Progress with the Learning Health System 2.0: a rapid review of Learning Health Systems' responses to pandemics and climate change.
COVID-19
Climate change
Learning Health Systems
Pandemics
Journal
BMC medicine
ISSN: 1741-7015
Titre abrégé: BMC Med
Pays: England
ID NLM: 101190723
Informations de publication
Date de publication:
22 Mar 2024
22 Mar 2024
Historique:
received:
06
09
2023
accepted:
23
01
2024
medline:
23
3
2024
pubmed:
23
3
2024
entrez:
23
3
2024
Statut:
epublish
Résumé
Pandemics and climate change each challenge health systems through increasing numbers and new types of patients. To adapt to these challenges, leading health systems have embraced a Learning Health System (LHS) approach, aiming to increase the efficiency with which data is translated into actionable knowledge. This rapid review sought to determine how these health systems have used LHS frameworks to both address the challenges posed by the COVID-19 pandemic and climate change, and to prepare for future disturbances, and thus transition towards the LHS2.0. Three databases (Embase, Scopus, and PubMed) were searched for peer-reviewed literature published in English in the five years to March 2023. Publications were included if they described a real-world LHS's response to one or more of the following: the COVID-19 pandemic, future pandemics, current climate events, future climate change events. Data were extracted and thematically analyzed using the five dimensions of the Institute of Medicine/Zurynski-Braithwaite's LHS framework: Science and Informatics, Patient-Clinician Partnerships, Continuous Learning Culture, Incentives, and Structure and Governance. The search yielded 182 unique publications, four of which reported on LHSs and climate change. Backward citation tracking yielded 13 additional pandemic-related publications. None of the climate change-related papers met the inclusion criteria. Thirty-two publications were included after full-text review. Most were case studies (n = 12, 38%), narrative descriptions (n = 9, 28%) or empirical studies (n = 9, 28%). Science and Informatics (n = 31, 97%), Continuous Learning Culture (n = 26, 81%), Structure and Governance (n = 23, 72%) were the most frequently discussed LHS dimensions. Incentives (n = 21, 66%) and Patient-Clinician Partnerships (n = 18, 56%) received less attention. Twenty-nine papers (91%) discussed benefits or opportunities created by pandemics to furthering the development of an LHS, compared to 22 papers (69%) that discussed challenges. An LHS 2.0 approach appears well-suited to responding to the rapidly changing and uncertain conditions of a pandemic, and, by extension, to preparing health systems for the effects of climate change. LHSs that embrace a continuous learning culture can inform patient care, public policy, and public messaging, and those that wisely use IT systems for decision-making can more readily enact surveillance systems for future pandemics and climate change-related events. PROSPERO pre-registration: CRD42023408896.
Sections du résumé
BACKGROUND
BACKGROUND
Pandemics and climate change each challenge health systems through increasing numbers and new types of patients. To adapt to these challenges, leading health systems have embraced a Learning Health System (LHS) approach, aiming to increase the efficiency with which data is translated into actionable knowledge. This rapid review sought to determine how these health systems have used LHS frameworks to both address the challenges posed by the COVID-19 pandemic and climate change, and to prepare for future disturbances, and thus transition towards the LHS2.0.
METHODS
METHODS
Three databases (Embase, Scopus, and PubMed) were searched for peer-reviewed literature published in English in the five years to March 2023. Publications were included if they described a real-world LHS's response to one or more of the following: the COVID-19 pandemic, future pandemics, current climate events, future climate change events. Data were extracted and thematically analyzed using the five dimensions of the Institute of Medicine/Zurynski-Braithwaite's LHS framework: Science and Informatics, Patient-Clinician Partnerships, Continuous Learning Culture, Incentives, and Structure and Governance.
RESULTS
RESULTS
The search yielded 182 unique publications, four of which reported on LHSs and climate change. Backward citation tracking yielded 13 additional pandemic-related publications. None of the climate change-related papers met the inclusion criteria. Thirty-two publications were included after full-text review. Most were case studies (n = 12, 38%), narrative descriptions (n = 9, 28%) or empirical studies (n = 9, 28%). Science and Informatics (n = 31, 97%), Continuous Learning Culture (n = 26, 81%), Structure and Governance (n = 23, 72%) were the most frequently discussed LHS dimensions. Incentives (n = 21, 66%) and Patient-Clinician Partnerships (n = 18, 56%) received less attention. Twenty-nine papers (91%) discussed benefits or opportunities created by pandemics to furthering the development of an LHS, compared to 22 papers (69%) that discussed challenges.
