A framework for scaling up health interventions: lessons from large-scale improvement initiatives in Africa.

Background: Scaling up complex health interventions to large populations is not a straightforward task. Without intentional, guided efforts to scale up, it can take many years for a new evidence-based intervention to be broadly implemented. For the past decade, researchers and implementers have developed models of scale-up that move beyond earlier paradigms that assumed ideas and practices would successfully spread through a combination of publication, policy, training, and example.

A stakeholder-driven agenda for advancing the science and practice of scale-up and spread in health.

Background: Although significant advances have been made in implementation science, comparatively less attention has been paid to broader scale-up and spread of effective health programs at the regional, national, or international level. To address this gap in research, practice and policy attention, representatives from key stakeholder groups launched an initiative to identify gaps and stimulate additional interest and activity in scale-up and spread of effective health programs. We describe the background and motivation for this initiative and the content, process, and outcomes of two main phases comprising the core of the initiative: a state-of-the-art conference to develop recommendations for advancing scale-up and spread and a follow-up activity to operationalize and prioritize the recommendations.

US organ donation breakthrough collaborative increases organ donation.

More than 92000 Americans are on waiting lists for organ transplants, and an average of 17 of them die each day while waiting. The US Organ Donation Breakthrough Collaborative (ODBC), which began in 2003 at the request of the Secretary of the US Department of Health and Human Services, was a formal, concerted effort of the donation and transplantation community to bring about a major change to improve the organ donation system. The nationwide Collaborative was housed within a Health and Human Services agency, the Health Resources and Services Administration (HRSA) Division of Transplantation, and included participation of the organ procurement organizations (OPOs) throughout the United States and the American hospitals with the largest organ-donor potential.

Saving 100,000 lives in US hospitals.

An initiative to cut avoidable deaths required rapid recruitment and support of large numbers of US hospitals. Campaign leaders describe how they coordinate nationwide implementation of effective healthcare interventions and document lessons for effective spread

Using a framework for spread: The case of patient access in the Veterans Health Administration.

Background: Experience indicates that an effective operational system will spread much more slowly than, for example, a new antinausea drug. The Veterans Health Administration (VHA) used a Framework for Spread to spread improvements in access to more than 1800 outpatient clinics between April 2001 and December 2003. The framework identifies strategies and methods for planning and guiding the spread of new ideas or new operational systems, including the responsibilities of leadership, packaging the new ideas, communication, strengthening the social system, measurement and feedback, and knowledge management.

Improving patient access to the Veterans Health Administration's primary care and specialty clinics.

Background: During the past four years the Veterans Health Administration (VHA) has been engaged in a national effort to improve access for patients to its 1,826 primary care, audiology, cardiology, eye care, orthopedics, and urology clinics by using the principles of open access or "advanced clinic access." The strategy entailed the development of successful cases to demonstrate the methods of advanced clinic access and provide evidence of its benefits for providers as well as patients in primary care and specialty clinics.

Results: Four clinics--one primary care clinic and three specialty care clinics--showed dramatic improvement in waiting times for appointments (reductions range from 20 days in urology to 78 days in primary care).

Quality improvement for pressure ulcer care in the nursing home setting: the Northeast Pressure Ulcer Project.

Objectives: The objectives of this study were to evaluate the impact of a collaborative model of quality improvement in nursing homes on processes of care for the prevention and treatment of pressure ulcers.

Study Design: The study design was experimental.

Setting: We studied 29 nursing homes in New Jersey, Pennsylvania, and Rhode Island.