The process of moving research insights into clinical practice can be slow and a gap often remains between best practices, frequently developed within single sites or small populations, and general practice delivered at a population scale. The field of implementation science seeks to mend this gap by promoting the adoption and appropriate use of effective interventions, practices, and programs, which includes the study of scale-up and spread of innovations. While hard-to-engage sites may have unique characteristics from sites that are engaged quickly or earlier, they are not typically differentiated in scale-up and spread processes. Thus, there is a lack of information about hard-to-engage sites and how to tailor approaches to these sites in scale-up and spread efforts. The objective of this project is to use systematic review and qualitative interview methods together to understand strategies available to scale up and spread clinical and administrative practices across large healthcare systems such as the VHA, with a focus on “hard-to-engage” sites.

Contents

• Preface
• Executive Summary
• Abbreviations
• Acknowledgments
• Introduction
• Methods
  • Topic Development
  • Search Strategy
  • Study Selection
  • Data Abstraction
  • Quality Assessment
  • Key Informant Interview Sampling and Data Collection
  • Data Synthesis and Analysis
  • Peer Review
• Results
  • Literature Flow
  • What does Large Magnitude Scale-up and Spread Look Like?
  • Considerations and Strategies for Working with Hard-to-Engage Sites
• Summary and Discussion
  • Summary
  • Limitations
  • Research Gaps and Recommendations for Future Research
  • Recommendations for Future Scale-up/Spread Efforts
  • Conclusions
• References
• APPENDIX A. Search Strategy
• APPENDIX B. Interview Guide Questions
• APPENDIX C. SAIL Data Exemplars
• APPENDIX D. QUERI and SAIL Templates Used in Analysis
• APPENDIX E. Peer Review Comments/Author Responses
• APPENDIX F. Citations for Excluded Studies
• APPENDIX G. Evidence Tables

Suggested citation:

Miake-Lye IM, Mak SS, Lambert-Kerzner AC, Lam CA, Delevan DM, Secada PM, Beroes-Severin JM, Olmos-Ochoa TT, Shekelle PG. Scaling Beyond Early Adopters: A Systematic Review and Key Informant Perspectives. VA ESP Project #05-226; 2019. Posted final reports are located on the ESP search page.

This report is based on research conducted by the Evidence Synthesis Program (ESP) Center located at the West Los Angeles VA Medical Center, Los Angeles, CA, funded by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (eg, employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report.