CONCLUSIONS
CONCLUSIONS
An LHS 2.0 approach appears well-suited to responding to the rapidly changing and uncertain conditions of a pandemic, and, by extension, to preparing health systems for the effects of climate change. LHSs that embrace a continuous learning culture can inform patient care, public policy, and public messaging, and those that wisely use IT systems for decision-making can more readily enact surveillance systems for future pandemics and climate change-related events.
TRIAL REGISTRATION
BACKGROUND
PROSPERO pre-registration: CRD42023408896.
Identifiants
pubmed: 38519952
doi: 10.1186/s12916-024-03345-8
pii: 10.1186/s12916-024-03345-8
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
131Subventions
Organisme : National Health and Medical Research Council
ID : 9100002
Organisme : National Health and Medical Research Council
ID : 1176620
Informations de copyright
© 2024. The Author(s).
Références
Levesque J-F, Sutherland K, Watson DE, Currow DC, Bolevich Z, Koff E. Learning systems in times of crisis: the COVID-19 Critical Intelligence Unit in New South Wales, Australia. NEJM Catalyst. 2020;1(6).
Groot G, Baer S, Badea A, Dalidowicz M, Yasinian M, Ali A, et al. Developing a rapid evidence response to COVID-19: the collaborative approach of Saskatchewan, Canada. Learn Health Syst. 2022;6(1):e10280.
pubmed: 34514125
doi: 10.1002/lrh2.10280
Ellis LA, Saba M, Long JC, Lyng HB, Haraldseid-Driftland C, Churruca K, et al. The rise of resilient healthcare research during COVID-19: Scoping review of empirical research. BMC Health Serv Res. 2023;23(1):833.
pubmed: 37550640
pmcid: 10405417
doi: 10.1186/s12913-023-09839-0
Manzanedo RD, Manning P. COVID-19: lessons for the climate change emergency. Sci Total Environ. 2020;742:140563.
pubmed: 32619845
pmcid: 7320672
doi: 10.1016/j.scitotenv.2020.140563
Ruiu ML, Ragnedda M, Ruiu G. Similarities and differences in managing the COVID-19 crisis and climate change risk. J Knowl Manag. 2020;24(10):2597–614.
doi: 10.1108/JKM-06-2020-0492
Marani M, Katul GG, Pan WK, Parolari AJ. Intensity and frequency of extreme novel epidemics. Proc Natl Acad Sci. 2021;118(35):e2105482118.
pubmed: 34426498
pmcid: 8536331
doi: 10.1073/pnas.2105482118
McMichael T, Blashki G, Karoly DJ. Climate change and primary health care. Aust Fam Physician. 2007;36(12).
Lin S, Hsu W-H, Van Zutphen AR, Saha S, Luber G, Hwang S-A. Excessive heat and respiratory hospitalizations in New York State: estimating current and future public health burden related to climate change. Environ Health Persp. 2012;120(11):1571–7.
doi: 10.1289/ehp.1104728
Kendrovski V, Schmoll O. Priorities for protecting health from climate change in the WHO European Region: recent regional activities. Bundesgesundheitsbla. 2019;62(5):537–45.
doi: 10.1007/s00103-019-02943-9
Braithwaite J, Glasziou P, Westbrook J. The three numbers you need to know about healthcare: the 60–30-10 Challenge. BMC Med. 2020;18(1):102.
pubmed: 32362273
pmcid: 7197142
doi: 10.1186/s12916-020-01563-4
Morris ZS, Wooding S, Grant J. The answer is 17 years, what is the question: understanding time lags in translational research. J R Soc Med. 2011;104(12):510–20.
pubmed: 22179294
pmcid: 3241518
doi: 10.1258/jrsm.2011.110180
Institute of Medicine (US) Roundtable on Evidence-Based Medicine. The Learning Healthcare System: Workshop Summary National Academies Press (US); 2007.
Institute of Medicine. Best care at lower cost: the path to continuously learning health care in America. The National Academies Press. 2013.
Roundtable on Value & Science-Driven Health Care. The Roundtable. Washington, DC: Institute of Medicine; 2012.
