Health Systems Framework Research Articles

Health systems research in burn care: an evidence gap map

BackgroundBurn injury is associated with significant mortality and disability. Resilient and responsive health systems are needed for optimal response and care for people who sustain burn injuries. However, the extent...

Unmet Needs and Barriers in Providing Hospital Care for Older Adults: A Qualitative Study Using the Age-Friendly Health System Framework.

This study aims to identify unmet needs and barriers for improving inpatient care for older adults at an academic hospital in Korea by using a qualitative focus group design and the Age-Friendly Health Systems (AFHS) framework. A total of 14 healthcare providers and employees participated in focus group interviews. Participants included medical doctors, registered nurses, a receptionist, a patient transporter, a pharmacist, a physical therapist, and a social worker. The data were analyzed qualitatively, as per the Consolidated Criteria for Reporting Qualitative Research guidelines. The analysis method encompassed a thematic framework analysis via the AFHS 4Ms framework, consisting of the four domains "What Matters", "Medication", "Mentation", and "Mobility". Multiple barriers and unmet needs were identified using the AFHS 4Ms framework in the provision of inpatient care for older adults at the hospital. The main barriers identified in the "What matters" domain are a lack of shared decision-making and individualized care plans, as well as economic and safety-conscious preferences among some older patients. In the "Medications" domain, the main barriers to providing adequate and safe pharmacotherapy include patient and caregiver-related factors, increased complexity of medication use, and lack of institutional support systems. In the "Mentation" domain, the main issues identified are communication barriers related to patients, caregiver factors, and insufficient delirium management due to a lack of adequate processes/environments such as delirium identification. In the "Mobility" domain, the main challenges include reduced mobility and geriatric complications, unnecessary mobility restrictions, and the increased risk of falls due to lack of resources and environmental factors. The study highlighted the need for improvements in inpatient care for older adults at an academic hospital in Korea. Identified unmet needs and barriers can be used to guide a more patient-centered approaches for an age-friendly inpatient environment.

An Insurance Value Modeling Approach That Captures the Wider Value of a Novel Antimicrobial to Health Systems, Patients, and the Population.

Background: Traditional health economic evaluations of antimicrobials currently underestimate their value to wider society. They can be supplemented by additional value elements including insurance value, which captures the value of an antimicrobial in preventing or mitigating impacts of adverse risk events. Despite being commonplace in other sectors, constituents of the impacts and approaches for estimating insurance value have not been investigated. Objectives: This study assessed the insurance value of a novel gram-negative antimicrobial from operational healthcare, wider population health, productivity, and informal care perspectives. Methods: A novel mixed-methods approach was used to model insurance value in the United Kingdom: (1) literature review and multidisciplinary expert workshops to identify risk events for 4 relevant scenarios: ward closures, unavoidable shortage of conventional antimicrobials, viral respiratory pandemics, and catastrophic antimicrobial resistance (AMR); (2) parameterizing mitigable costs and frequencies of risk events across perspectives and scenarios; (3) estimating insurance value through a Monte Carlo simulation model for extreme events and a dynamic disease transmission model. Results: The mean insurance value across all scenarios and perspectives over 10 years in the UK was £718 million, should AMR remain unchanged, where only £134 million related to operational healthcare costs. It would be 50%-70% higher if AMR steadily increased or if a more risk-averse view (1-in-10 year downside) of future events is taken. Discussion: The overall insurance value if AMR remains at current levels (a conservative projection), is over 5 times greater than insurance value from just the operational healthcare costs perspective, traditionally the sole perspective used in health budgeting. Insurance value was generally larger for nationwide or universal (catastrophic AMR, pandemic, and conventional antimicrobial shortages) rather than localized (ward closure) scenarios, across perspectives. Components of this insurance value match previously published estimates of operational costs and mortality impacts. Conclusions: Insurance value of novel antimicrobials can be systematically modeled and substantially augments their traditional health economic value in normal circumstances. These approaches are generalizable to similar health interventions and form a framework for health systems and governments to capture broader value in health technology assessments, improve healthcare access, and increase resilience by planning for adverse scenarios.

