What is the Health Systems Implementation Initiative, PCORI's new dissemination and implementation initiative? Dissemination and Implementation Director Joanna Siegel, SM, ScD, discusses some of the nuances of this new program for health systems with PCORI Communications staff.

Image

Why is PCORI launching this ambitious new initiative? What need are we looking to meet?

The essential job of the PCORI Dissemination and Implementation (D&I) team is to support getting the findings from PCORI-funded research taken up in to practice, so that the evidence actually reaches the patients, caregivers, and clinicians who can then use it to inform decisions and improve health care and health outcomes. We want to do that however we can, using existing channels, creating new channels, and doing what we know works. A key component of PCORI’s D&I work has been our investigator-initiated funded projects. These projects are well placed to take evidence the first few steps beyond the research context and into real-world practice. They’re also critically important in leveraging the enthusiasm and commitment of researchers, who really want to see their good work make an impact.

But we believe that health system executives and operational leaders have a different perspective on implementation, as well as the resources and commitment to make their vision a reality. They also have different metrics and priorities for it. We see HSII as a huge opportunity to take advantage of the perspective, enthusiasm, expertise, and influence of the leadership within health systems. They offer a great opportunity to expand our ability to do effective D&I work by bringing the full commitment of their organizations to the table.

How does HSII differ from other D&I initiatives?

The most visible difference is in who is leading the implementation project. Rather than being led by a member of a PCORI-funded research team, an HSII project will be led directly by skilled managers, administrators, and innovators responsible for the delivery of health care services.

There are also important differences in the funding process. HSII will occur over two stages. The first is for health systems—by which we mean healthcare delivery systems and provider-affiliated health plans—to apply to become Participants. These HSII Participants will then be able to apply for funding for implementation projects through an expedited process. Using a process like this means that once a system has been approved as a Participant it can then move more quickly and easily to the funding approval phase.

What have you been hearing so far in terms of interest in HSII?

We believe there is great interest! We talked with a number of organizations when we were launching our Request for Information on HSII and heard a lot of enthusiasm for the idea. We presented the concept to a number of associations representing health systems and health plans, and talked to attendees at one of our PCORI Payer Forums. We also received a great deal of formal input through the RFI itself, with 24 responses in total.

The audiences we spoke to, as well as our RFI respondents, talked about how this opportunity aligns with their organizational missions to provide high-quality care. They felt this initiative would provide more support for their efforts to transform care, ultimately benefitting their patients. One key piece of input we heard was the importance of speed. If we put out an opportunity, and Participants apply to promote uptake, they do not want to wait a year to learn whether they will receive the money to do it.

So HSII will be on a different timeframe compared to other projects?

Yes, it will be. That is why we have structured the process as we have—the first stage will identify health systems that have the interest, commitment, and capacity to participate fully. They will have already demonstrated the essential characteristics we are looking for, so we don’t have to look at that again.

Then for the next stage it will be an expedited pathway, just based on the specific project itself. That allows us to do our funding on a much more expedited timeline. The process also provides an opportunity for capacity building, to further enhance the readiness of health systems to conduct implementation projects. Very soon after we identify the HSII Participants, we will issue a call for capacity-building project proposals.

Image

What is in it for potential participants? Why would they want to participate?

Most health systems are very much committed to providing the best possible evidence-based care. But it can often be challenging to get over the hurdles of moving from existing routines to adopting new approaches. Doing so is very mission-consistent, but systems are aware that it takes time, effort, and resources. Participating in HSII provides an opportunity to focus on this shift in approach, with financial support, and support from like-minded colleagues around the country. Health systems told us that they have existing efforts to deliver evidence-based care, and this initiative will provide opportunities—and funding—for them to build on this important work.

Health systems have been stretched thin during the pandemic. What are the benefits of applying for and joining HSII now?

The COVID-19 pandemic has certainly stretched resources for many health systems. But the impact of COVID has also meant that systems have had to prioritize and will be interested in improving their care in a very thoughtful way. People are now even more focused on quality of care than ever. There have also been disruptions in care, through the increased use of telehealth, for example. We anticipate that the leaders of many of these implementation projects will be thinking about evidence-based approaches to overcome barriers to care, especially for populations that have experienced disadvantages and health inequities.

Another component of HSII will be a Learning Network. Tell us more about that.

All HSII Participants will take part in the HSII Learning Network, which we envision as a two-way street. We will consult with Participants about what implementation project topics would be of particular interest and make them aware of new findings from PCORI-funded studies. The Learning Network will also provide a supportive learning community.

For example, we anticipate sessions focused on evidence-based implementation strategies and what they require, and on approaches for adapting strategies for different settings. Depending on Participants’ interests, we might focus on efficient ways to use the electronic health record system to support audit-and-feedback, or what to look for in practice champions. We anticipate having experienced experts in the field presenting and serving as resources for HSII Participants.

HSII Participants will also be able to share their own learnings among the group. We expect that systems that are very experienced will be able to share with those that are less experienced or less resourced. In addition, the Participants will be able to collaborate on common challenges, such as developing evaluation techniques and metrics that are relevant and feasible to use across systems.

So there will be a strong evaluation component?

Yes. All of our implementation projects have an evaluation component to ensure both that implementation occurs in the expected way and that it produces the intended health and healthcare outcomes. For example, if the implementation team plans to hold training sessions, did those trainings happen? That is an implementation outcome. Using an asthma treatment intervention as an example, do we see better asthma control due to implementation of the intervention? Are there fewer visits to the emergency room? These are the kinds of healthcare utilization outcomes and health outcomes a project might track.

Will HSII especially support hospitals that serve patients with social and financial barriers to care?

Yes, it will. Like all health systems, these will want to make sure they are providing evidence-based care, but as I noted earlier it takes a concerted effort and dedicated resources to do this. Hospitals that support patients who are underserved, with complex healthcare needs, may be challenged to dedicate the time and resources it takes to change practice. But these health systems are taking note of the support that HSII will provide to facilitate that concerted effort.

What unique characteristics do provider-affiliated health plans bring to the table?

Provider-affiliated health plans have an interest in high-quality care and are in a great position to promote it. They are closely affiliated and work closely with care providers. For example, a health plan might become involved in improving hospital discharge planning to address problems they detect as patients transition across health systems. Provider-affiliated health plans have the advantages of extensive data and analytic resources as well as the potential to work across, as well as within, systems.

What else is important to know about HSII?

In all of our D&I efforts, our goal is to work toward actualizing the potential of PCORI-funded research to improve healthcare and health outcomes. HSII provides a trajectory for uptake—uptake that is designed to be sustainable and scalable within participating health systems. And then, across multiple health systems, we’ll have enough evaluation data to allow other organizations to extend this work even further. HSII is intended to be a springboard, a stepping stone, not just to the health systems initially involved but beyond to a wider audience. The ultimate goal is to get evidence from PCORI-funded research into widespread practice.