[State of knowledge: considerations relating to the adoption of the learning health-care system approach, the reflective approach, and audit and feedback in the context of managing chronic diseases and multimorbid states]

Moqadem K
Record ID 32018000946
Original Title: État des connaissances: systèmes apprenants et maladies chroniques
Authors' objectives: This report, produced by the Institut national d’excellence en santé et en services sociaux (INESSS), presents a state of knowledge on three approaches aimed at improving health-care practices. More specifically, this state of knowledge brings together the results from a selection of recent publications in the scientific and grey literature on the following three approaches: 1) the learning health-care system approach, 2) the reflective approach, and 3) audit and feedback (AF). An examination of these three approaches was prompted by a need that falls within a broader endeavour that the Ministère de la Santé et des Services sociaux (MSSS) assigned to INESSS: the CoMPAS project.
Authors' results and conclusions: RESULTS: It was found that the learning health-care system approach, the reflective approach and AF have the same overall objective, which is to improve the quality of health care, both for the patient and the health-care system, especially in the context of managing chronic diseases and multimorbid states at the primary care level. Although they operate at different levels (micro, meso and macro), they exhibit potentially synergistic complementarity in terms of implementation. More specifically, the literature examined shows that the cornerstone of these three approaches is speedy access and the possibility of analyzing locally collected data, combined, in the best of cases, with national data. This key element, which is facilitated by advances in communication and analytical technologies, is no longer a subject of debate. It is a prerequisite for improving the praxis of clinical and organizational practices, for the patient, the service user and the system as a whole. However, many factors for success or failure have caught the attention of the different countries that have opted for one of these three approaches. In short, technological, cultural, organizational, human and training-related factors continue to have a significant impact on the success of measures for improving practices in a complex system, as is the case with the three approaches examined here. In addition, there are organizational factors, such as a better fit by the network’s components and activities and putting levers and tools in place that meet the needs of clinicians and users of health services. CONCLUSIONS: This state of knowledge describes these aspects by way of lessons learned and possible courses of action taken from the examination of the literature, and a logical framework that integrates the three approaches in order to facilitate their implementation.
Authors' methods: The study selection criteria were as follows: 1) the description of the feasibility or implementation of each of the three approaches of interest; 2) the analysis of the results obtained in such a context; or 3) the analysis of any of the three approaches with regard to the organization of health services or the management of chronic diseases. Thus, the contribution of the three approaches in question – considered innovative by other countries and bodies – is examined from the perspective of managing the most prevalent chronic diseases, namely, diabetes, chronic respiratory conditions (CRCs), mental illnesses, cardiovascular diseases, and multimorbid states.
Project Status: Completed
Year Published: 2019
Requestor: Minister of Health
English language abstract: An English language summary is available
Publication Type: Other
Country: Canada
Province: Quebec
MeSH Terms
  • Chronic Disease
  • Primary Health Care
  • Pulmonary Disease, Chronic Obstructive
  • Diabetes Mellitus
  • Diabetes Mellitus, Type 2
  • Mental Disorders
  • Cardiovascular Diseases
  • Critical Pathways
  • Disease Management
  • Practice Guidelines as Topic
  • Multimorbidity
  • Evidence-Based Practice
  • Community Health Services
  • Chronic diseases
  • Health care system
Organisation Name: Institut national d'excellence en sante et en services sociaux
Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369
Contact Name: demande@inesss.qc.ca
Contact Email: demande@inesss.qc.ca
Copyright: Gouvernement du Québec
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.