Friedman C, Rubin J, Brown J, Buntin M, Corn M, Etheredge L, et al. Toward a science of learning systems: a research agenda for the high-functioning Learning Health System. J Am Med Inform Assoc. 2015;22(1):43–50.
pubmed: 25342177
doi: 10.1136/amiajnl-2014-002977
Institute of Medicine. Integrating Research and Practice: Health System Leaders Working Toward High-Value Care. 2015.
Zurynski Y, Smith CL, Vedovi A, Ellis LA, Knaggs G, Meulenbroeks I, et al. Mapping the learning health system: a scoping review of current evidence. Sydney: Australian Institute of Health Innovation and the NHMRC Partnership Centre for Health System Sustainability. 2020.
Friedman CP. What is unique about learning health systems? Learn Health Syst. 2022;6(3):e10328.
pubmed: 35860320
pmcid: 9284922
doi: 10.1002/lrh2.10328
Kilbourne AM, Schmidt J, Edmunds M, Vega R, Bowersox N, Atkins D. How the VA is training the Next-Generation workforce for learning health systems. Learn Health Syst. 2022;6(4):e10333.
pubmed: 36263263
pmcid: 9576233
doi: 10.1002/lrh2.10333
System GH. Learning healthcare system 2019 [Available from: https://www.geisinger.edu/research/research-and-innovation/learning-healthcare-system .
Bohmer R, Shand J, Allwood D, Wragg A, Mountford J. Learning systems: managing uncertainty in the new normal of Covid-19. NEJM Catalyst. 2020;1(4).
Lim HC, Austin JA, van der Vegt AH, Rahimi AK, Canfell OJ, Mifsud J, et al. Toward a learning health care system: a systematic review and evidence-based conceptual framework for implementation of clinical analytics in a digital hospital. Appl Clin Inform. 2022;13(2):339–54.
pubmed: 35388447
pmcid: 8986462
doi: 10.1055/s-0042-1743243
Ellis L, Sarkies M, Churruca K, Dammery G, Meulenbroeks I, Smith C, et al. The science of learning health systems: scoping review of empirical research. JMIR Med Inform. 2022;10:1–17.
Pomare C, Mahmoud Z, Vedovi A, Ellis LA, Knaggs G, Smith CL, et al. Learning health systems: a review of key topic areas and bibliometric trends. Learn Health Syst. 2022;6(1):e10265.
pubmed: 35036549
doi: 10.1002/lrh2.10265
McDonald PL, Phillips J, Harwood K, Maring J, van der Wees PJ. Identifying requisite learning health system competencies: a scoping review. BMJ Open. 2022;12(8):e061124.
pubmed: 35998963
pmcid: 9403130
doi: 10.1136/bmjopen-2022-061124
Budrionis A, Bellika JG. The Learning Healthcare System: where are we now? A systematic review. J Biomed Inform. 2016;64(87–92).
Braithwaite J, Dammery G, Spanos S, Smith CL, Ellis LA, Churruca K, Fisher G, Zurynski Y. Learning health systems 2.0: future-proofing healthcare against pandemics and climate change. A White Paper. Sydney, Australia: Australian Institute of Health Innovation, Macquarie University; 2023.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.
pubmed: 33782057
pmcid: 8005924
doi: 10.1136/bmj.n71
Garritty C GG, Kamel C, King VJ, Nussbaumer-Streit B,, Stevens A HC, Affengruber L. Cochrane Rapid Reviews. 2020.
Berrang-Ford L, Sietsma AJ, Callaghan M, Minx JC, Scheelbeek PFD, Haddaway NR, et al. Systematic mapping of global research on climate and health: a machine learning review. Lancet Planet Health. 2021;5(8):e514–25.
pubmed: 34270917
pmcid: 8358978
doi: 10.1016/S2542-5196(21)00179-0
Gustavson AM, Purnell A, Adly M, Awan O, Brau N, Braus NA, et al. A learning health system approach to long COVID care. Fed Pract. 2022;39(7):310–4.
pubmed: 36425345
pmcid: 9648579
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81.
pubmed: 18929686
doi: 10.1016/j.jbi.2008.08.010
Hong QN, Pluye P, Fàbregues S, Bartlett G, Boardman F, Cargo M, et al. Improving the content validity of the mixed methods appraisal tool: a modified e-Delphi study. J Clin Epidemiol. 2019;111:49–59.e1.
