(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.
Under health reform, public hospital systems are currently undergoing transformation across California. By leveraging the strengths of both UCSF and the Safety Net Institute, we have an unprecedented opportunity to create a network for the dissemination, implementation, and evaluation of innovative best practices that will be critical in supporting improvement across systems and improving patient outcomes statewide.