Implementation Research & Quality Improvement

GWEP (Geriatric Workforce Enhancement Project)

The 5-year GWEP grant works to advance northern New England’s capacity to address the healthcare needs of older adults by developing a rural geriatric workforce. GWEP aims to improve health outcomes among older adults through better integration of geriatrics with primary care, enhanced chronic care management between primary and specialty care, advance care planning and establishment of Advanced Directives, and increased patient and family engagement and self-efficacy in health care management. GWEP has several sub-projects with unique focus areas (e.g., interprofessional practice team transformation using Quality Improvement training and utilization), but the overall evaluation strategy uses a longitudinal, repeated measures design, in which data from a number of sources are collected throughout the course of each project. CPDE works closely with the project teams to maintain effective and efficient processes for data collection and feedback. Rapid-cycle feedback and reporting enables us to identify both effective program elements, as well as any barriers or obstacles that need to be addressed by project leaders. This allows our GWEP partner to make necessary adjustments and course corrections to planned activities in order to make progress toward their goals. (Funder: Health Resources and Services Administration)

P2P (Project LAUNCH and Partners to Promote Safety, Permanency, and Well-Being for Families Affected by Substance Use)

CPDE team members have partnered with the Dartmouth Trauma Interventions Research Center (DTIRC) at DHMC on two initiatives that aim to improve child and family well-being for at-risk families in the Upper Valley. The aim of Project LAUNCH is to increase the ability of the community to identify, engage, and serve at-risk and trauma-affected children and families through activities such as screening, evidence-based early intervention, staff training, and public awareness efforts. P2P specifically targets families affected by SUDs who are at risk of child placement outside of the home. The study uses a hybrid effectiveness and implementation design with randomization into a 12-month Wraparound intervention or treatment as usual. Families (n=160) will be enrolled over the duration of the study which aims to compare outcomes in child well-being, safety and permanency; parent recovery; and family functioning. CPDE is using multi-level, longitudinal mixed methods evaluations for both projects to study implementation processes and outcomes, including social network analysis of organizations in the Upper Valley, collection of standardized measures, interviews and surveys of providers and families to assess processes and outcomes. (Funders: Substance Abuse and Mental Health Services Administration for LAUNCH; Administration of Children and Families, Children’s Bureau, Department of Health and Human Services for P2P)

HOBSCOTCH (HOme Based Self-Management and COgnitive Training CHanges Lives)

HOBSCOTCH is an evidence-based self-management program that helps improve the lives of people living with epilepsy. The HOBSCOTCH Institute (HI) at Dartmouth Health has engaged CPDE to conduct a comprehensive program evaluation for a 5-year CDC grant, aimed to assess the effectiveness of a Hub & Spoke model with HI at the Hub and more than 20 clinics in two different types of Spoke settings. The co-produced evaluation and performance measurement plan includes mixed methods and reflects a health equity lens through which data collection instruments, program materials, and dissemination deliverables will be developed. (Funder: The Centers for Disease Control and Prevention (CDC))

NETT (New Hampshire Early Childhood and Family Mental Health System of Treatment)

CPDE is working with the Center for Trauma-Responsive Practice Change to measure the process, progress, and outcomes of a 5-year study that aims to expand and strengthen a network of providers and system partners who are working to decrease child and caregiver mental health symptoms, improve the child-caregiver relationship, and strengthen caregiver protective factors. The providers are trained and supported in Child-Parent Psychotherapy (CPP) by project leaders and other members of the network. We use mixed methods (training evaluation, referral pathway, and qualitative data) to assess the overall effectiveness and impact of the CPP provider network. (Funder: Substance Abuse and Mental Health Services Administration (SAMHSA))

CIPC (Climate Informed Pediatric Care)

Our partners at DHMC Department of Pediatrics, Dartmouth College, New Hampshire (NH) Healthcare Workers for Climate Action, NH Department of Public Health Climate and Health Program, and the NH Chapter of the American Academy of Pediatrics are conducting a pilot project to develop, launch, and test a model of practice-based learning and systems change across Dartmouth Health primary pediatric practices and beyond in later phases, to deliver climate-informed pediatric care. The team co-developed a comprehensive CIPC Toolkit including child activity booklets, parent guidance, provider videos, and other resources to educate families and practitioners in climate-related health impacts to children and strategies to address them. CPDE is supporting the CIPC leaders in project design, data collection and analysis, dashboard creation, and results dissemination. We draw upon principles and expertise in implementation science, quality improvement, and measurement of multi-level practice change. (Funder: Irving Foundation)