An Insurance Value Modeling Approach That Captures the Wider Value of a Novel Antimicrobial to Health Systems, Patients, and the Population

Background: Traditional health economic evaluations of antimicrobials currently underestimate their value to wider society. They can be supplemented by additional value elements including insurance value, which captures the value of an antimicrobial in preventing or mitigating impacts of adverse risk events. Despite being commonplace in other sectors, constituents of the impacts and approaches for estimating insurance value have not been investigated. Objectives: This study assessed the insurance value of a novel gram-negative antimicrobial from operational healthcare, wider population health, productivity, and informal care perspectives. Methods: A novel mixed-methods approach was used to model insurance value in the United Kingdom: (1) literature review and multidisciplinary expert workshops to identify risk events for 4 relevant scenarios: ward closures, unavoidable shortage of conventional antimicrobials, viral respiratory pandemics, and catastrophic antimicrobial resistance (AMR); (2) parameterizing mitigable costs and frequencies of risk events across perspectives and scenarios; (3) estimating insurance value through a Monte Carlo simulation model for extreme events and a dynamic disease transmission model. Results: The mean insurance value across all scenarios and perspectives over 10 years in the UK was £718 million, should AMR remain unchanged, where only £134 million related to operational healthcare costs. It would be 50%-70% higher if AMR steadily increased or if a more risk-averse view (1-in-10 year downside) of future events is taken. Discussion: The overall insurance value if AMR remains at current levels (a conservative projection), is over 5 times greater than insurance value from just the operational healthcare costs perspective, traditionally the sole perspective used in health budgeting. Insurance value was generally larger for nationwide or universal (catastrophic AMR, pandemic, and conventional antimicrobial shortages) rather than localized (ward closure) scenarios, across perspectives. Components of this insurance value match previously published estimates of operational costs and mortality impacts. Conclusions: Insurance value of novel antimicrobials can be systematically modeled and substantially augments their traditional health economic value in normal circumstances. These approaches are generalizable to similar health interventions and form a framework for health systems and governments to capture broader value in health technology assessments, improve healthcare access, and increase resilience by planning for adverse scenarios.

Implementation strategies to scale up self-administered depot medroxyprogesterone acetate subcutaneous injectable contraception: a scoping review

BackgroundSelf-administered depot medroxyprogesterone acetate subcutaneous injectable contraception (DMPA-SC) is registered in many countries. It shows great potential for improving contraceptive access, continuation, and autonomy. However, there are challenges in rolling out this new efficacious intervention, and major implementation problems have been encountered during scale-up.ObjectiveTo describe the implementation strategies to scale up self-administered DMPA-SC and the barriers, facilitators, and outcomes of these programs.MethodRecent guidelines, including the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews, were used to design and report this review. An article or report was eligible for inclusion if it reported interventions that could scale up self-administered DMPA-SC implementation or its facilitators, barriers, or outcomes. We searched six electronic databases and the grey literature for eligible articles and reports. Two reviewers independently screened the document titles, abstracts, and full texts to identify eligible documents. Data were extracted using structured forms. Using the Effective Practice and Organization of Care (EPOC) taxonomy of health systems framework for thematic analysis, data were presented in a narrative approach.ResultsOf the 755 retrieved documents, 34 were included in this review. Most of the documents included were multi-country reports (n = 14), and all documents were published within the last 5 years (2018–2021). This review identified documents that reported interventions in all EPOC domains. The most-reported interventions were: task-sharing amongst health workforce cadres, engaged leadership, encouraging policies, training and education, DMPA-SC demand generation, integration into existing programs, improved funding mechanisms, collaboration with development partners, and supply chain strengthening. The main barriers were suboptimal funding, inadequate human resources, and poor logistics supply of DMPA-SC. There was minimal evidence of scale-up outcomes.ConclusionThis scoping review reported a wide range of interventions employed by countries and programs to scale up DMPA-SC self-administration but minimal evidence of the scale-up outcomes. Evidence from this review can help design better programs that improves access to quality family planning services to achieve the Sustainable Development Goals (SDG) targets 3.7. However, efforts should focus on rigorous implementation research that assess scaled up self-administered DMPA-SC interventions and report their outcomes.RegistrationThe protocol for this review was registered in the protocols.io repository (https://www.protocols.io/view/a-protocol-for-a-scoping-review-of-implementation-x54v9yemmg3e/v1).

