International Journal of Health Policy and Management

International Journal of Health Policy and Management

Training an Embedded Workforce to Realize Health System Impacts and the Promise of Learning Health Systems; Comment on “Early Career Outcomes of Embedded Research Fellows: An Analysis of the Health System Impact Fellowship Program”

Document Type : Commentary

Author
Elizabeth M. Yano 1, 2, 3
1 VA HSR Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
2 Division of General Internal Medicine and Health Services Research, Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, CA, USA
3 Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
10.34172/ijhpm.8667
Abstract
Learning health systems (LHSs) are designed to systematically integrate external evidence of effective practices with internal data and experience to put knowledge into practice as a part of a culture of continuous learning and improvement. Researchers embedded in health systems are an essential component of LHSs, with defined competencies. However, many of these competencies are not generated by traditional graduate/post-graduate training programs; evaluation of new LHS training programs has been limited. This commentary reviews and extends results of an evaluation of early career outcomes of fellows in one such program designed to generate impact-oriented career pathways embedded in healthcare systems. Discussion considers the need for increasingly rigorous evaluation methods to ensure production of high-quality professionals ready for system engagement, the importance of training and preparing other LHS stakeholders as effective partners and evidence users, and the promise and challenges in advancing the science and practice of embedded research in LHSs.
Keywords
Learning Health Systems
Embedded Research
Implementation Science
Training Programs
Research Impacts
  1. Yano EM, Green LW, Glanz K, et al. Implementation and spread of interventions into the multilevel context of routine practice and policy: implications for the cancer care continuum. J Natl Cancer Inst Monogr. 2012;2012(44):86-99. doi:1093/jncimonographs/lgs004
  2. Kilbourne AM, Braganza MZ, Bowersox NW, et al. Research lifecycle to increase the substantial real-world impact of research: accelerating innovations to application. Med Care. 2019;57(10 Suppl 3):S206-S212. doi:1097/mlr.0000000000001146
  3. Smith M, Saunders R, Stuckhardt L, McGinnis JM. Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. Washington, DC: The National Academies Press; 2013.
  4. Forrest CB, Chesley FD Jr, Tregear ML, Mistry KB. Development of the learning health system researcher core competencies. Health Serv Res. 2018;53(4):2615-2632. doi:1111/1475-6773.12751
  5. Yano EM, Resnick A, Gluck M, Kwon H, Mistry KB. Accelerating learning healthcare system development through embedded research: Career trajectories, training needs, and strategies for managing and supporting embedded researchers. Healthc (Amst). 2021;8 Suppl 1:100479. doi:1016/j.hjdsi.2020.100479
  6. Kasaai B, Thompson E, Glazier RH, McMahon M. Early Career outcomes of embedded research fellows: an analysis of the health system impact fellowship program. Int J Health Policy Manag. 2023;12:7333. doi:34172/ijhpm.2023.7333
  7. Sheikh K, Abimbola S. Learning Health Systems: Pathways to Progress. Flagship Report of the Alliance for Health Policy and Systems Research. Geneva: World Health Organization; 2021.
  8. Ghaffar A, Gupta A, Kampo A, Swaminathan S. The value and promise of embedded research. Health Res Policy Syst. 2021;19(Suppl 2):99. doi:1186/s12961-021-00744-8
  9. Somerville M, Cassidy C, Curran JA, Johnson C, Sinclair D, Elliott Rose A. Implementation strategies and outcome measures for advancing learning health systems: a mixed methods systematic review. Health Res Policy Syst. 2023;21(1):120. doi:1186/s12961-023-01071-w
  10. Lannon C, Schuler CL, Seid M, et al. A maturity grid assessment tool for learning networks. Learn Health Syst. 2021;5(2):e10232. doi:1002/lrh2.10232
  11. Hill JE, Stephani AM, Sapple P, Clegg AJ. The effectiveness of continuous quality improvement for developing professional practice and improving health care outcomes: a systematic review. Implement Sci. 2020;15(1):23. doi:1186/s13012-020-0975-2
  12. Shojania KG, Grimshaw JM. Evidence-based quality improvement: the state of the science. Health Aff (Millwood). 2005;24(1):138-150. doi:1377/hlthaff.24.1.138
  13. Yano EM, Than C, Brunner J, et al. Impact of evidence-based quality improvement on tailoring VA's patient-centered medical home model to women veterans' needs. J Gen Intern Med. 2024;39(8):1349-1359. doi:1007/s11606-024-08647-4
  14. Atkins D, Kilbourne AM, Shulkin D. Moving from discovery to system-wide change: the role of research in a learning health care system: experience from three decades of health systems research in the Veterans Health Administration. Annu Rev Public Health. 2017;38:467-487. doi:1146/annurev-publhealth-031816-044255
  15. Rajit D, Reeder S, Johnson A, Enticott J, Teede H. Tools and frameworks for evaluating the implementation of learning health systems: a scoping review. Health Res Policy Syst. 2024;22(1):95. doi:1186/s12961-024-01179-7
International Journal of Health Policy and Management
Volume 13, Issue 1
2024
Pages 1-4

  • Received Date 22 June 2024
  • Revised Date 19 August 2024
  • Accepted Date 24 August 2024
  • First Published Date 26 August 2024
  • Published Date 01 December 2024