C. Joseph McCannon, IHIBrian S. Mittman, VA

Wynne E. Norton, UAB

Denise Dougherty, AHRQMichael Harrison, AHRQ

September 29th, 2010AHRQ Annual Research Meeting

AHRQ #R13HS019422

Taking Best Practices to Scale:Spreading Effective Healthcare

Practices & Programs

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Objectives

Achieving large-scale implementation requires a new set of research, policy, and practice efforts to understand and address these challenges and facilitate scale-up and spread. This session will (1) describe a series of activities, including a state-of-the-art conference held in July, that the presenters launched to stimulate greater interest and activity in scale-up and spread and (2) engage session attendees in generating ideas for additional activities needed to accelerate scale-up and spread of effective health programs throughout the United States and abroad.

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Overview

1. Introduction & Initial Activities

2. Overview of Conference

3. Example of Working Group

4. Deliverables & Post-conference Activities

5. Comments from AHRQ

6. Structured Discussion

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Introduction & Initial Activities

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Definition of Scale-up/Spread

“Deliberate efforts to increase the impact of health service

innovations successfully tested in pilot or experimental

projects so as to benefit more people and to foster policy

and program development on a lasting basis” --Simmons, Fajans, Ghiron, 2007

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Why Scale-up/Spread Now? Portfolio of Effective Health Innovations

Demonstrated efficacy and/or effectiveness Variety of settings, populations, and behaviors Guidelines, initiatives, simple and complex behavioral

interventions, etc.

Examples AHRQ Health Care Innovations Exchange National Registry of Evidence-based Programs & Practices Cancer Control P.L.A.N.E.T. National Guideline Clearinghouse

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Why Scale-up/Spread Now?Effective D/I Strategies

Increasing emphasis on D/I research

Increasing identification of effective or promising D/I strategies

Examples Technical Assistance (Hamdallah et al., 2006)

Organizational change models (Glisson & Schoenwald, 2005)

Models, theories, and frameworks (see Glasgow et al., 1999; Wandersman et al., 2008)

Reviews (see Bero et al., 1998; Grimshaw et al., 2006; Grol & Grimshaw, 2003)

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Why Scale-up/Spread Now? Need to Plan Ahead

Scale-up rarely happens automatically Scaling-up requires significant preparation and planning

Human and financial resources Political and policy support Community, organization, and agency collaboration

and buy-in State, regional, and/or national coordination

Issues faced during small-scale studies or pilots are different—and typically less complex—than those faced in large-scale trials or initiatives

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Increasing Focus on Scale-up/Spread Research

Cluster RCTs and PCTs Embedded research, mixed methods Frameworks, lessons learned, reviews

Case Studies Scaling up health service delivery: from pilot innovations to policies

and programs (Simmons, Fajans, & Ghiron, 2007)

Best Practices in Scaling-up (JSI, 2006)

Case Studies in Global Health: Millions Saved (Levine, 2007)

Meetings & Organizations ExpandNet/WHO USAID: Research and Evaluation Methods for Scaling-up Evidence-

based Interventions

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Initial Scale-up/Spread Activities

Think tank, NIH D&I Conference, January 2009 Presentations from NIH, Kaiser Permanente, AHRQ, RWJF, VA,

CDC, and UCONN and discussion with session attendees

Working dinner meeting, January 2009 30 stakeholder representatives from AHRQ, Commonwealth

Fund, CMS, HRSA, IHI, NIH, Harvard, RWJF, John A. Hartford Foundation, Kaiser Permanente, SAMHSA, VA, and the Universities of Michigan, Connecticut, Washington (St. Louis and Seattle)

What action is needed by key stakeholder groups to facilitate scale-up/spread?

Preliminary recommendations for promoting scale-up/spread

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Initial Scale-up/Spread Activities Health Funders Bending the Curve: Accelerating the Journey

from Evidence to Adoption, Donaghue Foundation & RWJF, June 2009

Discuss opportunities and challenges with adoption of research findings so funds can have greatest impact

Attendees included AHRQ, CA HealthCare Foundation, Commonwealth Fund, Grantmakers in Health, VA, Kellogg Foundation, John A. Hartford Foundation

Commissioned Study, 2009-2010 Funded by Donaghue Foundation Semi-structured interviews with 10 exemplary programs Barriers, facilitators, and initial recommendations for scaling-up

health promotion/disease prevention interventions

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Next Steps

Need for larger, more comprehensive meeting on scale-up/spread

Include researchers, practitioners and policymakers

Public health and health care

State-of-the-Art conference…

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Scale-up/Spread Conference

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A Conference to Advance the Science & Practice of Scale-up/Spread of Effective Health Programs

July 6-8th, 2010 in Washington, D.C.

