Evidence on Scaling in Health and Social Care: An Umbrella Review

CORÔA, ROBERTA DE CARVALHO; Gogovor, Amédé; Charif, Ali Ben; Hassine, Asma Ben; Zomahoun, Hervé Tchala Vignon; McLean, Robert K.D.; Milat, Andrew; Plourde, Karine V.; Rhéault, Nathalie; Wolfenden, Luke; Légaré, France

doi:10.1111/1468-0009.12649

Cited by 8 publications

(22 citation statements)

References 103 publications

(181 reference statements)

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“…Findings from the cluster-randomized trial were used to inform modifications to the SMARTER CRC intervention to prepare for scale-up [ 36 – 38 ]. Qualitative findings from analysis of clinic contact logs, interviews with clinics and health plans, and periodic reflections with practice facilitators were synthesized and made available to ECHO faculty to inform development of the ECHO didactic sessions.…”

Section: Methodsmentioning

confidence: 99%

Methods for scaling up an outreach intervention to increase colorectal cancer screening rates in rural areas

Coury,

Coronado,

Currier

et al. 2024

Implement Sci Commun

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Background Mailed fecal immunochemical test (FIT) outreach and patient navigation are evidence-based practices shown to improve rates of colorectal cancer (CRC) and follow-up in various settings, yet these programs have not been broadly adopted by health systems and organizations that serve diverse populations. Reasons for low adoption rates are multifactorial, and little research explores approaches for scaling up a complex, multi-level CRC screening outreach intervention to advance equity in rural settings. Methods SMARTER CRC, a National Cancer Institute Cancer Moonshot project, is a cluster-randomized controlled trial of a mailed FIT and patient navigation program involving 3 Medicaid health plans and 28 rural primary care practices in Oregon and Idaho followed by a national scale-up trial. The SMARTER CRC intervention combines mailed FIT outreach supported by clinics, health plans, and vendors and patient navigation for colonoscopy following an abnormal FIT result. We applied the framework from Perez and colleagues to identify the intervention’s components (including functions and forms) and scale-up dissemination strategies and worked with a national advisory board to support scale-up to additional organizations. The team is recruiting health plans, primary care clinics, and regional and national organizations in the USA that serve a rural population. To teach organizations about the intervention, activities include Extension for Community Healthcare Outcomes (ECHO) tele-mentoring learning collaboratives, a facilitation guide and other materials, a patient navigation workshop, webinars, and individualized technical assistance. Our primary outcome is program adoption (by component), measured 6 months after participation in an ECHO learning collaborative. We also assess engagement and adaptations (implemented and desired) to learn how the multicomponent intervention might be modified to best support broad scale-up. Discussion Findings may inform approaches for adapting and scaling evidence-based approaches to promote CRC screening participation in underserved populations and settings. Trial registration Registered at ClinicalTrials.gov (NCT04890054) and at the NCI’s Clinical Trials Reporting Program (CTRP no.: NCI-2021–01032) on May 11, 2021.

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Section: Methodsmentioning

confidence: 99%

Methods for scaling up an outreach intervention to increase colorectal cancer screening rates in rural areas

Coury,

Coronado,

Currier

et al. 2024

Implement Sci Commun

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“…Most of these guidelines were developed by nonacademic organizations that work mainly in low- and middle-income countries where most scaling programs occur. [ 1 , 10 ] Our assessment of evidence-based development of guidelines for designing scaling interventions would help actors in the field select the most appropriate ones while developing their scaling programs.…”

Section: Discussionmentioning

confidence: 99%

“…However, our identified guidelines included the framework (WHO/ExpandNet framework) that as of 2022 is still the one most frequently used by actors developing and reporting scaling programs. [ 10 ] We will also enrich the list of items by reviewing studies included in our umbrella review on evidence on scaling in health and social care [ 10 ] and with the input of experts in the field during our forthcoming international consensus study. Finally, we will conduct living reviews [ 4 ] to incorporate new items as the science evolves.…”

Section: Discussionmentioning

confidence: 99%

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Informing the development of the SUCCEED reporting guideline for studies on the scaling of health interventions: A systematic review

