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. 2023 Jan 19;24(1):22.
doi: 10.1186/s12875-022-01955-w.

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

Genevieve Dammery  1   2 , Louise A Ellis  1   2 , Kate Churruca  1 , Janani Mahadeva  3 , Francisco Lopez  4 , Ann Carrigan  1   2 , Nicole Halim  1   2 , Simon Willcock  3 , Jeffrey Braithwaite  5   6
Affiliations

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

Genevieve Dammery et al. BMC Prim Care. .

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.

Keywords: General practice; Learning health system; Primary care; Quadruple aim.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The relationship between the LHS framework and quadruple aim. Each arrow represents the way in which the LHS dimension enables aspects of the quadruple aim
See this image and copyright information in PMC

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