What allows a health care system to become a learning health care system: Results from interviews with health system leaders
What allows a health care system to become a learning health care system: Results from interviews with health system leaders
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DOI：
10.1002/lrh2.10015
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发表时间：
2017-01-01
影响因子：
3.1
通讯作者：
Grossmann, Claudia
中科院分区：
文献类型：
--
作者：
Morain, Stephanie R.;Kass, Nancy E.;Grossmann, Claudia
简介美国医疗保健系统面临着在管理复杂性、控制成本和减少低效的同时提高质量的压力。这些缺点激发了人们对学习卫生保健系统(LHCS)的兴趣，将其作为组织研究和临床护理的替代方法。尽管不同的利益相关者表达了对转向LHC模式的支持，但对于考虑这种过渡的机构来说，指导意见有限。方法采访了来自25个被认为处于LHC前沿的医疗保健系统的机构领导人。访谈的重点是向LHC过渡的过程，包括变革的动机、关键组成部分、遇到的挑战和成功的战略，以及遇到的道德和监管问题。结果受访者描述了与其LHC转型的起源相关的5个主题：(1)关键个人的远见卓识的领导或影响力，(2)适应不断变化的医疗保健环境，(3)外部资金，(4)监管或立法影响，以及(5)合并或扩张。他们描述了6项挑战：(1)组织文化，(2)数据系统和数据共享，(3)为学习活动提供资金，(4)有技能的个人供应有限，(5)管理相互竞争的优先事项，以及(6)监管挑战。最后，他们提出了8项支持转型的策略：(1)强有力的领导，(2)设定有限数量的组织优先事项，(3)建立现有的优势，(4)培训计划，(5)数据系统的“有目的”设计，(6)质量指标的内部透明度，(7)付款人/提供者整合，(8)学术/临床中心内，(8)学术/临床整合。他们的经验为考虑类似过渡的其他机构提供了洞察力，包括成功所必需的要素和可能的挑战。
Introduction The US health care system faces pressure to improve quality while managing complexity, curbing costs, and reducing inefficiency. These shortcomings have sparked interest in the Learning Health Care System (LHCS) as an alternate approach to organizing research and clinical care. Although diverse stakeholders have expressed support for moving toward an LHCS model, limited guidance exists for institutions considering such a transition.Methods Interviews were conducted with institutional leaders from 25 health care systems considered to be at the forefront of LHCS. Interviews focused on the process of transitioning toward an LHCS, including motivations for change, key components, challenges encountered, and strategies for success, and on ethics and regulatory issues encountered. Qualitative analysis identified key themes across institutions.Results Respondents described 5 themes related to the origin of their LHCS transformation: (1) visionary leadership or influence of a key individual, (2) adaptation to a changing health care landscape, (3) external funding, (4) regulatory or legislative influence, and (5) mergers or expansions. They described 6 challenges: (1) organizational culture, (2) data systems and data sharing, (3) funding learning activities, (4) limited supply of skilled individuals, (5) managing competing priorities, and (6) regulatory challenges. Finally, they suggested 8 strategies to support transformation: (1) strong leadership, (2) setting a limited number of organizational priorities, (3) building on existing strengths, (4) training programs, (5) "purposeful" design of data systems, (6) internal transparency of quality metrics, (7) payer/provider integration, and, within academic medical centers, (8) academic/clinical integration.Conclusions Even institutions at the forefront of LHCS described the transition as difficult. Their experiences provide insight into other institutions considering similar transitions, including elements essential for success and likely challenges.