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Learning Cycles

Overview

Each partner institution of the Swiss Learning Health System (SLHS) is working on a specific topic that will lead to policy briefs and stakeholder dialogues. The listed topics have been selected by means of a prioritization process taking into account their scientific and policy relevance. The topics underline the interdisciplinarity of health sciences and health systems research by including disciplines such as medical science, economics, communication, law, public health and theology.

Evidence Synthesis (Policy Briefs & Rapid Response Synthesis)

A prerequisite for issue deliberation and learning cycles in the health system is the review of evidence that describes possible options to target the problems initially identified. The Swiss Learning Health System (SLHS) delivers two such evidence synthesis tools, a) policy briefs, which serve as a basis for stakeholder dialogues, and b) rapid response syntheses.

Policy Brief

Once an issue for a stakeholder dialogue has been identified, the next step is to prepare a policy brief. A policy brief is a document that describes the problem at stake by explaining the relevant contextual factors. It presents a number of evidence-based solutions to the problem, and for each possible solution it explains relevant aspects, including expected benefits and costs, and potential barriers and facilitators to the implementation. The policy brief is then distributed to the participants of the dialogue prior to the deliberation.

Rapid Response Synthesis

The landscape of the Swiss health system is constantly changing and gaps in services or supplies can occur rather spontaneously. Rapid response syntheses are means to respond meaningfully and quickly to current issues in the health system. They identify and synthesize the best course of action by examining current evidence and possible solutions. The rapid response synthesis also includes an implementation guide with issue specific implementation considerations, monitoring and evaluation guidance.

Stakeholder Dialogue

Stakeholder dialogues are structured communication processes that aim at supporting and engaging stakeholders to implement evidence-based solutions to a particular issue at hand. Based on a policy brief, a group of 6-20 stakeholders work collaboratively toward a common understanding of the problem and the best course of action. 

Dialogues are guided by a moderator, who oversees the deliberation, stimulates participants to confront their views and facilitates confrontation over differences of opinion.

Dialogues in general close by deciding first whether there is agreement over a course of action, or not. Second, if there is no agreement, whether i) there is need to reconvene for a second dialogue to foster agreement, or ii) more research is needed given a possible lack of evidence to agree on the best solution. When outcome i) occurs, the SLHS engages stakeholders in a structured negotiation to solve the differences of opinion. When outcome ii) occurs, the SLHS informs the research agenda of the academic partners to address the open issues.

Stakeholder dialogues are promising mechanisms to successfully inform policy makers about evidence-based actions to identified problems on any levels of health, including policy, service delivery or financing and health information collection. Further, they are mechanisms that support the identification of research topics that match the current needs of the health system and thus create a culture of shared responsibility.

A list of stakeholder dialogues conducted in the SLHS can be found under Topics.

Topics

Each partner institution of the SLHS is working on a specific topic that will lead to Policy Briefs and Stakeholder Dialogues. The listed topics have been selected by means of a prioritization process taking into account their scientific and policy relevance.

Rapid Response Reviews

In March 2020, the Swiss Learning Health System invited its partners to think and work on ways current research efforts in Switzerland and outside of the country can be supported and strengthened to address the international COVID-19 emergency. Thereupon, three Rapid Response Reviews on the following topics have been written:

Rapid Review Response 1:                                                                     Sectorial and managerial response of non-profit assistance and homecare services of public interest in Ticino facing the SARS-CoV-2 pandemic outbreak: a case study (Download PDF)
Rapid Review Response 2:    Strategic and organizational response of Ticino's hospital system facing the COVID-19 emergency: three case studies (Download PDF)
Rapid Review Response 3:                                                      Sectorial and managerial response of nursing homes in Ticino facing the SARS-CoV-2 pandemic outbreak: a case study (Download PDF)

Evidence use in health policymaking

Policymakers have to consider various factors and information types when making decisions about policies, health service management and delivery. Apart from research and data, stakeholder interests, public opinion, ideology, values, and emotions may essentially influence how policymakers think and decide. To increase the relevance of research in policymaking within Swiss health authorities, this policy brief discusses recommendations for effective interventions to build capacity for evidence-use and the implementation thereof.

Stakeholder(s): Representatives from public administration, observatories and registries, NGOs and education 
SLHS Lead: Swiss Centre of International Health, Swiss TPH
Policy Brief: Download PDF
Key Messages: Download PDF 
Stakeholder dialogue summary:        Download PDF 

 


Measuring over- and underuse in family medicine

In order to reduce overuse and underuse in the healthcare system, it is necessary to define appropriate care according to current knowledge and to measure it. However, measurement is hampered by inadequate political and structural frameworks, limited availability of electronic data and poor data quality. To improve the measurement of over- and underuse in Swiss family medicine, this policy brief recommends i) the development of a comprehensive digital strategy, ii) the strengthening of a data-based quality culture and iii) the support of bottom-up initiatives.

