Final Research Report

View this project's final research report.

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:

  • The reviewers questioned the use of the term learning healthcare system to describe the systems and organizations studied in this project, noting that this terminology does not convey an interest in whole-person health as readily as the term learning health system (LHS). The researchers agreed that the second term was more appropriate to the goals of their study and revised the report accordingly.
  • The reviewers were concerned that the report was too focused on the distinction between research and quality improvement, questioning whether there was truly confusion about the differences between research and quality improvement concepts and methods. The researchers responded that the difference between research and quality improvement has been a major theme in the ethics literature on LHSs, and that this difference was an important motivator for the present study. In addition, the researchers explained that their qualitative interviews addressed the differences between research and quality improvement, asking interviewees to describe how their institutions navigated the distinctions.
  • Reviewers questioned how the researchers approached the issue of practice and standardization across an LHS. The reviewers explained that in particularly large and diverse health systems, standardization of health care approaches and procedures would be inappropriate as this would not account for the different needs of a diverse population. The researchers noted that the theme of standardization emerged in their qualitative interviews as a way to gauge system change and quality improvement. They revised the report to better address reviewers’ concerns about standardization across diverse systems.
  • One reviewer questioned how the researchers identified their sample of LHSs, noting that the inclusion criteria or justification for identifying certain systems as LHSs were not clear from the report and that this was a limitation of the research.  The researchers acknowledged this limitation and added detail to the report regarding the criteria they used to select the LHSs they invited to participate in the study. 

Conflict of Interest Disclosures

Project Information

Steven Joffe, MD, MPH
University of Pennsylvania
Governance of Learning Activities in Learning Healthcare Systems

Key Dates

April 2016
January 2022

Study Registration Information


Has Results
Award Type
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: April 26, 2022