pubmed: 30905698
doi: 10.1016/j.jclinepi.2019.03.008
Baethge C, Goldbeck-Wood S, Mertens S. SANRA—a scale for the quality assessment of narrative review articles. Research Integrity and Peer Review. 2019;4(1):5.
pubmed: 30962953
pmcid: 6434870
doi: 10.1186/s41073-019-0064-8
Aromataris EFR, Godfrey C, Holly C, Kahlil H, Tungpunkom P. Summarizing systematic reviews: methodological development, conduct and reporting of an Umbrella review approach. Int J Evid Based Healthc. 2015;13(3):132–40.
pubmed: 26360830
doi: 10.1097/XEB.0000000000000055
Sivan M, Greenhalgh T, Darbyshire JL, Mir G, O’Connor RJ, Dawes H, et al. Long covid multidisciplinary consortium optimising treatments and services across the NHS (LOCOMOTION): protocol for a mixed-methods study in the UK. BMJ Open. 2022;12:5 e063505.
pubmed: 35580970
doi: 10.1136/bmjopen-2022-063505
van Rensburg AJ, Petersen I, Awotiwon A, Bachmann MO, Curran R, Murdoch J, et al. Applying learning health systems thinking in codeveloping integrated tuberculosis interventions in the contexts of COVID-19. BMJ Glob Health. 2022;7(10).
Allen C, Coleman K, Mettert K, Lewis C, Westbrook E, Lozano P. A roadmap to operationalize and evaluate impact in a learning health system. Learn Health Syst. 2021;5(4):e10258.
pubmed: 34667878
pmcid: 8512726
doi: 10.1002/lrh2.10258
Bakshi S, Schiavoni KH, Carlson LC, Chang TE, Flaster AO, Forester BP, et al. The essential role of population health during and beyond COVID-19. Am J Manag Care. 2021;27(3):123–8.
pubmed: 33720669
doi: 10.37765/ajmc.2021.88511
Braganza MZ, Pearson E, Avila CJ, Zlowe D, Øvretveit J, Kilbourne AM. Aligning quality improvement efforts and policy goals in a national integrated health system. Health Serv Res. 2022;57(S1):9–19.
pubmed: 35243629
pmcid: 9108213
doi: 10.1111/1475-6773.13944
Brunet F, Malas K, Pomey M-P. Reconnecting health through innovation. Healthc Manage Forum. 2022;35(6):344–8.
pubmed: 35960988
doi: 10.1177/08404704221114249
English M, Irimu G, Akech S, Aluvaala J, Ogero M, Isaaka L, et al. Employing learning health system principles to advance research on severe neonatal and paediatric illness in Kenya. BMJ Global Health. 2021;6(3).
Fox J, Khan O, Curtis H, Wright A, Pal C, Cockburn N, et al. Rapid translation of clinical guidelines into executable knowledge: a case study of COVID-19 and online demonstration. Learn Health Syst. 2021;5(1):e10236.
pubmed: 32838035
doi: 10.1002/lrh2.10236
Levin A, Malbeuf M, Hoens AM, Carlsten C, Ryerson CJ, Cau A, et al. Creating a provincial post COVID-19 interdisciplinary clinical care network as a learning health system during the pandemic: Integrating clinical care and research. Learn Health Syst. 2022:e10316.
McCreary EK, Bariola JR, Minnier T, Wadas RJ, Shovel JA, Albin D, et al. Launching a comparative effectiveness adaptive platform trial of monoclonal antibodies for COVID-19 in 21 days. Contemp Clin Trials. 2022;113:106652.
pubmed: 34896293
doi: 10.1016/j.cct.2021.106652
Millimouno TM, Meessen B, Put WVD, Garcia M, Camara BS, Christou A, et al. How has Guinea learnt from the response to outbreaks? A learning health system analysis. BMJ Global Health. 2023;8(2).
