A Conference to Advance the State of the Science and Practice on Scale-up and Spread of Effective Health Programs
July 6th-8th, 2010
Gaylord National Hotel
Washington, D.C.
Joe McCannon (Chair)
Brian S. Mittman and Wynne E. Norton (Co-Chair s)
Background
The fields of health care and public health produce a steady stream of effective innovations and interventions with the ability to improve patient health. These innovations have the potential for significant benefit when widely and appropriately adopted; however, scale-up and spread efforts are frequently incomplete or delayed. An oft-cited statistic suggests that it takes approximately seventeen years from the time an evidenced-based practice emerges to the time that it is widely used in the United States. Countless anecdotes from policy and practice leaders, frustrated by their inability to realize the most modest gains in performance, reinforce these data.
Researchers and practitioners in health care and public health must together close the gap between knowledge and common practice by thoroughly assessing barriers to broad, rapid scale-up and spread of effective practices and programs and by identifying and deploying effective methods for spreading improvement. Achieving these goals requires coordinated efforts by research, policy and practice leaders to (a) gather and share existing knowledge related to scale-up and spread, (b) develop detailed agendas for future research, policy and practice action, and (c) collaborate to carry out these plans.
The Conference to Advance the State of the Science and Practice on Scale-up and Spread of Effective Health Programs represents a major step toward realizing this vision. Supported by the Agency for Healthcare Research and Quality, Commonwealth Fund, and the US Department of Veterans Affairs, with additional contribution from the Donaghue Foundation and the John A. Harford Foundation, the conference builds on recent attention to issues of scale-up and spread, including a conference session and dinner meeting convened in conjunction with the NIH Conference on the Science of Dissemination and Implementation (2009), which was coordinated by Drs. Mittman and Norton and attended by 30 senior leaders from healthcare delivery organizations, government agencies, and academic institutions. Together, dinner meeting participants generated a list of preliminary recommendations for research, policy and practice actions to promote scale-up and spread, and identified the need for a larger conference to assess current knowledge and practice and to develop a detailed consensus agenda for broader action.
Objectives
The conference has four main objectives:
1. To review existing knowledge and current practices related to the scale-up and spread of effective programs 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 innovations, 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, including prioritization of research, policy, and practice activity and powerful demonstrations of regional, national, and international scale-up in health care and public health.
The research, policy and practice leaders who gather for the conference will address the following types of questions:
· What are the attributes of the ideal system for spreading effective practice?
· Where are the major gaps in research, practice, and policy with respect to scale-up and spread? How can we close the gap between current practice and a more efficient system for broad adoption of new ideas?
· How much do we know about changing behavior at scale (versus simply raising awareness of new ideas or practices, or changing behavior in smaller settings)?
· Which “levers” and other methods for achieving large-scale behavior change are most effective and under which circumstances?
· How can we better design health care and public health programs, institutions and policies to achieve more effective scale-up and spread?
· What specific actions are needed from the research, policy and practice communities to achieve these aims?
Conference Format
The conference will include two days of intensive sessions in which multi-disciplinary teams will address key questions and develop comprehensive agendas for future action. The attendees will include approximately 100 research, policy and practice experts from a diverse set of U.S. and non-U.S. institutions representing government, academia, philanthropy, business and service delivery. Attendees will be divided into five pre-selected groups of approximately 20 individuals for working group sessions. Preparation for the conference will include a review of a core meeting framework and commissioned papers summarizing existing knowledge in the field.
Conference Products
To capture and share the ideas generated by the conference, planned products include:
· Peer-reviewed journal articles documenting conclusions and recommendations for action;
· Meeting proceedings available to the research community and public;
· A detailed report of conclusions and recommendations to government agencies, donors, delivery organizations and other major stakeholders;
· A learning network for ongoing discussion;
· A detailed agenda of future research, policy and practice projects to advance the field.
The products from the conference -- and the continued work of the attendees over the months and years to follow -- will yield durable guidance for researchers, practitioners, and policy leaders on this important topic.
Funding for this conference was made possible in part by grant 1R13HS019422-01 from the Agency for Healthcare Research and Quality (AHRQ). The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government. The Commonwealth Fund, The Veteran’s Health Administration, The Donaghue Foundation and The John A. Hartford Foundation also provided meeting support.
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