In this discussion paper, the authors aim to facilitate the growth of learning health environments by highlighting strategies and examples of operational and research collaborations within delivery system settings in the United States. Informed by empirical data, conceptual literature, and authors’ experiences, the paper explores barriers to successful research and operational collaborations within the current health care context, as well as strategies that various health systems have used to move further toward the goal of continuous learning.
Specifically, the authors highlight activities by the National Academy of Medicine (NAM) and the Patient-Centered Outcomes Research Institute (PCORI) to engage various stakeholders, specifically health executives, in the evidence-generation process; present an overview of collaborative activities that have resulted from these initiatives, including the findings from two research projects designed explicitly to explore the priorities, decisions, and analytic needs facing health executives at the delivery-system level as they consider further transitioning to a learning health system; and finally offer a series of priorities for actions and corresponding case examples, to demonstrate strategies for generating knowledge from care. While all types of research are essential to continuous learning, this Perspective focuses on those evidence-generating activities that are designed explicitly to be conducted within the care delivery system, embedded within the practice of routine care, and whose findings are used to impact the clinical enterprise.
It is the authors’ intention that this paper will add to the emerging body of knowledge around learning health systems while also serving as an actionable blueprint for institutions interested in transforming to a continuously learning system.