Stakeholder(s): Representatives from the practice, health insurances, physicians' network organisations, and education 
SLHS Lead: Institute for Familiy Medicine, University of Zurich 
Policy Brief: Download PDF (Currently only available in German)
Key Messages: Download PDF (Currently only available in German)
Stakeholder dialogue summary:        Download PDF (Currently only available in German)

PREMs in cancer care

Improving care and the experiences of care by providing high-quality care responding to people’s needs (i.e. patient-centered care), are important as it translates into more positive experiences of care, which in turn can translate into treatments working better and better health. Patient-centered care is especially important in cancer care, as cancer has a particular emotional, social and financial burden on patients and their families, in addition to the health burden. While information about the effectiveness of cancer care is available in Switzerland, reports from patients about cancer care are missing. To increase the patient-centeredness in cancer care, this policy brief recommends i) developing a position statement on the importance and value of patients’ experiences of cancer care and ii) collecting patients’ experiences of cancer care at the national level, by implementing a national survey or by integrating data collection in cantonal cancer registries.

Stakeholder(s): Representatives from cancer care, quality assessment, patients and physicians organizations, and education
SLHS Lead: Département Epidémiologie et Systèmes de Santé, Unisanté
Policy Brief:    Download PDF 
Key Messages: Download PDF 
Stakeholder dialogue summary:                               Download PDF 

International clinical guidelines for knee osteoarthritis management in Switzerland

International clinical guidelines for the conservative management of knee osteoarthritis (OA) recommend exercise, education, and weight control as first-line treatment for all people with knee OA. However, findings from various health care settings have identified an underuse of exercise and education. A recent survey among medical specialists in Switzerland identified an evidence-performance gap, implying that the strong evidence in favour of exercise is not being transferred into clinical practice. This policy brief describes the challenges facing the improvement of conservative disease management by presenting recommendations regarding i) tanslation of guideline recommendations into a specific exercise and education programme ii) facilitation of the systematic application of exercise through standardised treatment pathways and iii) promotion of the benefits of exercise in the long-term management of chronic diseases.

Stakeholder(s):

Representatives from research and practice

SLHS Lead: Institute of Physiotherapy, ZHAW (Zurich University of Applied Sciences)
Policy Brief: Download PDF
Key Messages: Download PDF
Stakeholder dialogue summary:

Download PDF (Currently only available in German)


Design principles of a central metadata repository as a key element of an integrated health information system

The Swiss Health System is a complex system with different groups of actors for which data is collected and analyzed using various methods, leading to a large heterogeneity and dispersion of available data. The specificities of a Swiss Health System favor a hybrid infrastructure to manage the heterogeneity and dispersion of Swiss health-related data. This policy brief shows the importance of a metadata management infrastructure to identify and describe health data resources and highlights several essential key elements for the design of a metadata repository and also raises important practical questions.

Stakeholder(s):

Representatives from the IT sector, policy, and health research

SLHS Lead: Information management institute, University of Neuchatel
Policy Brief: Download PDF
Key Messages: Download PDF
Stakeholder dialogue summary:

Download PDF


Discrimination in case of impotence

The Code of Law of the Roman Catholic Church contains an impediment to the marriage of impotence. It says that someone can only get married if the person can engage in sexual intercourse. To forbid marriage due to this reason poses discrimination for the people concerned because entering marriage is a fundamental and human right that cannot be exercised. This learning cycle meets the challenge to examine and eliminate the discrimination of people with a disability posed by the law of the Roman Catholic Church, by presenting information on i) the signing of the convention on the Rights of Persons with Disabilities by the Holy See with the consequence of a legislative adjustment, ii) the revision and discussion of the natural justice of the impediment to the marriage of impotence and iii) the discussion of the implementation/third-party effect of the fundamental rights.

Stakeholder(s): Canon law experts, lawyers, social workers
SLHS Lead: Center for Comparative Constitutional Law and Religion (ZRV), University of Lucerne
Policy Brief I: Download PDF (Currently only available in German)
Policy Brief II: Will follow soon 
Key Messages: Download PDF (Currently only available in German)
Summary of stakeholder dialogue(s): Download PDF (Currently only available in German)
Abstract:  Download PDF

Advanced practice nurses in general practice

For reasons such as non-standardized final competencies for Advanced Practice Nurses (APN) or the lack of role definitions, APNs are not sufficiently employed in general practitioners' (GP) practices in Switzerland. APNs are already taking over GPs' activities on their own responsibility, however these are performed in a "grey area" and are associated with many uncertainties. The aim is to leave this "grey area" and to promote the implementation of new care models with APNs in Swiss GP practices. To this end, this policy brief recommends (1.) clarifying and expanding the roles of APNs in primary care, as well as (2.) clarifying the training and legal framework for the employment of APNs (available only in german)

