California Safety Net Institute Innovation and Dissemination Network

描述(由申请人提供)：加州的公立医院(CA)是传播循证实践的成熟环境。这些综合交付系统为具有复杂健康需求的低收入、易受伤害的患者服务，其中大多数人没有或保险不足。此外，在这样的环境中和跨这些环境一致地纳入基于证据的创新可能会受到资金、技术和人力资本的限制。然而，CA最近的医疗改革举措为所有21家公立医院提供了新的机会，使其转型以产生显著的公共卫生利益--特别是CA 1115 2010年医疗补助豁免。根据这项豁免中的提供制度改革激励计划(DSRIP)，每年提供1000多万次门诊就诊的公立医院已经联合起来重新设计医疗服务，以在控制成本的同时提高质量和人口健康结果。这项为期5年的DSRIP计划是一项按绩效支付的计划，因为每个系统都将根据具体的指标改进进行支付。因此，这是 这是一个前所未有的时机，可以在全州各系统传播和实施循证做法，同时研究和了解实施过程。旧金山总医院的加州大学旧金山分校弱势人群中心在开发创新和实施科学方面有着出色的记录，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，最近它们合作开发了一个网络Dephi-Net，用于传播创新的最佳实践。这项提议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还将获得对可推广到其他安全网卫生系统和其他系统的实施过程的宝贵见解。Dephi-Net将打破人们普遍认为的公立医院变革缓慢、孤立和高度官僚的组织观念，并证明它们不仅是创新的源泉，而且可以成为迅速采用、适应和实施循证干预措施的灵活而灵活的学习型组织，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.