California Safety Net Institute Innovation and Dissemination Network

描述（由申请人提供）：加州（CA）的公立医院是传播循证实践的成熟环境。这些综合提供系统为低收入、有复杂保健需求的弱势患者提供服务，其中大多数人没有保险或保险不足。此外，在这些环境中和跨这些环境一致地纳入循证创新可能会受到资金、技术和人力资本方面的限制。然而，最近在加州的医疗改革举措为所有21家公立医院提供了新的机会，使其能够转型，从而产生重大的公共卫生效益，特别是加州 2010年1115医疗补助豁免。根据这一豁免中的“提供系统改革激励方案”，每年提供1 000多万次门诊服务的公立医院已联合起来重新设计护理服务，以提高质量和人口健康结果，同时控制成本。这个为期5年的DSRIP计划是一个按绩效付费的计划，因为每个系统将根据具体的指标改进进行付费。因此，这是 这是一个前所未有的时间，在全州范围内传播和实施基于证据的做法，同时也研究和理解实施过程。旧金山弗朗西斯科总医院的弱势群体中心在发展创新和实施科学方面有着出色的记录，而加州医疗安全网研究所对成功地让公立医院参与变革有着深刻的理解，最近合作开发了一个网络DEPHI-Net，用于传播创新的最佳实践。该提案将为可持续网络提供额外的基础设施支持。通过应用实施研究综合框架，DEPHI-Net还将获得可推广到其他安全网卫生系统及其他系统的实施过程的宝贵见解。DEPHI-Net将挑战人们对公立医院变革缓慢、孤立和高度官僚化的组织的普遍看法，并证明它们不仅是创新的源泉，而且可以成为敏捷和灵活的学习型组织，迅速采取、适应和实施基于证据的干预措施，以最大限度地提高人口健康。

DESCRIPTION (provided by the applicant): Public hospitals in California (CA) are a ripe setting for the dissemination of evidence-based practices. These integrated delivery systems serve low-income, vulnerable patients with complex health needs, a majority of whom are un- or under-insured. Furthermore, incorporating evidence-based innovations consistently within and across such settings can be constrained by limitations in finances, technology, and human capital. However, recent health reform initiatives in CA offer new opportunities for all 21 public hospitals to transform themselves to yield significant public health benefits - particularly the CA 1115 Medicaid Waiver of 2010. Under the Delivery System Reform Incentive Program (DSRIP) in this Waiver, public hospitals, which deliver more than 10 million ambulatory visits annually, have come together to redesign care delivery to improve quality and population health outcomes while controlling costs. This 5-year DSRIP program is a pay-for-performance initiative, as each system will be paid according to specific metric improvements. As such, this is an unprecedented time to disseminate and implement evidence-based practices across systems statewide while also studying and understanding implementation processes. The UCSF Center for Vulnerable Populations at San Francisco General Hospital, which has an outstanding track record in developing innovations and in implementation sciences, and the California Healthcare Safety Net Institute, which has a deep understanding of successfully engaging public hospitals in change, have recently partnered to develop a network, DEPHI-Net, for spreading innovative best practices. This proposal would provide additional infrastructure support for a sustainable network. By applying the Consolidated Framework for Implementation Research, DEPHI-Net will also gain valuable insights into implementation processes generalizable to other safety net health systems and beyond. DEPHI-Net will defy commonly held beliefs about public hospitals being slow to change, insular, and highly bureaucratic organizations, and demonstrate that they not only are sources of innovation but also can become nimble and flexible learning organizations that rapidly take up, adapt, and implement evidence-based interventions to maximize population health.