Implementing and Scaling up GPNC

Transcription

1 Implementing and Scaling up GPNC KRISTIN VAN DE GRIEND, PHD, MPH UNIVERSITY OF SOUTH CAROLINA Implementation Science Implementation= putting into practice components of an intervention/activities delivered within a specific setting Intervention #1 Intervention #2 Intervention #3 Widespread Implementation 1

2 What is needed for Implementation? Systemwide planning Demand for services Program evaluation Health Systems Governance & leadership Funding & resources Service delivery Stages of Implementation Fixsen Ch. 3, p. 15 2

3 Implementation Science Eight conditions for program implementation Fidelity Dosage Quality Participant responsiveness Program differentiation Monitoring groups Reach Adaptation Process Evaluation Process evaluation Examining the strengths/limitations of interventions Monitoring implementation in real-time Studying influences (context) Why the intervention has/does not have expected outcomes Which features were successful (or not) New implementing groups can learn from successes and overcoming challenges 3

4 Study Objective Inform future scaling up of evidence-based healthcare Health systems Government Donor programs Mixed-Methods, Qualitative, in-depth group and individual interviews Two online surveys Fidelity to the model Educational content GPNC observations at three sites Seven to nine sessions each 4

5 Participants Site steering committee members 5 steering committee groups interviewed, 3 times each Facilitators and co-facilitators 8 interviewed 27 invited to participate in two surveys Statewide Expansion Coordinators 2 interviewed, twice each Scaling up Health Programs Many evidencebased solutions for health problems exist Adoption of these interventions is slow Increase the impact of innovations Successfully tested in pilot or experimental projects Benefit more people Foster policy and program development On a lasting basis 5

6 GPNC Scale-up Plan CP was scaled from 2 to 12 medical practices Hospitals and private practices Client-base of Medicaid-eligible women Stakeholders involved in the expansion process were Providers and staff at the 12 practices Insurance payers Pregnant women seeking group prenatal care services 6

7 Complex Systems Science Scaling up health interventions is conceptually and logistically complex Multiple dimensions and components Environments, resources, system structures, policies Multiple levels within systems Diverse actors within systems Systems react and change due to implementation Change occurs in non-linear ways State-level Windows of Opportunity Identifying poor birth outcomes as a problem Presenting to state and health insurance leaders in South Carolina Local economy Political support Strong political will Funding through DHHS BCBS/Blue Choice enhanced reimbursement 7

8 State and Site-level Windows of Opportunity Advocacy and community support Creating buy-in Training, monitoring, and supervision Policies, norms, and guidelines Community-based and government collaborations State and Site-level Windows of Opportunity Community-based and government collaborations Health systems Arranged meetings Attended grant application forums Applied for funding Built staff committment 8

9 Health System Implementation Coordinated effort Training and technical assistance Strong stakeholder and administrative support Organizational collaborations Collaborations within healthcare systems Steering committees Organizational capacity Dedication of time and staff Lessons Learned The South Carolina CP Consortium Sharing lessons learned Technical assistance and training Support from organizational stakeholders was essential Needed before implementation Used existing systems to introduce CP Actively reach decision-makers who are not supportive Strategies to ensure decision-makers understand CP 9

10 Lessons Learned SC DHHS Strong political will and advocacy Start-up funding Enhanced Medicaid reimbursement Advocacy in seeking standard coverage and enhanced reimbursement Through private third party payers References Atun, R., de Jongh, T., Secci, F., Ohiri, K., & Adeyi, O. (2010). Integration of targeted health interventions into health systems: a conceptual framework for analysis. Health Policy Plan, 25(2), doi: /heapol/czp055de Savigny, D., & Adam, T. (2009). Systems thinking for health systems strengthening (Alliance for Health Policy and Systems Research, Trans.). Geneva, Switzerland: WHO Press. Durlak, J. A., & DuPre, E. P. (2008). Implementation matters: a review of research on the influence of implementation on program outcomes and the factors affecting implementation. Am J Community Psychol, 41(3-4), doi: /s Fixsen, D. L., Naoom, S. F., Blase, K. A., Friedman, R. M., & Wallace, F. (2005). Implementation research: A synthesis of the literature. Tampa, Florida: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network. 10