Learning about learning health systems: Strengthening theory through continuous evaluation and improvement.

Introduction: Learning Health Systems (LHSs) offer potential for transforming healthcare through continuous learning and improvement. However, the current literature lacks a robust connection between theory and practice, limiting knowledge transferability across diverse healthcare environments. This article proposes a novel framework for integrating theorizing and continuous evaluation into LHSs, illustrated through the case of the Bipolar Action Network (The Network). Methods: We use a process of theorizing to structure how mid-range theory, program theory and LHS design, development and evaluation can support improved practices and theories. We use the Conceptual Framework for Value-Creating Learning Health Systems as our initial mid-range theory, and the Bipolar Action Network serves as an illustrative case. Results: The framework emphasizes continuous multi-level LHS theory refinement based on real-world data, ensuring that both the system and its theoretical underpinnings evolve in response to new insights and challenges by connecting four steps: (1) Selecting an initial mid-range theory, (2) Creating a program theory for a specific LHS, (3) Evaluating LHS performance using operational data, and (4) Using evaluation findings to refine both the LHS program and mid-range theory. Conclusions: This article contributes to the field by offering a practical methodology for bridging the gap between LHS theory and practice. By promoting ongoing theorizing and evaluation, our framework aims to both enhance the effectiveness and adaptability of LHSs, as well as inform theory development. Challenges remain, including resource intensity for data infrastructure and potential limitations in data quality or accessibility, which must be addressed to realize the full potential of LHSs as adaptive, theory-driven systems.