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Research Projects

Overview

Each project partner of the Swiss Learning Health System (SLHS) is working on a specific research project that will lead to Policy Briefs and Stakeholder Dialogues. Research projects have been selected by means of a prioritization process taking into account their scientific and policy relevance. The projects underline the interdisciplinarity of health sciences and health systems research by including disciplines such as medical science, economics, communication, law, public health and theology.

Research Clusters

The Swiss Learning Health System (SLHS) currently covers seven research clusters that underline the interdisciplinary nature of health sciences and health systems research. The clusters are meant as a means to facilitate exchange and draw from the expertise of different research centers and institutes involved in the SLHS.

Innovation in Service Delivery

Technological progress in the health sector over the past century has contributed to tremendous improvements in population health. Advances in information technologies and the digitization of medical information will further add to this development. Nonetheless, only little innovation has occurred in the way that health services are delivered.

In the light of the increasing complexity of cases and treatments, new approaches are needed in the provision of health care and in the management of complex patients. Actively involving patients in the decision-making process will not only support the development of integrated care solutions but will also improve health outcomes and quality of services. From a health systems perspective, inter-sectoral collaboration and interprofessionality are essential elements to ensure that people receive the health care they need, when and where they need it. The SLHS fosters research that puts people into the center of service provision, to optimize and scale up community services in Switzerland, and to ensure the delivery of appropriate care, including the implementation of “choosing wisely” strategies.

Involved partner institutions:

Strengthening Rehabilitation

In response to the emerging needs of an aging population and the increasing prevalence of chronic health conditions, the SLHS coordinates a series of research projects that seek to strengthen the provision of rehabilitation services in Switzerland.

The Swiss health care system is currently challenged to rethink how to best provide rehabilitation services for its population in interaction with curative and supportive services, and how to develop the respective capacities across the six building blocks of the health system as defined by the WHO. This includes the organization of effective and efficient rehabilitation services, the availability of a suitably trained workforce, novel solutions in rehabilitation financing, and the mainstreaming of functioning information in health information systems.

Involved partner institutions:

Health Promotion and Prevention

Given the growing prevalence of chronic health conditions, health promotion and disease prevention are effective and basic ways to prevent, reduce or mitigate the burden of disease and promote well-being. This involves but is not limited to the promotion of behavioral determinants, such as physical activity, healthy diet, the reduction of excessive alcohol consumption, substance use, and media consumption.

Over the life course, developing health literacy and having access to evidence-based health information and health services are critical steps for taking informed decisions and coping with societal, environmental and personal challenges and chronic conditions. Of particular relevance is the health system perspective with its socio-economic, environmental and contextual factors as it is able to benefit more broadly the health of populations. Factors of mobility and mobile populations increasingly enter the research focus and request an integrative view of different sectors, including health. Research by the partner institutions of the SLHS helps to better understand the mechanisms associated with health systems, (risky) health behaviors, the determinants of screening and immunization decisions, and it supports the development of new and integrated approaches and incentives to promoting health and preventing disease. This cluster shares the engagement for coping with inequalities, ethical, economic and policy aspects collaboratively with other research clusters.

Involved partner institutions:

Equality of Opportunity

The Swiss health system is rated among the best in the world. The high quality of care, guaranteed access to necessary health services, and coverage through statutory health insurance are considered major strengths of the system. However, there also exist important inequalities throughout the health system, across different dimensions and population groups.

Some of the inequalities may not be avoidable, for example if linked to genetic variations. Other inequalities may be attributable to avoidable factors, in which case they become inequities. Examples include social and economic conditions that may influence health status and health services access, and the exposure to environmental risk factors. If there are avoidable or remediable differences in health, this calls for action and the Swiss government has responded to this by defining equality of opportunity as one of the four priority areas on the health policy agenda. Researchers in the SLHS seek to expand the evidence base on the origins of health inequalities in Switzerland and contribute to the development of new programs and interventions to reduce health inequities.

Involved partner institutions:

Health Systems Guidance and Intelligence

Clinical decisions are ideally based on guidelines informed by the best available evidence. Health systems decisions, that is decisions that involve specific arrangements of health systems domains such as the health workforce, financing mechanisms, or leadership and governance, are equally important and may have direct and/or indirect consequences for society and individuals’ health.

However, developing recommendations and guidelines on a systems level poses distinctive challenges. For example, health systems evidence is often context‐specific and more prone to bias. Even if good evidence exists, the uptake of health system recommendations heavily depends on the policy process, political economy, and decision culture. The implementation of effective health systems guidance requires transparent and systematic methods and suitable information systems to inform decision-making. The SLHS coordinates a number of projects that develop novel tools for health systems guidance, applying the principles of systems thinking, and new methodology, technology and standards supporting health intelligence.

Involved partner institutions:

Re-thinking Economic Incentives

The health sector is one of the fastest growing sectors in Switzerland, outpacing the growth of the overall economy and posing an increasing burden on public and private spending. Fragmentation of the health system at both the financing and delivery level increasingly leads to wasted resources and suboptimal outcomes. There is also growing realization that more care and/or expensive care does not always mean better care.

Systematically and transparently evaluating the costs and benefits of interventions, policies and programs, and providing suitable incentives to reduce or eliminate economic inefficiencies in the health system are a key to ensuring affordability of care. This inolves but is not limited to the financing of inpatient and outpatient care, the design of health insurance and premium subsidies for low-income households, an the organization and coordination of the different pillars of the social security system. Research in the SLHS seeks to contribute to a better understanding of the sources of inefficiencies and to inform policy makers about suitable reforms to reduce inefficiencies and ultimately create more value for the money.

Involved partner institutions:

Enhancing the legal and ethical framework

Modern health systems are complex, adaptive systems. The functioning of such systems crucially relies on a legal framework that can flexibly respond to emerging needs, learn and constantly improve itself in light of ethical considerations.

There are still many areas within the Swiss health system that are not or only insufficiently regulated and which require more attention from policy makers and researchers alike. Areas include, for example, human subjects research and the protection of personal (health) data, regulations of pharmaceutical products, gene technology and genetic testing, or legal aspects related to end of life decisions. Equally relevant are guidelines for ethical decision-making, from the perspective of individuals, organizations, governments and the health system as a whole. This includes aspects of patient care, such as counselling, psychotherapy or pastoral care, responsible organizations as well as fair access to health services and just resource allocations. The SLHS supports a variety of research activities that seek to enhance the legal and ethical framework in Switzerland on all levels of the health system.

Involved partner institutions:

Publications

The Swiss Learning Health System

The "Schweizerische Ärztezeitung" (Swiss Medical Journal) published an article, authored by Prof. Stefan Boes and his co-authors, on the Swiss Learning Health System and its aims. (Available in German only.)

Stakeholder Dialogue as Deliberation for Decision Making

The American Journal of Physical Medicine & Rehabilitation published an article on Stakeholder Dialogue as Deliberation for Decision Making in Health Policy and Systems, authored by Prof. Sara Rubinelli and Per von Groote.

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Swiss Learning Health System
University of Lucerne
Department of Health Sciences and Health Policy
Frohburgstrasse 3
6002 Lucerne
Switzerland
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