Stakeholder(s): Representatives from practice, education, health insurances and policy
SLHS Lead: Dipartimento economia aziendale, sanità e sociale, SUPSI and Institut für Hausarztmedizin & Community Care Luzern
Policy Brief: Download PDF Download PDF (Currently only available in German)
Key Messages Download PDF (Currently only available in German)
Stakeholder dialogue summary: Download PDF (Currently only available in German)

Strengthening Social Participation of Socially Disadvantaged Older Adults in Switzerland

Social isolation and loneliness in the elderly have a number of negative health consequences and are particularly harsh for the socially disadvantaged. Strengthening social participation of socially disadvantaged older people can contribute to reducing social isolation and loneliness and the associated health inequalities in this group. This learning cycle approaches the challenge of increasing social participation among the socially disadvantaged elderly by providing evidence-based insights on i) improved methods of outreach, ii) the inclusion of target groups in the planning and implementation of programs, and iii) improved program evaluation considering socially disadvantaged groups.

 Stakeholder(s):
Health Promotion Switzerland, Program Leaders
 SLHS lead: Department of Health Sciences and Medicine, University of Lucerne
 Policy brief: Download PDF
 Key Messages: Download PDF
 Summary of stakeholder dialogue: Download PDF (Currently only available in German)

Hospital Pastoral Care and Privacy

Greater awareness for the right for data protection leads to conflicts in the collaboration between hospitals and hospital pastors. This Policy Brief examines how the involvement of pastoral care in hospitals in the canton of Zurich can be better regulated in terms of legal requirements for patient data protection. In order to change the current situation, it is recommended (1.) to take the Palliative Care Concept as a model, (2.) to change the cantonal and federal legislation and (3.) to use the digital patient file to improve the holistic approach to treatment. 

Stakeholder(s):      

Representatives from practice, education, and legislation

SLHS lead:

Center for Comparative Constitutional Law and Religion, University of Lucerne
Policy brief:               

Download PDF (Currently only available in German)

Key Messages:             

Download PDF (Currently only available in German)

Stakeholder dialogue summary:          

Download PDF (Currently only available in German)

Additional Information:                                                                                                                        

Download PDF (Currently only available in German)
Handout:                    

This handout was developed in the context of the policy brief and stakeholder dialogue. It provides information on the right for hospital pastoral care and the access to patient data for the canton of Zurich. It is meant to serve as a basis for discussions and analysis in the hospital setting. (Currently only available in German)

Finding Evidence

Finding and synthesizing evidence, whether it is for Policy Briefs or Rapid Response Syntheses, is at the very core of the work that the Swiss Learning Health System (SLHS) is doing. Good starting points to look for relevant evidence are filtered resources that summarize and appraise evidence from different studies; these can include systematic reviews, evidence-based guidelines or critical appraised topics.

Cochrane Switzerland

Cochrane Switzerland

Cochrane Reviews are systematic reviews of primary research in human health care and health policy, and are internationally recognized as the highest standard in evidence-based health care resources. They investigate the effects of interventions for prevention, treatment, and rehabilitation. They also assess the accuracy of a diagnostic test for a given condition in a specific patient group and setting. Cochrane Reviews are peer reviewed and dynamic; they are adapted regularly to incorporate new research. In Switzerland, Cochrane reviews are freely available.


PubMed (MEDLINE)

PubMed (MEDLINE)

PubMed is a free search engine accessing primarily the MEDLINE database of references and abstracts on life sciences and biomedical topics. Find systematic reviews in PubMed by limiting your publication search to "Systematic Reviews" or adding it to your search string.


Epistemonikos

Epistemonikos

Epistemonikos is a multilingual database of evidence that links to systematic reviews, overview of reviews, primary studies and structured summaries. It is updated continually.

https://www.epistemonikos.org/


TRIP Database

TRIP Database

Trip is a clinical search engine designed to allow users to quickly and easily find and use high-quality research evidence to support their practice and/or care. As well as research evidence TRIP also allows clinicians to search across other content types including images, videos, patient information leaflets, educational courses and news.

https://www.tripdatabase.com/


McMaster Health Forum

McMaster Health Forum

The Canadian-based McMaster Health Forum provides research evidence about pressing issues in three main ways:

  1. evidence products, which are prepared in response to requests from health system leaders;
  2. sources of pre-appraised, synthesized research evidence about how to strengthen health systems (Health Systems Evidence) and social systems (Social Systems Evidence); and
  3. source of high-quality information about optimal aging for older adults, caregivers and professionals (McMaster Optimal Aging Portal).

https://www.mcmasterforum.org/find-evidence/overview

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University of Lucerne
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