J Eval Clin Pract. 2026 Sep;32(6):
e70605
RATIONALE: Evidence-Based Medicine (EBM) has strengthened clinical decision-making, but evidence alone cannot ensure that care is delivered safely, consistently, or in a manner that produces outcomes meaningful to patients. Patient safety, Quality Improvement (QI), Learning Health Systems (LHS), and Value-Based Healthcare (VBHC) have emerged to address these limitations. Understanding their relationships is important for healthcare systems seeking improvement and patient-centred care.
AIMS AND OBJECTIVES: To examine the historical development and conceptual relationships among EBM, patient safety, QI, LHS, and VBHC, and to propose an integrated framework for understanding their complementary roles in healthcare quality.
METHOD: A narrative review was conducted using PubMed as a database, supplemented by reference-list searching. Literature published from approximately 1990 to June 2026 was considered. Searches combined terms related to EBM, patient safety, QI, LHS, VBHC, implementation science, systems thinking, shared decision-making, quality of care, and healthcare transformation. Landmark publications, conceptual papers, guidelines, consensus statements, systematic reviews, and original studies were narratively synthesized.
RESULTS: The review identifies a Five-Stage Evolution Framework: EBM establishes what works; patient safety addresses how effective care can be delivered safely; QI enables reliable and continuous improvement; LHS creates feedback loops that allow healthcare systems to learn from routine clinical practice; and VBHC evaluates whether these efforts generate outcomes that matter to patients relative to the resources required. These paradigms are complementary rather than competing approaches. Their integration also requires systems thinking, data literacy, interprofessional collaboration, shared decision-making, and attention to patient values and equity. Challenges include the evidence-to-practice gap, organizational barriers, data quality, algorithmic bias, privacy, and the difficulty of measuring individualized value.
CONCLUSION: Modern healthcare should move beyond isolated quality initiatives toward an integrated system that generates evidence, delivers care safely, continuously learns and improves, and creates meaningful value for patients. The proposed framework is conceptual and requires empirical evaluation.
Keywords: Evidence‐Based Medicine; Learning Health Systems; Quality Improvement; Value‐Based HeaLthcare; clinical decision‐making; evidence‐based safety; healthcare transformation; medical education; patient safety; systems thinking