Minnesota is at the forefront of a transformative development in healthcare research and delivery that has the potential to fundamentally change the research-to-practice process. Embedding researchers directly into healthcare systems, an innovative model known as Learning Health Systems, fosters a dynamic environment where care delivery is continuously informed by the latest scientific evidence, and research is inspired by immediate and actionable clinical needs.
The LHS model has several advantages over the typical clinical research process. In the traditional process, it can take a long time for research to be applied to practice and findings can have limited applicability for patients with complex needs. LHS models, on the other hand, focus on systems-based, participatory research that engages administrators, patients, and providers to co-create care improvements. They also increase the rapid discovery and translation of research into practice. Rather than relying on the traditional model — publishing research and hoping it trickles down to clinical practice — LHS researchers are able to apply interventions in clinical settings in real time, while also tracking results that inform practical improvements in an iterative feedback loop.
Translation Services
“We spend $4.5 trillion annually on delivering healthcare, but about a third of that spending is unnecessary, ineffective, preventable, or harmful,” says SPH Mayo Professor Timothy Beebe, deputy director of the Center for Learning Health System Sciences (CLHSS) and director of the Minnesota Learning Health System Mentored Career Development Program (MN-LHS).
Beebe adds that it takes an average of 17 years for new treatments to be integrated into routine care. “The LHS is a dynamic way of making sure that care is evidence-based, and that the best evidence makes it to the bedside in a timely way,” he says.
CLHSS was founded at the University of Minnesota in 2021 as a collaboration between the Medical School, the School of Public Health, and M Health Fairview. It has since expanded to work with a total of five healthcare systems across the state, including the Minneapolis Veterans Administration (VA), Essentia Health, HealthPartners, and Hennepin Healthcare.
Expanding Care
While other learning health systems have sprung up around the country, CLHSS is unique in its geographic and demographic breadth, its blend of medical and public health expertise, and its emphasis on training scholars in LHS practices.
“So far, we’ve trained 15 scholars from five different healthcare systems to do this work,” Beebe says. They include both clinicians and non-clinician scientists representing primary care, specialty care, anthropology, sociology, psychology, engineering, epidemiology, and biostatistics. “We really want to connect healthcare delivery systems with public health and community-based organizations to look at whole-person health,” Beebe says.
MN-LHS recently received a $5 million grant from the Agency for Healthcare Research and Quality and the Patient-Centered Outcomes Research Institute to expand its work with its five Minnesota healthcare system partners.
“The LHS is a dynamic way of making sure that care is evidence-based, and that the best evidence makes it to the bedside in a timely way.”
Timothy Beebe
“We will be representing almost all the geography in Minnesota, as well as every patient type — rural, urban, children, veterans, and socially and clinically complex patients,” Beebe says. Ultimately, the aim is to treat the whole state as a learning health system.
Proof Points
Dr. Debbie Pestka was part of the LHS Scholars program, serving as an embedded learning health systems researcher at M Health Fairview through the MN-LHS. She has since moved on from the scholar program and assumed leadership roles in CLHSS and at the Minneapolis VA.
Pestka has seen the LHS process lead to clear improvements in care. At the VA, one initiative tested having pharmacists reach out to patients with chronic kidney disease who were candidates for a beneficial medication, to see if it was more effective than leaving the decision to the primary care team.
“We’ve been doing it for a little over a year now and have shown that this proactive pharmacist outreach is more impactful,” Pestka says. Thanks to this data, the program has since received approval to be expanded to the regional Veterans Integrated Service Network.
Dr. Steven Fu, associate chief of staff for research at the Minneapolis VA, says the VA is particularly conducive to this kind of research because it has made investing in LHS infrastructure a priority. “That’s how we’re going to be a learning organization to improve the care we provide for our veterans,” he says.
Training investigators through MN-LHS will continue to democratize LHS tools and approaches. “We want to create a community of learning with these new scholars,” Beebe says. “By training scholars who go back to their home division or department and keep changing hearts and minds. We want to change how research is done.”
