Learning health systems in rehabilitation care - findings and recommendations from a scoping review

Abstract

Abstract To meet the challenges posed by an aging population and changing health needs, healthcare systems require transformative action at a systemic level. One solution is to create “learning” health systems (LHS) that generate and apply evidence, innovation and quality to improve the provision of care. Given the lack of research focusing on operationalizing LHSs and the predominance of acute care studies, this scoping review aimed to fill this gap by exploring how LHS frameworks have been conceptualized and operationalized in rehabilitation organizations. The review was conducted according to the JBI guidelines and Arksey & O’Malley methodological framework. Comprehensive search was performed across 5 databases to capture the extent of the literature on this topic specific to rehabilitation. Following screening and data extraction, qualitative content analysis and thematic mapping was employed to explore the selected studies (n = 26). Results were reported in accordance with PRISMA guidelines. Studies conceptualised LHS as organizational infrastructure that supports continuous learning by integrating clinical care and research. It aims generate new knowledge by capturing data from every clinical encounter and applying it to practice through iterative learning cycles, characterized by three phases: Data to Knowledge, Knowledge to Performance, and Performance to Data. Four themes emerged regarding the operationalization of LHS in rehabilitation: creating a functioning data infrastructure; facilitating research; promoting an organizational culture of learning; and person-centredness. This study is the first scoping review on LHSs in the context of rehabilitation, employing a systematic and rigorous process to capture the relevant literature. The review identified key transformational steps to become a LHS e.g., generation, dissemination and implementation of new institutional knowledge and early stakeholder engagement. Findings can be applied across non-acute health settings. Key messages • This is the first scoping review on LHSs in the context of rehabilitation. • The findings will aid organisations in non-acute health settings with the transformational process of becoming LHSs.