Learning health systems (LHS) is a multidisciplinary field of research that seeks to improve clinical decision-making, promote personalized medicine, and identify best practices to optimize patient outcomes. By creating a feedback loop between real-time research and practitioners in the field, LHS aims to improve the information scholars have access to and to help accelerate the translation of this information into tangible improvements in patient care.

New research from the University of Minnesota School of Public Health (SPH) adds to our understanding of the effectiveness of LHS by exploring an important aspect of LHS called embeddedness, in which a researcher is part of the system where research and practice happen, either as an employee or as a consulting expert who assists with the development, implementation, and dissemination of research. Embeddedness is a vital part of LHS research because it entails a researcher being located within — and thus, connected to — the systems that they are trying to improve.

Despite the significance of embeddedness, tools to track it have not been previously developed. To address this gap, the researchers describe how they designed, deployed, and then tested the MN-LHS Embeddedness Tool. The tool is a self-administered rating system in which respondents (those conducting projects in health systems) rate their level of engagement across four domains:

• Patients and family advisory groups
• Practice committees and local and regional healthcare system leadership
• Research institutions and other agenda-setting organizations
• National clinical and professional networks

The researchers described the MN-LHS Embeddedness Tool as a component of scholar assessments and program evaluation, and said its primary goal is to help guide discussions in Individual Development Plan (IDP) meetings, in which researcher trainees or employees outline an action plan for their project and for their own career development within an organization.

“Previous research has underscored LHS’s ability to improve healthcare practices through the systematic collection and analysis of data, and embeddedness is widely acknowledged as a core piece of LHS research and training,” says Nathan Shippee, SPH associate professor and lead author. “But despite the importance of embeddedness, my co-authors and I were not aware of tools for addressing its impact or improving its usefulness in scholar training programs.

“The MN-LHS Embeddedness Tool is simple, broadly applicable, and useful both in assessing current-state embeddedness, and in planning career development goals for scholars. Our research shows how this new tool can demonstrate the utility of tracking embeddedness over time, and to help scholars determine how they might become more embedded with organizations in the four domains as they move forward with their research and careers.”

In addition to describing the development of the tool, the study measured the embeddedness of several scholars by examining the trajectories of their careers within the four domains. The study, which was published in the Journal of Clinical and Translational Science,  found:

• While rates of embeddedness within each domain at baseline and completion of the study period varied, on average they increased. Of the participants who used the tool to measure their embeddedness at baseline and completion, the average “mean embeddedness” increased.
• Increases in embeddedness varied greatly across research trainees. Some had large increases across domains of embeddedness, while others had most modest or focused increases. With an average increase of two points, this could mean substantial growth in one domain (becoming much more integrated with patients, for instance), or more moderate growth across domains (modest gains within one’s local practice and patient engagement).
• The study used research trainee narratives to describe different trajectories of growth in embeddedness, including movement into local research administrative leadership, national professional groups, development of ties with patient groups, and others.

“We believe this tool can and should play a role in ensuring that embeddedness becomes an explicit part of training programs going forward” Shippee said.

The study complements previous work by this team, specifically on the Learning Health System Competency Appraisal Inventory (LHS-CAI). Whereas the embeddedness tool examines how well the project and researcher are integrated or located within the system, the LHS-CAI focuses on the research trainee’s specific research skills necessary to carry out the project. As the authors note, these are designed to work together to help research trainees and programs make improvements that are optimally designed both scientifically and for best health care practices.