Health risk communication and infodemic management in Iran: development and validation of a conceptual framework

ObjectiveThe COVID-19 pandemic exposed significant gaps in Iran’s and other health systems’ risk communication. The accompanying infodemic undermined policy responses, amplified distrust in government and reduced adherence to public health...

Status of Health-care Systems for Diabetes Mellitus and Diabetic Retinopathy in Jordan: Stakeholders and Health-care Providers Survey.

The purpose of the study was to evaluate the status of health services for diabetes mellitus (DM) and diabetic retinopathy (DR) in Jordan in terms of availability and accessibility by interviewing people engaged with health-care process including decision makers, professional providers, and community representatives. This is a qualitative study where participants were invited to respond by direct interview to a standard questionnaire that is validated by the World Health Organization (WHO), "Tool for Assessment of Diabetic Retinopathy and DM Management Systems". The questionnaire casts out of the WHO Health Systems Framework concept, assessing the presence of programs, guidelines, health technology and workforce, health promotion, and financing of DM and DR care in Jordan. Forty-two participants were included. DM is considered as priority in Jordan, but no programs are implemented. National guidelines are present for DM but not for DR. Networking should be improved between different disciplines caring for DM and DR. Human resources for DM and DR care were found insufficient and inadequately distributed. Health technology is only present in major cities and central hospitals. There is no nationwide data on disease burden nor a screening program for DR. More collaborated efforts should be spent on health education and raising awareness among people living with diabetes about the risk of DR. Advanced DM and DR care is not accessible to most people. Programmatic efforts from the government and NGOs must formulate a national action plan to reduce the human and financial impact of the disease in Jordan.

Assessing HIV Care Services in Nigeria: A Comparative Study of the North-East and South-South regions of Nigeria

This study conducted a comparative case study analysis of the HIV program in Nigeria’s South-South and North-East regions of Nigeria to determine the access and quality of HIV care and treatment services. Service delivery is an essential component of the WHO Health systems framework. Data were collected from 385 respondents using structured questionnaires and analysed using descriptive and inferential statistics. The study found that the North-East region of Nigeria had significantly lower numbers of primary healthcare facilities and inpatient beds per 10,000 population compared to the South-South region. The North-East region had an average of 0.02 inpatient beds per 1,000 population, significantly below the WHO standard, while the South-South region had an average of 0.18 inpatient beds per 1,000 population, relatively closer to the WHO standard. The general service readiness score for delivering HIV program services was at least 94% in all health facilities in both the North-East and South-South regions. The HIV service readiness index for the North-East region was higher than that of the South-South region, with some disparities in the availability of national ART guidelines, national HIV counselling and testing guidelines, staff training, and availability of HIV prevention services. HIV testing and counselling services were described as readily available and accessible in both regions, with some communities taking ownership of promoting the availability of these services. However, both regions had a relatively high service readiness score for delivering HIV program services, with some disparities in the availability of national guidelines and training of staff. These findings demonstrate extensive investment of government and donor agencies in delivering quality HIV services with areas to improve to ensure alignment with WHO system strengthening framework. Keywords: Health systems, HIV, North-East, Service delivery, South-South, WHO.

