Implementation Science as Catalyst for Transforming Health Systems to Learning Organizations: Beyond Big Data Chair ir & Moderator: Laura Damschroder, VA A Center for or Cli linical Man anagement Res esearch, An Ann Arb Arbor MI Panel l Members: • Bla lake Henderson, , VA A Dif Diffusi sion of of Ex Exce cellence Ini nitiative, Was ashi hington DC DC • George Ja Jackson, , VA A Center of of Inn nnovation to Ac Accelerate Disc Discovery and and Prac actice Transformation, , Du Durham NC • Sarah Cutrona, , VA A Center for or Hea ealthcare Organization and and Implementation Res esearch (C (CHOIR), , Bedford/Boston MA • Lucy Savi vitz, , Kai aiser Perm ermanente Nort orthwest Center for or Hea ealth Rese esearch, Port ortland OR
Acknowledgements Spreading Healthcare Access, Activities, Research and Knowledge (SHAARK): VA QUERI Grant PEC-17-002 Innovators Network – Population Factors, Organizational Capacity, Workflow and Resources (INPOWR): VA QUERI Grant PEC-18-015 The views expressed in this presentation are our own and do not reflect the POCition or policy of any entities with which we are affiliated
Learning Health System Foundations • Continuous knowledge building • Improvement at all levels of the system • Agile implementation of effective innovations Patients get higher quality, safer, efficient care Data is necessary to achieve these ideals… …but much more is needed beyond big data DO NOT SHARE WITHOUT PERMISSION POC: LAURA.DAMSCHRODER@VA.GOV
“Without concerted attention to evidence -based implementation strategies, learning health systems risk developing massive, expensive rePOCitories of information without adequate strategies to actually utilize such data for system change…the assumption that comprehensive, elegant, real-time datasets will, in and of themselves, lead to practice change is at best an optimistic aspiration and at worst, a massively expensive error ” Bauer MS, Damschroder L, Hagedorn H, Smith J, Kilbourne AM. An introduction to implementation science for the non- specialist. BMC psychology. 2015 Dec;3(1):32. DO NOT SHARE WITHOUT PERMISSION POC: LAURA.DAMSCHRODER@VA.GOV
How do we get from here to there? How do we get from How do we get from here to there? here to there? Guise JM, Savitz LA, Friedman CP. Mind the Gap: Putting Evidence into Practice in the Era of Learning Health Systems. Journal of general internal medicine . 2018 Dec DO NOT SHARE WITHOUT PERMISSION POC: LAURA.DAMSCHRODER@VA.GOV 1;33(12):2237-9. Image Attribution: Ben Davis from the Noun Project
Agenda • Introductions & Setting the stage (10 minutes) • 1st Round: • 5- minute “Story Bites” from each panel member (20 minutes) • Audience Discussion (10 minutes) • 2nd Round • 5- minute “Story Bites” from each panel member (20 minutes) • Audience Discussion (10 minutes) • Endnotes: Pulling it all together (10 minutes) • Q&A (10 minutes) DO NOT SHARE WITHOUT PERMISSION POC: LAURA.DAMSCHRODER@VA.GOV
Blake Henderson DO NOT SHARE WITHOUT PERMISSION POC: LAURA.DAMSCHRODER@VA.GOV
VHA Diffusion of Excellence Mission To Change and Save Veteran Lives by transforming VHA into the nationally recognized leader in the discovery and spread of emerging evidence-based health care practices in the United States. DO NOT SHARE WITHOUT PERMISSION POC: LAURA.DAMSCHRODER@VA.GOV
VHA Shark Tank Competition DO NOT SHARE WITHOUT PERMISSION POC: LAURA.DAMSCHRODER@VA.GOV
Phase Gate Model of Innovation DO NOT SHARE WITHOUT PERMISSION POC: LAURA.DAMSCHRODER@VA.GOV
DO NOT SHARE WITHOUT PERMISSION POC: LAURA.DAMSCHRODER@VA.GOV
Phase-Gate Model of Innovation DO NOT SHARE WITHOUT PERMISSION POC: LAURA.DAMSCHRODER@VA.GOV
National Implementations VHA Rapid Naloxone Initiative Project HAPPEN Expanding rapid access at VA to naloxone at VA facilities Hospital Acquired Pneumonia Prevention through Engaging via Police, AED cabinets, and educating at-risk patients Nurses to complete oral care AT LEAST 116 FACILITIES FULLY IMPLEMENTED 39 FACILITIES FULLY IMPLEMENTED OR IN PROGRESS IMPACT IMPACT • Since its inception, 202 cases of NV-HAP have been prevented, and an • Makes life-saving naloxone more readily available in the event of an estimated 36 lives have been saved as of April 2019 opioid overdose on VA grounds (2 min or less response time) • Potential for hundreds of Veterans lives saved when diffused nationally • Has led to at least 132 Veteran lives saved, with likely many more Clinical Clinical reversals unreported • Trains VA Police officers and other basic life support (BLS)-trained staff • Risk of non-ventilator associated hospital-acquired pneumonia to recognize opioid overdoses and administer naloxone decreased by 90% at pilot site • 116 facilities have their VA Police forces carrying naloxone (68% Operational increase in adoption since September 2018) Operational • 56 VA facilities have select AED cabinets that contain naloxone (107% • Reduces Veterans’ hospital stays, while reducing the risk of increase in adoption since September 2018) readmission Societal • Saves Veteran lives and improves patient safety • Addresses the national opioid epidemic that disproportionately affects • $8.09M in estimated cost avoidance across 8 facilities as of April 2019 • Potential for >$100M cost avoidance when diffused nationally Veterans Societal Financial DO NOT SHARE WITHOUT PERMISSION POC: LAURA.DAMSCHRODER@VA.GOV
Diffusion Marketplace SEARCH IMPLEMENT Enable practice discovery and sharing Facilitate informed “buying” DO NOT SHARE WITHOUT PERMISSION POC: LAURA.DAMSCHRODER@VA.GOV
Sarah Cutrona DO NOT SHARE WITHOUT PERMISSION POC: LAURA.DAMSCHRODER@VA.GOV
What is the VHA In Innovators Network? Innovation Specialists (at 37 Sites Nationwide) • VA Employees selected for leadership and expertise • FTE dedicated toward training VA staff at their site Participants in Spark-Seed-Spread Investee Bootcamp Spark-Seed-Spread (S-S-S) Investment Program FY19 Portfolio: 90 projects across 36 facilities & 17 VISNs/regions • Funding for frontline VA employees to develop innovative projects. • >$10 million invested in over 300 S-S-S projects • Projects include clinical, administrative, educational, and health information technology initiatives. Nationwide distribution of FY19 Spark-Seed-Spread Investments Innovation Specialists with DO NOT SHARE WITHOUT PERMISSION POC: LAURA.DAMSCHRODER@VA.GOV Innovators Network Team
In Innovators Network: A Complex Learning Health System Diverse set of • Innovation Sites (VA Medical Centers) • Innovation Specialists & Project Leads (varied professional backgrounds) • Projects (Clinical, administrative, educational, health IT) • Project Stages of Implementation Completion • Pre-implementation; Implementation; Spread QUERI Partnered Evaluation (‘INPOWR’) conducting ongoing evaluation Is there a unifying theme that can inform evaluation & ongoing improvement? DO NOT SHARE WITHOUT PERMISSION POC: LAURA.DAMSCHRODER@VA.GOV
accessed 5/19/2019 Wikipedia https://commons.wikimedia.org/w/index.php?curid=322029 Attribution (CC BY-SA 3.0) Created by Wolfgang Beyer with the program Ultra Fractal 3 . - Own work; Learning Health Systems sup suppo port t Inn Innova vation tion at multiple t multiple le levels els Local sites and local challenges can be unique (“You’ve seen one VA, you’ve seen one VA”) What we learn at the grassroots/micro level … • Identify problems • Develop local solutions • Find local problem-solvers/champions … Can (and should!) be applied at macro levels (medical center, nationwide) • Expected barriers & POCsible facilitators • Power of networks to improve access to expertise • Centralization to avoid duplications of effort DO NOT SHARE WITHOUT PERMISSION POC: LAURA.DAMSCHRODER@VA.GOV
Learning Health Systems suppor support t Inn Innova vation tion at multiple le t multiple levels els Veterans and their families DO NOT SHARE WITHOUT PERMISSION
Learning Health Systems suppor support t Inn Innova vation tion at multiple le t multiple levels els Frontline Employees Veterans and their families DO NOT SHARE WITHOUT PERMISSION
Learning Health Systems suppor support t Inn Innova vation tion at multiple le t multiple levels els Sites (VA Medical Centers) Frontline Employees Veterans and their families DO NOT SHARE WITHOUT PERMISSION
Nation (VHA) Learning Health Systems suppor support t Inn Innova vation tion at multiple le t multiple levels els Sites (VA Medical Centers) Frontline Employees Veterans and their families DO NOT SHARE WITHOUT PERMISSION
Nation (VHA) Network Level (Nationwide) : INNOVATORS NETWORK • Funds Locally Developed Projects with Varied Scope (Spark-Seed-Spread) • Centralized support (contracting, data collection) • Centralized Training & Resources for Innovation Specialists & Investees Sites (VA Medical Centers) Frontline Employees Veterans and their families DO NOT SHARE WITHOUT PERMISSION
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