Scaling-up Evidence-based Health Promotion/Disease Prevention Interventions Wynne E. Norton, UAB Charles B. Collins, CDC Karen Glanz, UPenn Russ Glasgow, NCI Brian Mittman, CIPRS/VA Society of Behavioral Medicine April 29, 2011 Washington, D.C. 1

Overview 1. Introduction 2. Presentations
Scale-up practice (Collins)
Scale-up research (Glanz)
Scale-up progress and initiatives (Norton) 3. Perspectives on scale-up
NCI (Glasgow)
VA (Mittman)

4. Questions/Comments

2

Introduction to Scale-up

3

Scale-Up Defined


Variability in use of term (Mangham & Hanson, 2010)




“Objective or process of either increasing the coverage of health interventions or increasing the financial, human or capital resources that are required to expand coverage” (Mangham & Hanson, 2010)




“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 et al, 2007) 4

Conceptualizing Scale-Up

Source: Simmons R, Fajans P, Ghiron L, Eds. 2007. “Scaling up Health Service Delivery: From Pilot Innovations to Policies and Programmes.” World Health Organization.

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Key Issues in Scale-Up





Cost
Actual cost, cost-effectiveness, affordability Constraints





Equity and quality





Absorptive capacity, amenable vs. fixed Maximize coverage or target most in need?

Service delivery


Human resources, horizontal vs. vertical Mangham & Hanson, 2010; Oliveira-Cruz et al., 2004 6

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 SAMHSA National Registry of Evidence-based Programs & Practices Cancer Control P.L.A.N.E.T. National Guideline Clearinghouse CDC Diffusion of Effective Behavioral Interventions Canadian Best Practices Portal 7

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)

8

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


Scale-up rarely happens automatically (McCannon et al., 2007; Simmons & Shiffman, 2007)




Scaling-up requires significant preparation and planning
Human and financial resources
Political and policy support
Community, organization, and agency collaboration
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 9

Objectives


Present challenges and lessons learned in scaling-up health interventions from a practice perspective and from a research perspective




Discuss recent progress and an ongoing initiative to advance research, practice, and policy activity in scale-up




Perspectives on scale-up from key funding and delivery organizations (NCI and VA)




Open discussion and debate with panelists and attendees 10

Scale-up Practice: Challenges and Lessons Learned through CDC’s Diffusion of Effective Behavioral Interventions Project Charles B. Collins, PhD Team Leader, Science Application Team Capacity Building Branch National Center for HIV, STD, and TB Prevention CDC 11

Scale-up Research: Challenges and Lessons Learned from the Pool Cool Diffusion Trial Karen Glanz, PhD, MPH George A. Weiss University Professor Professor of Epidemiology and Nursing University of Pennsylvania

12

Recent Progress & Ongoing Activities in Scale-up Research, Practice, & Policy Wynne E. Norton, PhD Assistant Professor School of Public Health University of Alabama at Birmingham

13

Recent 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 What action is needed by key stakeholder groups to facilitate scale-up/spread? Preliminary recommendations for promoting scaleup/spread 14

Recent 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

15

Recent Scale-up/Spread Activities


Commissioned Study, 2009-2010
Funded by Donaghue Foundation
Semi-structured interviews with 10 exemplary programs
Barriers, facilitators, and initial recommendations for scaling-up 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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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 18

Conference Attendees








Donors Payers Practitioners Researchers Policymakers Media Industry

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Attendees













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


















Stanford UCSF 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 Aims 1.

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)

22

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) 23

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 24

6 Key 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 25

6 Key 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

26

Post-Conference Activities










VA-sponsored scale-up/spread webinar series Peer-reviewed publications Agenda for research and practice Update and expand scale-up/spread databases and resource listings (e.g., tools, literature, projects/programs) Presentations at targeted meetings Scale-up/Spread Listserv www.ihiscaleupconference10.blogspot.com 27

Perspectives on Scale-up Russ Glasgow, PhD Deputy Director, Dissemination & Implementation Science NCI Division of Cancer Control and Population Sciences

Brian S. Mittman, PhD Director, VA Center for Implementation Practice and Research Support

28

Discussion Topics


How do we encourage more research, practice, and policy work in this area?




How can researchers develop interventions with the potential for scale-up?




Next steps?

29

Thank you!

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Contact Information


Wynne Norton: [email protected]




Karen Glanz: [email protected]




Charles Collins: [email protected]




Brian Mittman: [email protected]




Russ Glasgow: [email protected] 31

Additional Information


CDC DEBI: www.effectiveinterventions.org




Pool Cool: www.poolcool.org




CIPRS: www.queri.research.va.gov/ciprs




Expand Net: www.expandnet.net




Scale-up/Spread Conference: www.ihiscaleupconference10.blogspot.com 32