Organizational Change and Capacity Building Initiatives

CPDE often collaborates with partners leading initiatives aimed at transforming systems and enhancing organizational capacity and infrastructure to improve services and workforce capability to meet the needs of its target population. Since these initiatives often involve the implementation of new or improved processes at the practice or organizational level, CPDE draws on principles of Implementation Science in designing the evaluation.

Organizational Change and Capacity-Building Initiatives include:

DHMC Geriatric Emergency Department Hub & Spoke Initiative

The focus of this initiative is for Dartmouth-Hitchcock Medical Center (DHMC) to become a center of excellence in Geriatric Emergency Care and improve geriatric acute care throughout Northern New England. This work, supported by West Health, serves as proof-of-concept of a model that delivers quality acute care to vulnerable older adult populations in rural areas in a way that is sustainable in terms of cost, workforce, and other resources. After the DHMC emergency department (ED) becomes an accredited Geriatric ED at the highest level, it will serve as the “hub” that partners with several “spoke” hospitals as they also work to become accredited. Using telehealth tools and processes, the hub and spokes will work together to provide highest quality geriatric acute care in the region. CPDE uses a mixed methods evaluation design in which multiple qualitative and quantitative data are collected, analyzed, and triangulated throughout the implementation period. Data for this evaluation includes survey results, qualitative data (from focus groups, interviews, observations) and clinical/operational data. To determine and measure outcomes associated with this initiative, we use a before and after study design. (Funder: West Health)

Geriatric Workforce Enhancement Project (GWEP)

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)

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

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)