Vahidy F, Jones SL, Tano ME, Nicolas JC, Khan OA, Meeks JR, et al. Rapid response to drive COVID-19 research in a learning health care system: rationale and design of the Houston Methodist COVID-19 surveillance and outcomes registry (CURATOR). JMIR Med Inform. 2021;9(2):e26773.
pubmed: 33544692
pmcid: 7903978
doi: 10.2196/26773
Vinson AH. Putting the network to work: Learning networks in rapid response situations. Learn Health Syst. 2021;5(1):e10251.
pubmed: 33490384
doi: 10.1002/lrh2.10251
Anderson JL, Reamey RA, Levitan EB, Asif IM, Aswani MS, Fletcher FE, et al. Learn Health Syst. 2022;6(2):e10292.
pubmed: 34901441
doi: 10.1002/lrh2.10292
Atkins D, Makridis CA, Alterovitz G, Ramoni R, Clancy C. Developing and implementing predictive models in a learning healthcare system: traditional and artificial intelligence approaches in the Veterans Health Administration. Annu Rev Biomed Data Sci. 2022;5:393–413.
pubmed: 35609894
doi: 10.1146/annurev-biodatasci-122220-110053
Daniel C, Paris N, Pierre O, Griffon N, Breant S, Orlova N, et al. AP-HP Health Data Space (AHDS) to the test of the Covid-19 pandemic. Stud Health Technol Inform. 2022;294:28–32.
pubmed: 35612010
Foraker RE, Lai AM, Kannampallil TG, Woeltje KF, Trolard AM, Payne PRO. Transmission dynamics: data sharing in the COVID-19 era. Learn Health Syst. 2021;5(1):e10235.
pubmed: 32838037
doi: 10.1002/lrh2.10235
Hunt RC, Struminger BB, Redd JT, Herrmann J, Jolly BT, Arora S, et al. Virtual peer-to-peer learning to enhance and accelerate the health system response to COVID-19: the HHS ASPR Project ECHO COVID-19 Clinical Rounds Initiative. Ann Emerg Med. 2021;78(2):223–8.
pubmed: 34325856
pmcid: 8052469
doi: 10.1016/j.annemergmed.2021.03.035
Ros F, Kush R, Friedman C, Gil Zorzo E, Rivero Corte P, Rubin JC, et al. Addressing the Covid-19 pandemic and future public health challenges through global collaboration and a data-driven systems approach. Learn Health Syst. 2021;5(1):e10253.
pubmed: 33349796
doi: 10.1002/lrh2.10253
Saleh F, Popoola BO, Arinze C, Elisha AA, Dan-Nwafor C, Olajide L, et al. Adapting public health response through lessons learnt: Nigeria’s experience from Lassa fever and COVID-19. BMJ Global Health. 2022;7(Suppl 7).
Wood WA, Marks P, Plovnick RM, Hewitt K, Neuberg DS, Walters S, et al. ASH Research Collaborative: a real-world data infrastructure to support real-world evidence development and learning healthcare systems in hematology. Blood Adv. 2021;5(23):5429–38.
pubmed: 34673922
pmcid: 9153041
doi: 10.1182/bloodadvances.2021005902
Cassidy C, Sim M, Somerville M, Crowther D, Sinclair D, Elliott Rose A, et al. Using a learning health system framework to examine COVID-19 pandemic planning and response at a Canadian Health Centre. PLoS ONE. 2022;17(9):e0273149.
pubmed: 36103510
pmcid: 9473619
doi: 10.1371/journal.pone.0273149
Dash D, Gokhale A, Patel BS, Callahan A, Posada J, Krishnan G, et al. Building a learning health system: creating an analytical workflow for evidence generation to inform institutional clinical care guidelines. Appl Clin Inform. 2022;13(1):315–21.
pubmed: 35235994
pmcid: 8890914
doi: 10.1055/s-0042-1743241
Groot G, Witham S, Badea A, Baer S, Dalidowicz M, Reeder B, et al. Evaluating a learning health system initiative: lessons learned during COVID-19 in Saskatchewan, Canada. Learn Health Syst. 2022:e10350.