Examining HIV Essential Medicines Access in Nigeria: A Comparative Study of South-South and North-East Regions through WHO Health Systems Framework

Availability and accessibility of essential medicines for HIV recipients of care varies across regions in Nigeria. This study seeks to compare access and availability of medicines for HIV in the South south and Northeast regions of Nigeria. Data were collected from 120 health facilities and 385 respondents using structured questionnaires and analysed using descriptive statistics and thematic analysis. The study methodology included an exploratory sequential mixed of quantitative and qualitative methods, including facility assessments, in-depth interviews, client satisfactory questionnaire conducted amongst HIV program stakeholders and HIV recipients of care. The study found that the HIV program in the regions have made progress in improving the accessibility of essential medicines for HIV patients. The North-East had an average access rate of 87.1%, while the South-South had a slightly higher average access rate of 85.6%. The North-East had a prescription rate of 100% for antiretroviral therapy (ART) for adolescents and for the preventive treatment for tuberculosis (INH + Pyridoxine). On the other hand, access to micronutrient supplementation was higher in the South-South region at 94.7%, compared to the North-East region with a rate of 74.2%. In conclusion, this study highlights that the availability of essential medicines such as ART drugs, micronutrients and prophylaxis for opportunistic infections, medicine supply, storage and documentation has improved overtime with support from donor agencies, though still challenged with electronic management systems and need for adequate procurement, quantification, additional technical assistance, funding and supply chain infrastructure is recommended to be addressed towards achievement of HIV epidemic control in Nigeria. Keywords: Essential medicines, Health systems, HIV, North-East, South-South.

Is It Time to Explore the Health Policy Process Within Governance and Health Systems Frameworks? Comment on "Modelling the Health Policy Process: One Size Fits All or Horses for Courses?"

There is clearly a need to improve the use of more robust policy theory on health policy analysis. Powell and Mannion in an editorial on the relationship between health policy analysis and the wider field of public policy theory note, as others have done before, the limited application of policy theory in health policy analysis. However, they also highlight that within the health policy analysis arena new models have emerged which have wider use within policy analysis such as the health policy triangle. While Powell and Mannion suggest that health policy analysis can take one of two paths I argue that we should be developing more integrated frameworks of health policy processes, governance and systems which would involve the use of robust public policy theories and models.

Ретроспективный анализ формы отраслевого статистического наблюдения №131/о в части регистрации факторов риска развития хронических неинфекционных заболеваний

To monitor, assess, analyze and register the prevalence of behavioral and biological risk factors, the form of industry statistical reporting No. 131/o “Information on preventive medical examination and medical examination of certain groups of the adult population” is used. The quality and reliability of the primary statistical data presented in Form No. 131/o determines the further planning and implementation of preventive measures within the framework of interdepartmental interaction and cooperation with broad segments of the population. The reliability and quality of statistical materials collected during the medical examination of certain groups of the adult population should guarantee the adoption of adequate management decisions on the development of preventive medicine and the basis for improving the effectiveness of the public health system. Purpose: to conduct a retrospective analysis of the orders of the Ministry of Health of the Russian Federation regulating the procedure for filling out and submitting the form of industry statistical reporting № 131/o “Information on preventive medical examination and medical examination of certain groups of the adult population” for the period from 2013 to 2021, in terms of providing primary data on the registered risk factors. Material and methods. Content analysis of orders of the Ministry of Health of the Russian Federation regulating the procedure for filling out and submitting the form of industry statistical reporting № 131/o for 2013, 2015, 2020; reporting forms № 131/o; orders regulating the procedure for preventive medical examination and medical examination of certain groups of the adult population for the period from 2012 to 2021. Results. A retrospective analysis of the orders of the Ministry of Health of the Russian Federation regulating the procedure for filling out and submitting the form of industry statistical reporting № 131/o for the period from 2013 to 2021, in terms of providing primary data on the registration of risk factors, showed that, despite the shortcomings, only this form allows you to study and analyze information on the prevalence of risk factors and on this basis to identify priority areas for the prevention of chronic non-communicable diseases. That is, the analysis of form № 131/o allowed us to conclude that it is necessary not only to reconsider approaches to the organization of medical examinations and the collection of primary data, but also to modernize the concept of the largest preventive measure carried out within the framework of the state health system. Conclusions. A retrospective analysis of the orders of the Ministry of Health of the Russian Federation regulating the procedure for filling out and submitting the form of industry statistical reporting No.131/o for the period from 2013 to 2021, in terms of providing primary data on the registration of risk factors, showed that, despite the shortcomings, only this form allows you to study and analyze information on the prevalence of risk factors and on this basis identify priority areas for the prevention of chronic non-communicable diseases. The analysis of form No. 131/o allowed us to conclude that it is necessary not only to reconsider approaches to the organization of medical examinations and the collection of primary data, but also to modernize the concept of the largest preventive measure carried out within the framework of the state health system.

