<unk>  (LHS) are<unk> care<unk>  in which knowledge generation processes are embedded in daily practice to produce continual improvement in care. The idea was first conceptualised in a 2007 workshop organised by the US Institute of Medicine, building on ideas around evidence-based medicine and "practice-based evidence". There has since been increasing interest in the topic, including the creation of the Wiley journal<unk> . LHS can be described as having four key elements: #an organizational architecture that supports the formation of communities of patients,<unk> care professionals and researchers who collaborate to produce and use "big data"; #large electronic<unk>  data sets, i.e. "big data"; #quality improvement at the point of care for each patient using new knowledge generated by research; #research done in routine<unk> care settings. They are thus dependent on the use of electronic<unk>  records (EHRs) and have inherited the adoption challenges of EHRs. LHS entails a clinical lifecycle. Patient data is collected, it is amalgamated across multiple patients and a problem is defined. These are activities largely driven by<unk> care professionals. With the support of technology, an analysis is performed, which returns evidence, from which knowledge is generated, which leads to changed clinical practice, and thus to new patient data being collected. McLachlan and colleagues (2018) suggest a taxonomy of nine LHS classification types: #Cohort identification looks for patients with similar attributes. #Positive deviance finds examples of better care against a benchmark. #Negative deviance finds examples of sub-optimal care. #Predictive patient risk modeling uses patterns in data to find groups at greater risk of adverse events. #Predictive care risk and outcome models identify situations that are at greater risk of poor care. #Clinical decision support<unk>  use patient algorithms applied to patient data to make specific treatment recommendations. #Comparative effectiveness research determines the most effective treatments. #Intelligent assistance use data to automate routine processes. #Surveillance monitors data for disease outbreaks or other treatment issues. Next Generation of<unk>  Researchers: The Agency for<unk> care Research and Quality (AHRQ) and the Patient-Centered Outcomes Research Institute (PCORI) have awarded $40 million in grants over 5 years to 11 institutions to support the training of clinician and research scientists to conduct patient-centered outcomes research within LHS. The LHS Centers of Excellence are: #A Chicago Center of Excellence in<unk>  Research Training (ACCELERAT), Northwestern University, Chicago, Ill. #CATALyST: Consortium for Applied Training to Advance the<unk> with Scholars/Trainees, Kaiser Permanente Washington Research Institute, Seattle, WA.<unk><unk> <unk> Scholar Program at Vanderbilt, Vanderbilt University, Nashville, Tenn. #Leveraging Infrastructure to Train Investigators in Patient-Centered Outcomes Research in<unk> (LITI- PCORLHS), Indiana University School of Medicine, Indianapolis, Ind. #Minnesota<unk> Mentored Career Development Program (MN-LHS), University of Minnesota, Minneapolis, Minnesota. #Northwest Center of Excellence & K12 in Patient Centered<unk>  Science, Oregon<unk>  and Science University, Portland, Oregon. #PEDSnet Scholars: A Training Program for Pediatric<unk> Researchers, Children’s Hospital of Philadelphia, Philadelphia, PA #Stakeholder-Partnered Implementation Research and Innovation Translation (SPIRIT) program, University of California Los Angeles, Los Angeles, California. #The Center of Excellence in Promoting LHS Operations and Research at Einstein/Montefiore (EXPLORE), Albert Einstein College of Medicine, Bronx, N.Y. #Transforming the Generation and Adoption of PCOR into Practice (T-GAPP), University of Pennsylvania, Philadelphia, PA. #University of California-San Francisco<unk> K12 Career Development Program, University of California San Francisco, San Francisco, California.
Learning health systems
Community health trust
Cost sharing
Access to medicines
NHS Improvement
Continuing medical education
Community health
Public security