Co-Creating a National Evidence Base for Implementing Learning Health Systems to Advance Integrated Care in Canada

Abstract

Background: Integrated care depends on the ability of health systems to continuously learn, adapt, and improve across organizational and sectoral boundaries. However, many systems still face persistent evidence-to-practice gaps that lead to fragmentation, inefficiency, and inequity. The Learning Health System (LHS) model provides a structure for integration by linking data, research, implementation, and evaluation within continuous learning cycles.   Across Canada, LHS activity is emerging but remains fragmented, with few resources to guide implementation in diverse contexts. This pan-Canadian project, led by the Learning Health Hub (LHH), aims to co-create a national evidence base and context-adapted guidebook to advance integrated, equity-focused LHSs as a foundation for system-wide learning and coordination.   Approach: Using an integrated knowledge translation approach, the project unites more than 40 researchers, clinicians, health system leaders, and patient, caregiver, and community (PCC) partners. Building on findings from the 2024 LHH symposium, three national learning priorities were identified: (1) partnering with PCC, (2) creating enabling environments where learning thrives, and (3) advancing approaches to LHS measurement and evaluation. Corresponding working groups are synthesizing international evidence, building consensus, and adapting best practices to the Canadian context.    To date, one jurisdictional scan (measurement and evaluation) is complete, and two evidence syntheses (partnering with PCC; enabling environments) are underway. PCC and equity leads are integrated throughout, ensuring that resulting guidance reflects diverse perspectives and supports implementation across community, primary, and acute care settings.   Results: Findings: from these two evidence syntheses reveal key enablers for integrated, learning-oriented systems. From the enabling environments review, cross-cutting conditions are emerging, including strong and distributed leadership, psychological safety, multi-level learning networks, data-enabled decision-making, and alignment between improvement and governance structures. The partnering with PCC review underscores the need for relational infrastructure—reciprocal partnerships, shared decision-making mechanisms, and long-term capacity for patient and community engagement. Collectively, these findings are informing the co-development of best-practice “bundles,” each providing actionable strategies for building learning-oriented integrated care systems. The bundles will be synthesized into a bilingual, open-access LHS Implementation Guidebook to be launched through a national knowledge exchange event in fall 2026.   Implications:This project represents Canada’s first coordinated effort to unify evidence and lived experience into practical, consensus-driven guidance for Learning Health Systems that operationalize integrated care. For international delegates, three lessons are key. First, partnership is foundational: meaningful co-design with patients and communities ensures integration reflects what matters most.    Second, integration requires infrastructure: data, leadership, and culture must align to connect learning across care settings. Third, equity must anchor improvement: learning cycles should close gaps in access and outcomes, not widen them. By translating theory into accessible, context-relevant guidance, this project offers a scalable model for building integrated, learning-oriented health systems worldwide.