The Academic Learning Health System: A Framework for Integrating the Multiple Missions of Academic Medical Centers

Abstract

The learning health system (LHS) has emerged over the past 15 years as a concept for improving health care delivery. Core aspects of the LHS concept include: promoting improved patient care through organizational learning, innovation, and continuous quality improvement; identifying, critically assessing, and translating knowledge and evidence into improved practices; building new knowledge and evidence around how to improve health care and health outcomes; analyzing clinical data to support learning, knowledge generation, and improved patient care; and engaging clinicians, patients, and other stakeholders in processes of learning, knowledge generation, and translation. However, the literature has paid less attention to how these LHS aspects may integrate with the multiple missions of academic medical centers (AMCs). The authors define an academic learning health system (aLHS) as an LHS built around a robust academic community and central academic mission, and they propose 6 features that emphasize how an aLHS differs from an LHS. An aLHS capitalizes on embedded academic expertise in health system sciences; engages the full spectrum of translational investigation from mechanistic basic sciences to population health; builds pipelines of experts in LHS sciences and clinicians with fluency in practicing in an LHS; applies core LHS principles to the development of curricula and clinical rotations for medical students, housestaff, and other learners; disseminates knowledge more broadly to advance the evidence for clinical practice and health systems science methods; and addresses social determinants of health, creating community partnerships to mitigate disparities and improve health equity. As AMCs evolve, the authors expect that additional differentiating features and ways to operationalize the aLHS will be identified and hope this article stimulates further discussion around the intersection of the LHS concept and AMCs.

Figure 1

Academic Learning Health System (aLHS) Framework. The aLHS framework recognizes at its core the 5 key aspects of a learning health system (LHS). The framework then proposes 6 differentiating features (areas of emphasis) of an aLHS. The aLHS (1) capitalizes on embedded academic expertise in health system sciences, (2) engages the full spectrum of translational investigation from mechanistic basic sciences to population health, (3) builds pipelines of experts in LHS sciences and clinicians with fluency in practicing in learning health systems, (4) applies core LHS principles to the development of curricula and clinical rotations for medical students, house staff, and other learners, (5) disseminates knowledge more broadly to advance the evidence for clinical practice and health systems science methods, and (6) addresses social determinants of health and creates community partnerships to mitigate disparities and improve health equity. These aspects and features drive improvements in health care quality (i.e., safe, effective, patient-centered, timely, efficient, equitable health care), leading to improved health. Abbreviation: CQI, continuous quality improvement.