Gogovor,

Zomahoun,

Ben Charif

et al. 2024

Medicine

Self Cite

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Background: Quality reporting contributes to effective translation of health research in practice and policy. As an initial step in the development of a reporting guideline for scaling, the Standards for reporting stUdies of sCaling evidenCEd-informED interventions (SUCCEED), we performed a systematic review to identify relevant guidelines and compile a list of potential items. Methods: We conducted a systematic review according to Cochrane method guidelines. We searched the following databases: MEDLINE, Embase, PsycINFO, Cochrane Library, CINAHL, Web of Science, from their respective inceptions. We also searched websites of relevant organizations and Google. We included any document that provided instructions or recommendations, e.g., reporting guideline, checklist, guidance, framework, standard; could inform the design or reporting of scaling interventions; and related to the health sector. We extracted characteristics of the included guidelines and assessed their methodological quality using a 3-item internal validity assessment tool. We extracted all items from the guidelines and classified them according to the main sections of reporting guidelines (title, abstract, introduction, methods, results, discussion and other information). We performed a narrative synthesis based on descriptive statistics. Results: Of 7704 records screened (published between 1999 and 2019), we included 39 guidelines, from which data were extracted from 57 reports. Of the 39 guidelines, 17 were for designing scaling interventions and 22 for reporting implementation interventions. At least one female author was listed in 31 guidelines, and 21 first authors were female. None of the authors belonged to the patient stakeholder group. Only one guideline clearly identified a patient as having participated in the consensus process. More than half the guidelines (56%) had been developed using an evidence-based process. In total, 750 items were extracted from the 39 guidelines and distributed into the 7 main sections. Conclusion: Relevant items identified could inform the development of a reporting guideline for scaling studies of evidence-based health interventions. This and our assessment of guidelines could contribute to better reporting in the science and practice of scaling.

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“…A growing body of evidence on the science of scaling up healthcare innovations has identified several enabling factors. 1 , 4 , 9 , 10 , 15 - 17 These factors include (1) identifying population needs and system problems; (2) dedicating human, financial, and technical resources; (3) creating relational and political connections and actively involving key actors; (4) strong health professional leadership; (5) adapting to the political context and integrating with existing services; and (6) measuring and disseminating innovation and scale-up outcomes.…”

Section: Introductionmentioning

confidence: 99%

Scaling-Up eConsult: Promising Strategies to Address Enabling Factors in Four Jurisdictions in Canada

Breton,

Lamoureux-Lamarche,

Smithman

et al. 2023

Int J Health Policy Manag

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Background: Effective healthcare innovations are often not scaled up beyond their initial local context. Lack of practical knowledge on how to move from local innovations to large-system improvement hinders innovation and learning capacity in health systems. Studying scale-up processes can lead to a better understanding of how to facilitate the scale-up of interventions. eConsult is a digital health innovation that aims to connect primary care professionals with specialists through an asynchronous electronic consultation. The recent implementation of eConsult in the public health systems of four Canadian jurisdictions provides a unique opportunity to identify different enabling strategies and related factors that promote the scaling up of eConsult across jurisdictions. Methods: We conducted a narrative case study in four Canadian provinces, Quebec, Ontario, Manitoba, and Newfoundland & Labrador, over a 3-year period (2018–2021). We observed provincial eConsult committee meetings (n=65) and national eConsult forums (n=3), and we reviewed internal documents (n=93). We conducted semi-structured interviews with key actors in each jurisdiction (eg, researchers, primary care professionals, specialists, policy-makers, and patient partners) (n=40). We conducted thematic analysis guided by the literature on factors and strategies used to scale up innovations. Results: We identified a total of 31 strategies related to six key enabling factors to scaling up eConsult, including: (1) multi-actor engagement; (2) relative advantage; (3) knowledge transfer; (4) strong evidence base; (5) physician leadership; and (6) resource acquisition (eg, human, material, and financial resources). More commonly used strategies, such as leveraging research infrastructure and bringing together various actors, were used to address multiple enabling factors. Conclusion: Actors used various strategies to scale up eConsult within their respective contexts, and these helped address six key factors that seemed to be essential to the scale-up of eConsult.

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Evidence on Scaling in Health and Social Care: An Umbrella Review

Cited by 8 publications

References 103 publications

Methods for scaling up an outreach intervention to increase colorectal cancer screening rates in rural areas

Methods for scaling up an outreach intervention to increase colorectal cancer screening rates in rural areas

Informing the development of the SUCCEED reporting guideline for studies on the scaling of health interventions: A systematic review

Scaling-Up eConsult: Promising Strategies to Address Enabling Factors in Four Jurisdictions in Canada

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