Learning about learning health systems: Strengthening theory through continuous evaluation and improvement

Area of Science:

• Healthcare Systems Science
• Health Services Research
• Implementation Science

Background:

• Learning Health Systems (LHSs) aim to transform healthcare via continuous learning and improvement.
• A gap exists between LHS theory and practice, hindering knowledge transfer across diverse settings.
• The Bipolar Action Network (The Network) serves as a case study for developing a novel framework.

Purpose of the Study:

• To propose a novel framework for integrating theorizing and continuous evaluation into LHSs.
• To bridge the gap between theoretical concepts and practical application in LHSs.
• To enhance the adaptability and effectiveness of LHSs through iterative theory refinement.

Main Methods:

• Utilized a process of theorizing to structure mid-range theory, program theory, and LHS design, development, and evaluation.
• Employed the Conceptual Framework for Value-Creating Learning Health Systems as the initial mid-range theory.
• Applied a four-step process: selecting mid-range theory, creating program theory, evaluating performance, and refining theory based on findings.

Main Results:

• The proposed framework emphasizes continuous, multi-level LHS theory refinement using real-world data.
• The framework connects four steps: theory selection, program theory creation, performance evaluation, and iterative refinement.
• This process ensures both the LHS and its theoretical underpinnings evolve with new insights and challenges.

Conclusions:

• The framework offers a practical methodology to connect LHS theory and practice.
• Ongoing theorizing and evaluation enhance LHS effectiveness, adaptability, and theory development.
• Addressing challenges like data infrastructure and quality is crucial for realizing fully adaptive, theory-driven LHSs.