and Interview B). Quantitative data were analyzed descriptively, and qualitative data were analyzed through inductive content analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirteen participants (13/20, 65%) completed Survey A. All (100%) rated the program and cross-country network as “high value.” Eleven participants (11/20, 55%) completed Survey B. All participants reported applying program learnings regularly on most days (6/11, 55%) or most weeks (5/11, 45%). Nine participants (82%) reported influencing team culture and five (45%) reported influencing organizational change. Qualitative analysis of 20 Interview A and 10 Interview B identified four themes: (1) developing a systems leadership identity, (2) translating leadership intent into practice, (3) contextual challenges to applying learnings, (4) resilience via adaptive leadership capacity and programmatic support.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study demonstrates how a longitudinal leadership program based on the LHS framework supported LMIC health professionals to develop systems leadership identity, foster learning culture, and cultivate adaptive, distributed leadership to build resilience in resource-limited settings. The variability of health information systems in LMICs should not be seen as a barrier to implementing LHS, as improvement can begin with the effective use of locally available data. These findings can inform future capacity-building initiatives to advance LHSs in LMICs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":43916,"journal":{"name":"Learning Health Systems","volume":"10 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13449691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148698105","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

Availability and Quality of Electronic Health Record Data to Track Physical Function Across a Care Transition 在整个护理过渡期间跟踪身体功能的电子健康记录数据的可用性和质量。

IF 2.3 Q2 HEALTH POLICY & SERVICES

Learning Health Systems

Pub Date : 2026-08-02 DOI: 10.1002/lrh2.70110

Robin L. Marcus, Kelly Daley, Margaret A. French, Anne Thackeray, Erik H. Hoyer, Donna Beck, Daniel L. Young

Introduction

Physical function (PF) is critical to quality of life and healthcare value, especially for older adults following hospitalization. Monitoring PF supports recovery, reduces adverse events, and improves care transitions. Despite the potential of electronic health records (EHRs) enabling systematic PF tracking, such data are rarely captured consistently. Here we examine the availability of PF-related data in EHRs for patients transitioning from hospital to homecare in a large health system, highlighting challenges and offering recommendations.

Methods

We assessed availability of elements previously identified important to PF measurement from a single healthcare system. Working with Johns Hopkins Health System informatics and homecare leaders, we determined which recommended elements were captured in the EHR and which were feasible to extract within our resource constraints. We then requested an extraction of a refined data set for adult patients with a hospital admission between July 2016 and March 2021. After validation, data were securely transferred to University of Utah Health.

Results

Data from 21 702 patients were included. Of 27 desired elements, 17 were available and successfully extracted. Individual elements were marked “present” if documented at least once during admission, or “missing” if absent. Administrative data had low missingness, although missingness for assessments of cognition and mobility performance in hospital was over 65%, and assessments of PF capacity in home health were missing in over 80% of patients. However, 81.7% of those receiving home health rehabilitation had the expected mobility measure. Overall, 73% of patients had at least 75% of the extracted data elements.

Conclusions

Assembling a comprehensive view of PF across a care transition using EHR data proved highly challenging. Our recommendations address data element identification, generation and storage; data extraction, cleaning, and validation; interoperability across care settings; adequate resources to manage complex data; and prospective infrastructure development.

身体功能（PF）对生活质量和医疗保健价值至关重要，特别是对于住院后的老年人。监测PF有助于康复，减少不良事件，并改善护理过渡。尽管电子健康记录（EHRs）有可能实现系统的PF跟踪，但很少能始终如一地捕获此类数据。在这里，我们研究了大型卫生系统中从医院转到家庭护理的患者的电子病历中pf相关数据的可用性，强调了挑战并提供了建议。方法：我们评估了先前从单一医疗保健系统中确定的对PF测量重要的元素的可用性。我们与约翰·霍普金斯卫生系统信息学和家庭护理负责人合作，确定了哪些推荐元素在电子病历中被捕获，哪些在我们的资源限制下是可行的。然后，我们要求提取2016年7月至2021年3月期间住院的成年患者的精炼数据集。验证后，数据被安全地转移到犹他大学健康。结果：数据来自21 702例患者。在27种需要的元素中，有17种可用并成功提取。如果在入学期间至少记录一次，则标记为“存在”；如果没有记录，则标记为“缺失”。行政数据的缺失率较低，但在医院对认知和活动能力的评估缺失率超过65%，超过80%的患者在家庭健康中对PF能力的评估缺失。然而，81.7%接受家庭健康康复的人有预期的活动能力。总体而言，73%的患者至少有75%的提取数据元素。结论：利用电子病历数据在护理过渡期间收集PF的综合视图被证明是极具挑战性的。我们的建议涉及数据元素的识别、生成和存储；数据提取、清理和验证；跨护理环境的互操作性；有足够的资源来管理复杂的数据；以及未来的基础设施发展。