Health systems interventions for hypertension management and associated outcomes in Sub-Saharan Africa: A systematic review.

Hypertension is a significant global health problem, particularly in Sub-Saharan Africa (SSA). Despite the effectiveness of medications and lifestyle interventions in reducing blood pressure, shortfalls across health systems continue to impede progress in achieving optimal hypertension control rates. The current review explores the health system interventions on hypertension management and associated outcomes in SSA. The World Health Organization health systems framework guided the literature search and discussion of findings. We searched PubMed, CINAHL, and Embase databases for studies published between January 2010 and October 2022 and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We assessed studies for the risk of bias using the tools from the Joanna Briggs Institute. Twelve studies clustered in 8 SSA countries met the inclusion criteria. Two thirds (8/12) of the included studies had low risk of bias. Most interventions focused on health workforce factors such as providers' knowledge and task shifting of hypertension care to unconventional health professionals (n = 10). Other health systems interventions addressed the supply and availability of medical products and technology (n = 5) and health information systems (n = 5); while fewer interventions sought to improve financing (n = 3), service delivery (n = 1), and leadership and governance (n = 1) aspects of the health systems. Health systems interventions showed varied effects on blood pressure outcomes but interventions targeting multiple aspects of health systems were likely associated with improved blood pressure outcomes. The general limitations of the overall body of literature was that studies were likely small, with short duration, and underpowered. In conclusion, the literature on health systems internventions addressing hypertension care are limited in quantity and quality. Future studies that are adequately powered should test the effect of multi-faceted health system interventions on hypertension outcomes with a special focus on financing, leadership and governance, and service delivery interventions since these aspects were least explored.

What are the implications of the adoption of the new fiscal framework for the Brazilian Unified Health System?

What are the implications of the adoption of the new fiscal framework for the Brazilian Unified Health System?

Assessment of a Tertiary Hospital’s Systems Thinking Approach Using the World Health Organization Health System Framework in Response to the COVID-19 Pandemic in Nigeria

Background: The coronavirus disease 2019, (COVID-19) pandemic dealt a catastrophic blow to health systems globally, especially those of middle and low-income-countries, whose health systems were already frail, pre-pandemic. The World Health Organization (WHO) recognizes six building blocks (BBs) for a sturdy health system, whose synergistic interaction, through a systems thinking approach, guarantees optimal and equitable health outcomes for the populace, while shielding them from financial risk. 
 Objectives: To showcase a Nigerian tertiary hospital’s response to the COVID-19 pandemic, through the application of systems thinking, to the WHO health systems BBs.
 Methods: A questionnaire-based survey (utilizing a Likert scale of 1=very poor; 2=poor; 3=fair; 4=good and 5=excellent) of the hospital-wide efforts, employed by the leadership of the University of Nigeria Teaching Hospital (UNTH) Enugu, utilizing the WHO BBs, during the COVID-19 pandemic, assessed the perceived impact of the individual BBs on the hospital system. Eighty key stakeholders (Females=55%), heads of departments and supervisors, comprising various categories of medical personnel, overseeing twenty critical service areas of the hospital undertook the survey.
 Results: Leadership/Governance ranked highest in impact among the BBs (68.6%), with the availability of Medical products/Technology (65.9%), and Service delivery (64.4%) trailing closely at second and third, respectively. Perceived robustness and overall motivation of the Health Workforce was least ranked at 57.1%, closely followed by Healthcare Financing (58.2%) and Health Information Systems (61.9%).
 Conclusion: At an average cumulative score of 62.7% for all the BBs, the UNTH leadership may be adjudged to have performed creditably in their efforts at COVID-19 containment. Staff welfare should be enhanced, to ensure a well-motivated staff which will likely translate to improved service delivery.

