Advancing Rehabilitation Practice Using Embedded Learning Health System Researchers

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Physical Therapy





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Health services researchers and clinical operations leaders share similar goals to resolve inefficiencies and variability in health care delivery to improve outcomes, but have traditionally conducted their work using distinct paradigms, mostly separate from one another. Health services researchers often work on extended timeframes—typically tied to cycles of grant funding—methodically addressing a problem and publishing the findings in scientific journals with less consideration to the implementation of the findings. Clinical operations leaders work in rapid cycles of problem identification, analysis, and action to improve care processes with less emphasis on methodological rigor. An alternative paradigm is one that blends the rigor of academic research with the practicality of clinical operations. Learning health systems (LHSs) provide an environment and infrastructure to support such a paradigm. The aim of an LHS is to continuously and routinely improve health through cycles of discovery and implementation. This is accomplished by the creation of an infrastructure in which informatics, incentives, culture, and science are aligned. The “science” of an LHS includes purposeful aggregation and rigorous analysis of health care system data collected as part of usual care, combined with external evidence, to identify and implement best practices. This work is complex and time-intensive.8 Embedding a health services researcher into the health system infrastructure can facilitate the completion and quality of LHS work. A health services researcher who is embedded in a health system and has particular skills to conduct science aligned with system priorities has been termed an “LHS researcher.” An LHS researcher becomes part of the health system in some capacity, develops relationships with the clinical and administrative staff in that system, and enables coproduction of knowledge that addresses system-specific problems. Health systems face a multitude of challenges that limit their ability to embed LHS researchers within their operations. We believe, however, that doing so can quickly advance rehabilitation practice and be of value to both the patient (eg, improved outcomes) and the health system (eg, improved efficiency). The purposes of this article are to (1) discuss potential barriers to embedding LHS researchers into health systems, (2) describe 4 innovative models that have overcome some of these barriers, and (3) describe characteristics of embedded research models that we think are most likely to contribute to successful adoption of learning health systems in rehabilitation.


Evidence-Based; Health Services Administration; Models; Organizational; Practice


Physical Therapy | Rehabilitation and Therapy



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