McCreary EK, Kip KE, Bariola JR, Schmidhofer M, Minnier T, Mayak K, et al. A learning health system approach to the COVID-19 pandemic: System-wide changes in clinical practice and 30-day mortality among hospitalized patients. Learn Health Syst. 2022;6(3):e10304.
pubmed: 35860323
pmcid: 9284933
doi: 10.1002/lrh2.10304
McCreary EK, Bariola JR, Minnier TE, Wadas RJ, Shovel JA, Albin D, et al. The comparative effectiveness of COVID-19 monoclonal antibodies: a learning health system randomized clinical trial. Contemp Clin Trials. 2022;119:106822.
pubmed: 35697146
pmcid: 9187853
doi: 10.1016/j.cct.2022.106822
Polancich S, Hall AG, Miltner R, Poe T, Enogela EM, Montgomery AP, et al. Learning during crisis: the impact of COVID-19 on hospital-acquired pressure injury incidence. Journal for Healthcare Quality : official publication of the National Association for Healthcare Quality. 2021;43(3):137–44.
pubmed: 33955955
doi: 10.1097/JHQ.0000000000000301
Tai-Seale M, May N, Sitapati A, Longhurst CA. A learning health system approach to COVID-19 exposure notification system rollout. Learn Health Syst. 2022;6(2):e10290.
pubmed: 34901440
doi: 10.1002/lrh2.10290
The UMPC REMAP-COVID Group. Implementation of the randomized embedded multifactorial adaptive platform for COVID-19 (REMAP-COVID) trial in a US health system-lessons learned and recommendations. Trials. 2021;22(1):100.
doi: 10.1186/s13063-020-04997-6
Sheikh A, Anderson M, Albala S, Casadei B, Franklin BD, Richards M, et al. Health information technology and digital innovation for national learning health and care systems. The Lancet Digital Health. 2021;3(6):e383–96.
pubmed: 33967002
doi: 10.1016/S2589-7500(21)00005-4
Platt JE, Raj M, Wienroth M. An analysis of the learning health system in its first decade in practice: scoping review. J Med Internet Res. 2020;22(3):e17026.
pubmed: 32191214
pmcid: 7118548
doi: 10.2196/17026
McLachlan S, Potts HWW, Dube K, Buchanan D, Lean S, Gallagher T, et al. The Heimdall framework for supporting characterisation of learning health systems. BMJ Health & Care Inform. 2018;25(2):77–87.
doi: 10.14236/jhi.v25i2.996
Menear M, Blanchette MA, Demers-Payette O, Roy D. A framework for value-creating learning health systems. Health Res Policy Syst. 2019;17(1):79.
pubmed: 31399114
pmcid: 6688264
doi: 10.1186/s12961-019-0477-3
Foley TVL. A framework for understanding, designing, developing and evaluating learning health systems. Learn Health Syst. 2023;7(1): e10315.
pubmed: 36654802
doi: 10.1002/lrh2.10315
Platt J, Raj M, Buyuktur AG, Trinidad MG, Olopade O, Ackerman MS, et al. Willingness to participate in health information networks with diverse data use: evaluating public perspectives. EGEMS (Wash DC). 2019;7(1):33.
pubmed: 31367650
Davis HE, McCorkell L, Vogel JM, Topol EJ. Long COVID: Major findings, mechanisms and recommendations. Nat Rev Microbiol. 2023;21(3):133–46.
pubmed: 36639608
pmcid: 9839201
doi: 10.1038/s41579-022-00846-2
DA Ghazali GM, Thys F, Sarasin F, Arcos González P, Casalino E. Climate change impacts on disaster and emergency medicine focusing on mitigation disruptive effects: an international perspective. Int J Environ Res Public Health. 2018;15(7):1379.
pubmed: 29966379
pmcid: 6069477
doi: 10.3390/ijerph15071379
Pichler P-P, Jaccard IS, Weisz U, Weisz H. International comparison of health care carbon footprints. Environ Res Lett. 2019;14(6):064004.
doi: 10.1088/1748-9326/ab19e1
Romanello M, Di Napoli C, Drummond P, Green C, Kennard H, Lampard P, et al. The 2022 report of the Lancet Countdown on health and climate change: health at the mercy of fossil fuels. Lancet. 2022;400(10363):P1619–54.
doi: 10.1016/S0140-6736(22)01540-9
Geiger NGA, Squire CV, Attari SZ. Investigating similarities and differences in individual reactions to the COVID-19 pandemic and the climate crisis. Clim Change. 2021;167(1–2):1.
pubmed: 34248235
pmcid: 8253462
doi: 10.1007/s10584-021-03143-8
Spence A, Poortinga W, Butler C, et al. Perceptions of climate change and willingness to save energy related to flood experience. Nat Clim Chang. 2011;1:46–9.
