While hundreds of innovative complex care models exist across the country, few of them have been successfully replicated or scaled beyond a single site. Replicating exemplary health care models is critical to the advancement of complex care, and to effecting the kind of systems change that the field is working toward. That’s why the National Center is teaming up with Health Quality Partners (HQP), a nonprofit research and development organization in Doylestown, PA, and the Peterson Center on Healthcare to rigorously design and test new methods of replicating HQP’s Advanced Preventive Care model at pilot sites across the country.
In order to replicate and scale models that work, we need to better understand the science behind successful replication efforts. How do we ensure fidelity to the model when it’s being implemented hundreds of miles away, but also allow for adjustments to local contexts? What is the best way to train teams that might be new to delivering complex care? How do we get buy-in from large health systems with a lot of competing priorities?
In the first phase of this project, Advanced Preventive Care: Scaling Through Innovations in Replication, we will be working to design new methodologies for replicating the Advanced Preventive Care model, as well as an evaluation framework to test the performance of each new method of replication. In the second phase, we will use the newly designed replication methodologies and evaluation framework to implement Advanced Preventive Care at sites across the country.
HQP’s Advanced Preventive Care model is a great candidate for this kind of project because of its strong evidence base. More than 17 years of rigorous design thinking, research, and evaluation have gone into developing and honing the model, including large-scale, longitudinal studies that have shown significant improvements in health outcomes, and, for many sub-populations, fewer hospitalizations, readmissions, skilled nursing facility stays, and a net reduction in total health care costs. The model was cited in the National Academy of Medicine’s landmark publication Effective Care for High Need Patients, and was featured in its webinar series on improving care for those with complex health and social needs.
Advanced Preventive Care was designed specifically for preventing avoidable complications of aging and chronic disease among older adults with an array of physical health, behavioral health and social needs. It fills the gap between office-based primary care preventive interventions and later stage interventions like palliative care and hospice.
Advanced Preventive Care begins by using data to proactively identify and engage higher-risk, chronically ill older adults in collaboration with their primary care providers. Participants and families then form a trusting, personal relationship with a skilled nurse specifically trained in Advanced Preventive Care who makes frequent in-person contacts to assess, monitor, educate, coach, support, and activate the participant and their support network to anticipate and proactively address a wide variety of health risks.
Health Quality Partners has already developed one method to replicate the Advanced Preventive Care model. Known as replication consultancy, it is an intensive, collaborative training and coaching method where originators of a complex care program train and advise implementing staff, and gradually reduce the intensity of their support as the implementation site demonstrates effective adoption and operational integrity.
The Advanced Preventive Care: Scaling Through Innovations in Replication project will compare and test new replication methods against the replication consultancy model to determine which replication methods work best. As we work to advance the field of complex care, we are looking forward to expanding our knowledge of what does and does not work for efficiently and effectively replicating high-performing models of care for complex populations.
This project is supported by the Peterson Center on Healthcare.