Learning health systems in primary care: a systematic scoping review

Area of Science:

• Healthcare systems research
• Primary care innovation
• Health services research

Background:

• Learning health systems (LHS) are increasingly recognized for improving healthcare quality and outcomes.
• The adoption and operationalization of LHS in primary care settings remain underexplored.
• Understanding the landscape of LHS implementation is crucial for advancing primary care.

Purpose of the Study:

• To map the implementation of learning health systems (LHS) within primary care.
• To describe how these systems operate and identify associated challenges and solutions.
• To provide insights into the global movement for LHS in primary care.

Main Methods:

• A comprehensive scoping review was conducted, systematically searching major databases (OVID Medline®, Embase®, IEEE Xplore®) and relevant journals.
• Gray literature was identified through targeted Google searches.
• The review covered publications from 2007 to 2020.

Main Results:

• 21 unique learning health systems (LHS) were identified from 1924 database articles and 51 other sources.
• Only one LHS was exclusively in primary care; others were integrated within broader health systems or networks.
• Common applications included real-time surveillance, quality improvement, pragmatic trials, and decision support, with challenges noted in data, sustainability, and culture.

Conclusions:

• The 21 identified LHS represent early-stage models, with limited exclusive primary care implementation.
• Integrated health systems and data networks offer valuable early examples for advancing LHS in primary care.
• Further development and research are needed to optimize LHS specifically for primary care settings.