Organizers: Joe McCannon (IHI), Brian Mittman (VA), and Wynne Norton (UAB)

Funders: AHRQ, Commonwealth Fund, VA, Donaghue Foundation, and John A. Hartford Foundation

Planning Committee Members: IHI, NIMH, VA, CMS, Karolinska, Gates Foundation, AHRQ, Commonwealth Fund, URC, and Univ. Wisconsin

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Attendees IHI UAB VA RWJF AHRQ CMS Gates Foundation Kaiser Permanente CDC U.S. Dept of Education NIMH CIHR

Stanford USCF UNC Johns Hopkins Harvard Yale Georgetown USAID/URC AHA (HRET) Karolinska Institute ExpandNet Blue Cross Blue Shield John A. Harford Foundation Health Partners Donaghue Foundation

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Conference Aims1. To review existing knowledge and current practices related to the scale-up

and spread of effective practice in health care and public health;

2. To identify key challenges and gaps in current research, policy, and practice related to scale-up and spread in health care and public health;

3. To develop and disseminate a detailed agenda outlining critical research, policy, and practice initiatives on these topics for the next five to seven years; and

4. To launch specific activities to operationalize this agenda, creating a plan of action to prioritize research, policy, and practice activity and initiating powerful demonstrations of regional, national, and international scale-up in health care and public health.

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Conference Format Modeled after VA State-of-the-Art meetings Brief introduction and background Small working groups, product-oriented Evening session speakers

Huggy Rao (Stanford) Nancy Dixon (GW) Rashad Massoud (URC) Russ Glasgow (Kaiser) Chris Goeschel (Johns Hopkins) Anne-Marie Audet (Commonwealth)

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Conference Content

General meeting overview, logistics, worksheets Background papers and case studies Working bibliography Database of research and practice activities

Commissioned papers Health care (Perla et al., IHI) Public health (Edwards, CIHR) International (Øvretveit , Karolinska) General framework (McCannon, IHI)

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Working Groups

Working Group Charge: Envision the ideal system for scale-up and spread Identify gaps between current state and future state Make detailed recommendations for action

Working Group Chairs: Health Care Research: Denise Dougherty, AHRQ Policy: Maulik Joshi, HRET/AHA Public Health Research: Todd Molfenter, Univ. Wisconsin Health Care Practice: Marie Schall, IHI Public Health Practice: Jürgen Unützer, Univ. Washington

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Recommendations

1. Create more thoughtful incentives for scale-up/spread (e.g., funding, recognition, career advancement)

2. Stimulate donor-researcher-funder coordination in order to coordinate goals, priorities and activities

3. Enhance “pull” systems of change to complement “push” efforts

4. Develop environments for learning and sharing on scale-up Knowledge exchanges, webinars, curricula

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Recommendations

5. Develop tools and resources on executing scale-up and spread How-to guides (what, when, and how to spread for

different types of interventions) Case studies Taxonomies Technologies

6. Develop and catalogue expanded research methods and improved data collection systems

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Example of Conference Working Group

Health Care Research Working GroupChair: Denise Dougherty, AHRQ

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Deliverables & Post-Conference Activities

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Short-Term Deliverables

VA-sponsored scale-up/spread webinar series Peer-reviewed publications Detailed agenda for research and practice, including

“performance challenges” (meeting proceedings) Update and expand scale-up/spread databases and

resource listings (e.g., tools, literature, projects/programs)

Presentations at targeted meetings Interactive Scale-up/Spread Listserv

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Potential Longer-Term Actions

Active contribution to major scale-up projects Advocacy: Active connection to donors,

policymakers, etc. Durable learning network: Case studies, information

exchanges, community of practice Annual gathering Course development Tool development

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Comments from AHRQ Attendees

Michael Harrison, PhDDenise Dougherty, PhD

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Thank you!

Scale-up/Spread Blog: http://www.ihiscaleupconference10.blogspot.com

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