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A learning health system, or LHS, is a health system that constantly looks for new ways to improve patient care. At an LHS, doctors and other hospital staff use learning activities to improve care, put what they've learned into practice, and share findings with other hospitals. Activities may include doing studies that compare treatments to see which one works better for which patients.

Governance refers to the way LHSs oversee learning activities. Governance includes people, committees, and policies that regulate learning activities. Including patients as partners in governance helps make sure learning activities address what's important to patients and protect patients' rights and interests. But LHSs don't always include patients in governance.

In this study, the research team wanted to learn how LHSs include patient partners in governance. The team interviewed patients and health system leaders to answer this question.

Patient-centered outcomes research, or PCOR, is a type of research that focuses on patient values and needs. PCOR includes patients in many parts of the research process, including helping to plan and conduct the study. Institutional Review Boards, or IRBs, oversee research studies to make sure patients participating in a study are protected from harm. But current IRB guidance may not address ethical issues that arise when patients are involved in other roles.

In this study, the research team created recommendations to guide IRB oversight of PCOR studies.

Sometimes a study can get better results using data from different sites. In these cases, researchers may want to share patient data, including personal and private information such as dates of birth and addresses. However, researchers may not want to share data across sites because of worries about patient privacy. Some statistical methods can change patients' sensitive individual data into summary data that hides individuals' personal information. These privacy-protecting methods, or PPMs, make it safe to share data across sites. But researchers don't know if PPMs produce accurate results.

In this study, the research team compared combinations of PPMs with methods that use patients' individual data.

To access the methods, software, and R package, please visit the distributed GitHub.

For people with serious chronic conditions, healthcare that defaults to all available treatments without considering patient preferences risks harms that may exceed benefits. Advance care planning (ACP) has the potential to align healthcare with what is important to patients and maximize quality of life. While primary care is where most people receive most of their care, engaging patients in ACP is not routine in primary care given competing demands and limited resources. Primary care clinicians, patients, and families agree that it is preferred to make plans before there is a medical crisis. The research team's goal was to make ACP routine in primary care and to "move it upstream" so that it included improving the quality of the last years of life as well as respecting wishes for end of life care.

This study included a comparative effectiveness trial of team-based versus individual clinician-focused ACP in primary care practices. The research team adapted Ariadne Labs' Serious Illness Care Program (SICP) and aimed to determine if a team approach produces better patient outcomes and explore factors influencing implementation of ACP across practices.

Seven practice-based research networks (PBRNs) in the United States and Canada randomized their primary care practices to team-based or individual clinician-focused versions of SICP. Team members and clinicians completed training, and implementation was supported through practice facilitation. Consented patient participants completed a baseline survey after initial conversations and follow-up surveys at 6 and 12 months later. Forty practices (21 team, 19 clinician) completed training and referred patients to the study. Half of the practices were rural, 80 percent were family medicine, and 33 percent were medical residency training sites. 535 healthcare staff completed training. Both arms trained primary care providers; the team arm also trained nurses, medical assistants, and other roles. 1,321 patients and care partners were referred; and 917 consented and were enrolled (455 from team practices, 462 from clinician). Data from 802 patients were included in the primary analyses. Qualitative implementation data was collected during practice facilitation and from practice interviews.

This collection includes quantitative data collected from primary care practices (DS1) and team members and clinicians (DS2) from study sites located in the United States.

Researchers researched and analyzed 280 cases of serious wrongdoing in medicine involving three kinds of violations: improper prescribing of controlled substances (IPCS), sexual abuse of patients (SAP), and unnecessary invasive procedures (UIP). They focused on these three types of wrongdoing because each is traumatizing to patients, causing physical and emotional harm, financial loss, and sometimes death. They are often the cause of major disciplinary actions by medical boards.

The methodological approach involved identifying potential cases of serious wrongdoing through systematic literature reviews of court records, medical boards reports, newspaper articles, and online materials for each case. Using a detailed codebook, researchers performed descriptive coding of the literature and used a criminal law framework to identify the salient individual and environmental factors that predicted motive, means, and opportunity (MMO) for each case. Within each of the three types of wrongdoing, they identified typologies of cases using qualitative analysis.

Finally, researchers held a working group meeting with experts to reach a consensus on how findings can inform medical education, policies, and oversight practices to reduce the rates and the duration of serious wrongdoing.

This collection includes 10 focus group transcripts conducted with participants in Geisinger Health System's MyCode Community Health Initiative, an unselected biobank. Geisinger is a large, integrated health system in central and northeast Pennsylvania. Focus groups were conducted at clinics throughout the system's catchment area. Focus group participants were asked to discuss their views of the appropriateness of using their clinical and genomic data to study several phenotypes, including social and behavioral phenotypes.

Legislative support for physician aid-in-dying (PAD) in the US has risen steadily in recent years. In May 2013, Vermont became the fourth state to legalize PAD, through the "Patient Choice and Control at End of Life" Act (Act 39). The law authorized physicians to prescribe a lethal dose of medication to a mentally competent, terminally ill, adult patient for the purpose of ending the patient's life. With ongoing legislative activities in many other states, these laws are expected to spread nationally. This shifting legislative climate raises questions about how societies respond to changes in the sociocultural and biopolitical organization of death. While social scientists have examined the social and political forces that shape 'right to die' movements and counter-movements, sanctioning the right to die is only the first step in institutionalizing PAD as a new cultural and medical practice. What happens once these rights are legally authorized?

The purpose of this study was to learn about how people in Vermont have been affected by Act 39. This 2-year ethnographic study (July 2016-June 2018) addressed the following overarching research questions:

1. How do ordinary people understand, access, experience, and contest the 'right to die' through PAD once it has been granted?
2. How do healthcare providers and policy stakeholders accommodate or resist PAD as a new end-of-life practice?
3. How does PAD affect the cultural landscape of care for the dying in the US?

Due to the recent enactment of Act 39, and Vermont's small size and the geographic proximity of key institutions, Vermont offered an ideal setting to explore these questions and document emergent responses to a new socio-legal phenomenon across multiple sites. By tracing the social life of Act 39 from the Vermont State House to the institutions, experts, and ordinary people responsible for managing death, this study yielded valuable information about the broad sociocultural consequences of legalizing PAD, including unintended consequences, that will be relevant to US policymakers, clinicians, patients, and families.

This collection includes semi-structured interviews with seriously ill Vermont patients, survivors of people who have used Act 39, healthcare providers and administrators, activists, and legislators, as well as participant observation in settings in which PAD is likely to be discussed. Participants were asked about their personal and professional backgrounds, attitudes on death and the legalization of PAD, understandings of the physician's role and responsibilities regarding end-of-life care, and interactions between healthcare providers, patients, and caregivers about PAD. The age, gender, and race of the participants are also provided.