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引用次数: 0

A Standards-Based, Cloud-Hosted CDS System for Gonorrhea Treatment and HIV Screening 基于标准、云托管的淋病治疗和HIV筛查CDS系统

IF 2.3 Q2 HEALTH POLICY & SERVICES

Learning Health Systems

Pub Date : 2026-07-30 DOI: 10.1002/lrh2.70104

Edna Shenvi, Aziz Boxwala, Sarah Shaw, Andre Berro, Saugat Karki, Matthew Pooser, Jane E. Yang, Gema Dumitru, Jeanne Ocampo, Amrita Tailor, Sanjat Kanjilal, Carlos Paredes, Ritche Hao, Nitu Kashyap, David Liebovitz, Alejandro Pérez

Objective

Neisseria gonorrhoeae (or gonococcus, GC) infections have increased in incidence and antibiotic resistance, prompting updates to management guidelines. Additionally, patients with recent GC infections have been identified as a target population for human immunodeficiency virus (HIV) screening and prevention. With the rapidly changing nature of such biomedical knowledge, there is an imperative to adopt public health guidelines speedily to deliver knowledge to clinicians at the point of care. Therefore, the Public Health Informatics Institute and the United States Centers for Disease Control and Prevention sought to create a scalable clinical decision support (CDS) solution that could be easily integrated using interoperability standards with widely used electronic health record (EHR) systems in the United States.

Methods

A project team including informaticians and clinical partners developed a cloud-hosted CDS system, with rule logic written in the Health Level Seven (HL7) Clinical Quality Language and using the HL7 CDS Hooks protocol. The system was designed to present alerts to clinicians who, based on available data, appeared to be treating uncomplicated GC with doses or agents that were not recommended based on the patient's weight, allergies, and other characteristics. Actionable suggestions were offered for the correct regimen, and HIV testing, if applicable.

Results

After extensive testing, the system was successfully integrated with the EHR system at two academic medical institutions. Subsequently, a three-month pilot was conducted in emergency and urgent care settings.

Conclusions

There were limitations related to functionality, workflow issues, and data quality. This successful implementation, however, demonstrates the feasibility of this approach for select use cases of CDS, and yields further understanding of the requirements for developing scalable solutions for disseminating public health guidance.

目的淋病奈瑟菌（或淋球菌，GC）感染的发病率和抗生素耐药性增加，促使管理指南更新。此外，近期胃癌感染的患者已被确定为人类免疫缺陷病毒（HIV）筛查和预防的目标人群。随着这种生物医学知识性质的迅速变化，必须迅速采用公共卫生指南，以便在护理点上将知识传递给临床医生。因此，公共卫生信息学研究所和美国疾病控制和预防中心寻求创建一个可扩展的临床决策支持（CDS）解决方案，该解决方案可以使用互操作性标准与美国广泛使用的电子健康记录（EHR）系统轻松集成。方法由信息学家和临床合作伙伴组成的项目组开发了一个云托管的CDS系统，其规则逻辑使用HL7临床质量语言编写，并使用HL7 CDS Hooks协议。该系统旨在向临床医生发出警报，根据现有数据，临床医生似乎在治疗简单的GC时使用的剂量或药物是根据患者的体重、过敏和其他特征不推荐的。为正确的治疗方案和艾滋病毒检测（如果适用）提供了可行的建议。结果经过广泛的测试，该系统成功地与两家学术医疗机构的电子病历系统集成。随后，在紧急和紧急护理环境中进行了为期三个月的试点。结论：存在与功能、工作流程问题和数据质量相关的局限性。然而，这一成功的实施证明了这种方法对于CDS的特定用例的可行性，并使人们进一步了解为传播公共卫生指导而开发可扩展解决方案的需求。

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引用次数: 0