BACKGROUND Interest in value-based healthcare, generally defined as providing better care at lower cost, has grown worldwide, and learning health systems (LHSs) have been proposed as a key strategy for improving value in healthcare. LHSs are emerging around the world and aim to leverage advancements in science, technology and practice to improve health system performance at lower cost. However, there remains much uncertainty around the implementation of LHSs and the distinctive features of these systems. This paper presents a conceptual framework that has been developed in Canada to support the implementation of value-creating LHSs. METHODS The framework was developed by an interdisciplinary team at the Institut national d'excellence en santé et en services sociaux (INESSS). It was informed by a scoping review of the scientific and grey literature on LHSs, regular team discussions over a 14-month period, and consultations with Canadian and international experts. RESULTS The framework describes four elements that characterise LHSs, namely (1) core values, (2) pillars and accelerators, (3) processes and (4) outcomes. LHSs embody certain core values, including an emphasis on participatory leadership, inclusiveness, scientific rigour and person-centredness. In addition, values such as equity and solidarity should also guide LHSs and are particularly relevant in countries like Canada. LHS pillars are the infrastructure and resources supporting the LHS, whereas accelerators are those specific structures that enable more rapid learning and improvement. For LHSs to create value, such infrastructures must not only exist within the ecosystem but also be connected and aligned with the LHSs' strategic goals. These pillars support the execution, routinisation and acceleration of learning cycles, which are the fundamental processes of LHSs. The main outcome sought by executing learning cycles is the creation of value, which we define as the striking of a more optimal balance of impacts on patient and provider experience, population health and health system costs. CONCLUSIONS Our framework illustrates how the distinctive structures, processes and outcomes of LHSs tie together with the aim of optimising health system performance and delivering greater value in health systems.

中文翻译：

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创造价值的学习健康系统框架。


背景技术对基于价值的医疗保健（通常定义为以更低的成本提供更好的护理）的兴趣在世界范围内不断增长，并且学习健康系统（LHS）已被提议作为提高医疗保健价值的关键策略。 LHS 正在世界各地兴起，旨在利用科学、技术和实践的进步，以更低的成本提高卫生系统的绩效。然而，LHS 的实施以及这些系统的独特特征仍然存在很大的不确定性。本文介绍了加拿大开发的一个概念框架，用于支持创造价值的 LHS 的实施。方法 该框架由国家健康与社会服务卓越研究所 (INESSS) 的跨学科团队开发。它是通过对 LHS 的科学和灰色文献进行范围审查、为期 14 个月的定期团队讨论以及与加拿大和国际专家的磋商而得出的。结果该框架描述了 LHS 的四个特征要素，即 (1) 核心价值观、(2) 支柱和加速器、(3) 过程和 (4) 结果。 LHS 体现了某些核心价值观，包括强调参与性领导、包容性、科学严谨性和以人为本。此外，公平和团结等价值观也应指导 LHS，这在加拿大等国家尤其重要。 LHS 支柱是支持 LHS 的基础设施和资源，而加速器是那些能够实现更快速学习和改进的特定结构。为了让 LHS 创造价值，此类基础设施不仅必须存在于生态系统内，而且还必须与 LHS 的战略目标相连接并保持一致。 这些支柱支持学习周期的执行、常规化和加速，这是 LHS 的基本流程。执行学习周期所追求的主要成果是创造价值，我们将其定义为对患者和提供者体验、人口健康和卫生系统成本的影响达到更佳平衡。结论 我们的框架说明了 LHS 的独特结构、流程和结果如何与优化卫生系统绩效和为卫生系统创造更大价值的目标结合在一起。