The Learning Health System Competency Appraisal Inventory (LHS-CAI): A novel tool for assessing LHS-focused education needs

Alexandra J. Greenberg-Worisek, Nathan D. Shippee, Cory Schaffhausen, Kelli Johnson, Nilay D. Shah, Mark Linzer, Timothy Beebe, Felicity Enders

Research output: Contribution to journalComment/debatepeer-review

8 Scopus citations


There is increasing interest in health care organizations functioning as learning health systems (LHSs) to improve the quality and efficiency of health care delivery while generating new knowledge. Individuals must be trained in associated concepts and competencies and subsequently positioned (or embedded) within the delivery system for maximum effect as they perform their scholarship. Potential researchers within LHSs come from many different training backgrounds; therefore, each LHS scholar requires a goal-directed plan tailored to his or her needs. There are few tools available to guide development, training, or evaluation of individuals interested in becoming leaders of research in LHSs. In this paper, we present a newly developed tool for guiding the training of such researchers, the Learning Health Systems Competency Appraisal Inventory (LHS-CAI). The LHS-CAI is modeled after the Clinical Research Appraisal Index (CRAI) used within Clinical and Translational Science Award sites across the United States. The LHS-CAI is a tool for trainees at all levels to use with their mentors in an interactive manner. The tool can then identify areas in which more training is needed and at what level to ensure success as a researcher within LHSs. We further modified the CRAI format to better leverage the LHS-CAI as a key part of an LHS scholar's individual development plan. To implement the LHS-CAI, we have identified key points within the Minnesota Learning Health System Mentored Career Development Program (MN-LHS) at which assessment of expertise for each competency would be useful to LHS scholars, mentors, and program leaders. Scholars in this program come from various clinical and academic backgrounds but are all targeting their career trajectories toward leading embedded LHS research. They will reevaluate their expertise upon completion of the program, with comparison to baseline serving as a key program evaluation tool. The LHS-CAI is currently being implemented with the first cohort of scholars in the MN-LHS program.

Original languageEnglish (US)
Article numbere10218
JournalLearning Health Systems
Issue number2
StatePublished - Apr 2021

Bibliographical note

Funding Information:
In the 18 years since the National Academy of Medicine's report, Crossing the Quality Chasm, there has been increasing emphasis on improving care delivery by ensuring that health care delivery research findings are quickly and safely implemented into clinical practice.1 Specifically, the report puts forth the learning health system (LHS) as a framework or tool to achieve this goal. LHSs are defined as health care provider, payer, or policy systems ?in which science, informatics, incentives, and culture are aligned for continuous improvement and innovation, with best practices seamlessly embedded in the delivery process and new knowledge captured as an integral by-product of the delivery experience.?1 This process entails integration of internal data and external evidence to build knowledge, applying knowledge to improve practice, and using data thereby generated to continue the cycle.2,3 In contrast to static or haphazardly evolving organizations, LHSs intentionally generate, curate, adopt, disseminate, and manage evidence to improve care and outcomes.

Publisher Copyright:
© 2020 The Authors. Learning Health Systems published by Wiley Periodicals, Inc. on behalf of the University of Michigan.


  • competency-based learning
  • learning health systems
  • research education


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