HTA69 Towards a Minimum Information Set Needed to Define Patient-Facing Digital Health Technology for Outcomes Research

Umbrella terms for Digital Health Technology (DHT) (digital health, eHealth, mHealth, telehealth/telemedicine) are insufficiently defined for health economics and outcomes research (HEOR). Definitions of secondary terms for DHTs lack information about PICOTS (population, intervention, comparator, outcome, timing, and setting) and health system or technology frameworks. We aim to develop a minimum information set to define patient-facing DHTs for HEOR purposes.

Hospital Governance During the COVID-19 Pandemic: A Multiple-Country Case Study

ABSTRACT In response to the disruptions caused by COVID-19, hospitals around the world proactively or reactively developed and/or re-organized their governance structures to manage the COVID-19 response. Hospitals’ governance played a crucial role in their ability to reorganize and respond to the pressing needs of their staff. We discuss and compare six hospital cases from four countries on different continents: Brazil, Canada, France, and Japan. Our study examined how governance strategies (e.g., special task forces, communications management tools, etc.) were perceived by hospital staff. Key findings from a total of 177 qualitative interviews with diverse hospital stakeholders were analyzed using three categories drawn from the European Observatory on Health Systems and Policies framework on health systems resilience during the COVID-19 pandemic: 1) delivering a clear and timely COVID-19 response strategy; 2) coordinating effectively within (horizontally) and across (vertically) levels of decision-making; and 3) communicating clearly and transparently with the hospital’s diverse stakeholders. Our study gleaned rich accounts for these three categories, highlighting significant variations across settings. These variations were primarily determined by the hospitals’ environment prior to the COVID-19 crisis, namely whether there already existed a culture of managerial openness (including spaces for social interactions among hospital staff) and whether preparedness planning and training had been routinely integrated into their activities.

Postgraduate dental resident education: A pilot in age-friendly "mentation" training.

Postdoctoral dental education in caring for older adults lacks didactic and clinical training in mentation topics, one of the core elements of the Age-Friendly Health Systems (AFHS) framework. Our primary goal was to launch a pilot project in clinical geriatrics focusing on older adults' mentation concerns, with a secondary goal to improve dental residents' confidence and competence in dental care and oral health. Age-friendly care elements are not routinely incorporated into the dental education of residents caring for older adults with cognitive impairment or dementia. Therefore, we implemented a pilot educational project, providing the missing educational opportunity for residents in geriatric training covering cognitive impairment and focusing on Alzheimer's disease and related dementias. We designed educational sessions through a needs assessment, focus group discussions, and expert validation. We developed three e-Learning modules covering mentation concerns and dementia screening. We tested the modules in a pilot study of 15 dental postdoctoral residents as an essential part of their clinical practice. The dementia dental learning module increased the residents' satisfaction with didactic preparedness (4.45 0.97) and knowledge acquisition (4.36 0.84). Residents strongly believed that learning about the AFHS-mentation topic would improve patient care. Our pilot study is a pioneer project in support of a new AFHS-themed dental curriculum for clinical education. Further expansion of the age-friendly principles to include mobility, medications, and what matters to older adults will establish a model framework of redesigned geriatric dental education for academic centers.

