Implementing a rapid-learning health system in early intervention services for psychosis: Qualitative evaluation of its feasibility and acceptability

Abstract Background: The early intervention service for psychosis (EIS) model is increasingly implemented. Yet, despite the development of guidelines and standards for EIS in several countries, heterogeneity persists in implementing the essential evidence-based practices. One remedy to these implementation challenges entails the use of a rapid-learning health system (RLHS), an approach that involves ongoing, systematic data collection, analysis and visualization using an electronic platform to design capacity-building activities and promote learning. In 2019, our team implemented SARPEP (Système Apprenant Rapide pour les Programmes de Premiers Épisodes Psychotiques), the first Canadian RLHS in EIS. This paper presents findings from the qualitative phase of the mixed-method study that evaluated the feasibility and acceptability of implementing a RLHS in EIS, which was the primary objective of the SARPEP research project. Methods: We conducted six focus groups, two with service users, and one each with family members, psychiatrists, managers, and team leaders to ensure multistakeholder perspectives. Participants (n=24) were asked to share their experiences with implementation of the RLHS over three years. Focus groups drew on the five dimensions of the RE-AIM framework, as did the quantitative study phase, while Lessard’s five dimensions for a learning health system guided development of the focus group questions. Results: Reach: invited members from all five stakeholder groups of the RLHS attended focus group meetings and shared their experiences: service users (n=5), family members (n=2), psychiatrists (n=4), managers (n=6), and team leaders (n=7). Effectiveness: all stakeholder groups confirmed the ability of the RLHS to improve the capacity of programs to collect data on core indicators and to promote evidence-based practices. Adoption: stakeholders acknowledged the value of selecting specific indicators for a RLHS and the need to improve technologies for data gathering. They also recognized challenges in deploying and integrating digital platforms into routine care. Implementation and maintenance: all stakeholders elaborated on how the RLHS enabled mutual learning, self-reflection, and shared practices among EIS in Québec. Conclusions: Stakeholders agreed that a RLHS can promote evidence-based care in EIS. The RLHS created a sense of belonging in a community aiming to learn and improve. Trial registration: N/A