doi: 10.1038/nclimate1059
Ecker UKH, Butler LH, Cook J, Hurlstone MJ, Kurz T, Lewandowsky S. Using the COVID-19 economic crisis to frame climate change as a secondary issue reduces mitigation support. J Environ Psych. 2020;70:101464.
doi: 10.1016/j.jenvp.2020.101464
Stoddart MCJ, Ramos H, Foster K, Ylä-Anttila T. Competing crises? Media coverage and framing of climate change during the COVID-19 pandemic. Environ Commun. 2023;17(3):276–92.
doi: 10.1080/17524032.2021.1969978
Smirnov OHP. COVID-19, climate change, and the finite pool of worry in 2019 to 2021 Twitter discussions. Proc Natl Acad Sci U S A. 2022;119(43):e2210988119.
pubmed: 36251993
pmcid: 9618108
doi: 10.1073/pnas.2210988119
Diseases TLI. Transitioning to endemicity with COVID-19 research. Lancet Infect Dis. 2022;22(3):297.
doi: 10.1016/S1473-3099(22)00070-6
Akl EA, Meerpohl JJ, Elliott J, Kahale LA, Schünemann HJ. Living systematic review network, Living systematic reviews: 4. Living guideline recommendations J Clin Epidemiol. 2017;91:47–53.
pubmed: 28911999
doi: 10.1016/j.jclinepi.2017.08.009
Cross DA, Pestka DL, White KM, Shah S. Business not as usual: implementation strategies that support learning during the COVID-19 pandemic. Mayo Clinic proceedings Innovations, Quality & Outcomes. 2021;5(6):1008–11.
doi: 10.1016/j.mayocpiqo.2021.09.002
El-Kareh R, Brenner DA, Longhurst CA. Developing a highly-reliable learning health system. Learning Health Systems. 2023;7(3): e10351.
pubmed: 37448457
doi: 10.1002/lrh2.10351
Aryal D, Beane A, Dondorp AM, Green C, Haniffa R, Hashmi M, Jayakumar D, Marshall JC, McArthur CJ, Murthy S, Webb SA, Acharya SP, Ishani PGP, Jawad I, Khanal S, Koirala K, Luitel S, Pabasara U, Paneru HR, Kumar A, Umrani Z. Operationalisation of the randomized embedded multifactorial adaptive platform for COVID-19 trials in a low and lower-middle income critical care learning health system. Wellcome Open Research. 2021;6:14.
pubmed: 33604455
pmcid: 7883321
doi: 10.12688/wellcomeopenres.16486.1
Duchen R, Iskander C, Chung H, Paterson JM, Kwong JC, Bronskill SE, et al. The role of a resilient information infrastructure in COVID-19 vaccine uptake in Ontario. Healthc Q. 2021;24(2):7–11.
pubmed: 34297657
doi: 10.12927/hcq.2021.26553
Heys M, Kesler E, Sassoon Y, Wilson E, Fitzgerald F, Gannon H, et al. Development and implementation experience of a learning healthcare system for facility based newborn care in low resource settings: The Neotree. Learning Health Systems. 2023;7(1):e10310.
pubmed: 36654803
doi: 10.1002/lrh2.10310
Beck AF, Hartley DM, Kahn RS, Taylor SC, Bishop E, Rich K, et al. Rapid, bottom-up design of a regional learning health system in response to COVID-19. Mayo Clin Proc. 2021;96(4):849–55.
pubmed: 33714596
doi: 10.1016/j.mayocp.2021.02.006
Khanna N, Klyushnenkova EN, Kaysin A, Stewart DL. Utilizing the learning health system adaptation to guide family medicine practice to COVID-19 response. J Prim Care Community Health. 2020;11:2150132720966409.
pubmed: 33063617
pmcid: 7580135
doi: 10.1177/2150132720966409
Stefan MS, Salvador D, Lagu TK. Pandemic as a catalyst for rapid implementation: how our hospital became a learning health system overnight. Am J Med Qual. 2021;36(1):60–2.
pubmed: 33001709
doi: 10.1177/1062860620961171
Clancy CM, Kirsh S. Virtual care and the pandemic: are we reaching all patients? Ann Intern Med. 2021;174(1):116–7.
pubmed: 32776779
doi: 10.7326/M20-5593