Prescription trends for preservative free glaucoma medication in a public health system.

To analyze the prescribing trends over a 7-years period, between 2013 and 2020, in a tertiary hospital (Hospital Clinico San Carlos, Madrid, Spain) and its health area. A retrospective study on the data collected from the information systems, "farm@web" and "Farmadrid", of glaucoma prescriptions in the framework of a public health system (Spanish National Health System) during the last seven years. Prostaglandin analogues were the most commonly used drugs in monotherapy during the study period (range: 36.82% - 47.07%). Fixed combinations of topical hypotensives had an upward trend since 2013 (range: 39.99% - 54.21%), becoming the most dispensed drugs in 2020 (48.99%). Preservative-free eye drops (lacking benzalkonium chloride, BAK) have displaced preservative containing topical treatments in all pharmacological groups. In 2013, BAK-preserved eye drops accounted for 91.1% of the total prescriptions, however in 2020 they only accounted for 34.2% of total prescriptions. The results of the present study highlight the current trend to avoid BAK-preserved eye drops for the treatment of glaucoma.

Learning from the COVID-19 pandemic response to strengthen undocumented migrant-sensitive health systems: case studies from four countries

Undocumented migrants are a vulnerable population group in the context of the COVID-19 pandemic due to increased risk of infection, severe morbidity, and mortality. In this Personal View, we analyze the COVID-19 pandemic responses, particularly vaccination campaigns, vis à vis undocumented migrants, and discuss lessons learned. Our empirical observations as clinicians and public health practitioners in Italy, Switzerland, France, and the United States are supplemented by a literature review, and presented through country case studies focusing on Governance, Service Delivery, and Information. We propose recommendations to capitalize on the COVID-19 pandemic response as an entry point to strengthen migrant-sensitive provisions into health system frameworks, by: providing specific guidance in health policies and plans; developing tailored implementation approaches with outreach and mobile services, with translated and socio-culturally adapted information, and engagement of migrant communities and third sector actors; and developing systematic monitoring & evaluation systems with disaggregated migrant data from National Health Service and third sector providers.

405 Integrating a Learning Health System Framework Into a Large Academic Medical Center

OBJECTIVES/GOALS: The Learning Health System (LHS) framework at Columbia University Irving Medical Center (CUIMC) aims to optimize health system performance through enhancing the patient and care team experience, reducing inequities, costs and improving population health outcomes, through a collaborative, interdisciplinary and data driven approach. METHODS/STUDY POPULATION: In alignment with the Quintuple Aim, the LHS program at CUIMC is composed of five critical components: data integration (particularly using Epic EHR and real-time informatics data), utilization of evidence-based practices, a methodology for continuous improvement, and leadership commitment. Our methodology incorporates an iterative process improvement project cycle into an integrated infrastructure and governance of an academic medical center and its hospital partners to fulfill rapid project design and implementation. The LHS at CUIMC aims to bring a cultural shift through stakeholder engagement, symposia, training, accelerated pilot award opportunities, and building external partnership engagement. RESULTS/ANTICIPATED RESULTS: At CUIMC, our definition of a successful integration of a LHS framework is a cultural shift in thinking, method, and continuous improvement. The LHS program has developed multidisciplinary teams that are involved in defining and sharing data, design, and project management resources. In 2021, the first annual symposium was launched and brought together over 200 stakeholders from across the organization to support continuous education, training, and scaling of the framework. As a result of this foundation, two pilot initiatives have been funded and launched, the innovation accelerator model developed and is supporting over ten unique innovative and transformative clinical and operational programs, and several research grant applications have been submitted citing learning health system methodologies. DISCUSSION/SIGNIFICANCE: Our LHS framework has broken down silos and institutional barriers, creating a network of stakeholder groups. Our interdisciplinary approach has enabled us to create sustainable processes, resources and training on rapid, rigorous design, evaluation and implementation of interventions using real-time informatics data and digital health tools.