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Background

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Modern medicine has brought remarkable advances. The application of scientific rigour to the art of healing has resulted in a better understanding of diseases, a proliferation of new treatments and has given hope to many. In large areas of medicine however, the complexity of the health condition and the heterogeneity of patient characteristics means that experimental studies such as randomised controlled trials are too costly and often too difficult to conduct with the necessary rigour.
 
Furthermore, the proliferation of new studies means that it is impossible for a practitioner to keep abreast of the latest developments in all but the very narrowest of fields. Even evidence based medicine approaches such as the development of systematic review methodology can only partially address this problem because of the volume and complexity of studies.  The net result is that much medical practice still relies on gut feeling and all of the associated biases.
 
In addition to the rapid expansion in the evidence base, health care faces other challenges from growing and ageing populations, rising levels of chronic illness, constrained budgets, health inequalities, and the proliferation of high cost interventions and technologies that bring diminishing returns in terms of the health improvements that they provide. Furthermore, variations in practice that cannot be justified are increasingly seen as unacceptable.
 
This section contains information about the concept of the learning healthcare system and why it is needed.  We also describe the methodology for this research. 

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