Diffusion of Excellence: Accelerating the Spread of Clinical Innovation and Best Practices across the Nation's Largest Health System.

The time it takes for clinical innovation and evidence-based practices to reach patients remains a major challenge for the health care sector. In 2015, the Veterans Health Administration (VHA) launched the Diffusion of Excellence Initiative aimed at aligning organizational resources with early-stage to midstage promising practices and innovations to replicate, scale, and eventually spread those with greatest potential for impact and positive outcomes. Using a 5-step systematic approach refined over time, frontline VHA staff have submitted more than 1676 practices since the initiative's inception, 47 of which have been selected as high-impact, Gold Status practices. These Gold Status practices have been replicated more than 412 times in Veterans Affairs hospitals across the country, improving care for more than 100,000 veterans and approximately $22.6 million in cost avoidance for the VHA. More importantly, practices such as Project HAPPEN (Hospital-Acquired Pneumonia Prevention by Engaging Nurses to complete oral care) and rapid availability of intranasal naloxone have saved veterans' lives. Several practices are now being implemented across the country, and the Diffusion of Excellence Initiative is playing a pivotal role as the VHA works to modernize its health care system. This initiative serves as a promising model for other health care systems seeking to accelerate the spread and adoption of clinical innovation and evidence-based practices.

Family practice versus specialist care for low-risk obstetrics: examining patient satisfaction in Newfoundland and Labrador.

OBJECTIVE: To investigate patient satisfaction with 3 models of low-risk obstetrics care: solo care by a GP, group care by GPs, and specialist care. DESIGN: Three-arm study comparing results of a self-administered, anonymous questionnaire. SETTING: Two academic family practices and the labour and delivery ward in St John's, Nfld. PARTICIPANTS: A total of 220 women deemed to have low-risk pregnancies; 82 women completed the questionnaire (37% response rate). MAIN OUTCOME MEASURES: Patient satisfaction scores obtained from a modified version of the Patient Expectations and Satisfaction with Prenatal Care instrument. RESULTS: Low-risk maternity patients' satisfaction with obstetric care provided by GPs in a group-care setting was equivalent to that with obstetric care provided by GPs working solo and greater than that with obstetric care provided by specialists. CONCLUSION: Patients found that group care by GPs was an acceptable means of receiving obstetric services in a low-risk setting. Therefore, a group practice model might provide an attractive means for FPs to keep obstetrics within the scope of primary care.

Physical therapy treatment options for lumbar spinal stenosis.

BACKGROUND: Given the dearth of high quality research on conservative treatment for spinal stenosis, an empirical understanding of the scope of physical therapy provided in the community can help focus research and build standards of care. OBJECTIVES: Provide preliminary insight into current physical therapy practice in the treatment of lumbar spinal stenosis (LSS), from both patient and physical therapist perspectives. METHODS: Patients greater than 50 years of age with LSS diagnosed by a spine surgeon were recruited to participate in a telephone survey regarding treatment. Physical therapists were recruited to complete a survey regarding treatments offered to patients with LSS. RESULTS: Of the patients participating in the study (n=75), 44 (59%) reported receiving physical therapy treatment. Treatments most frequently reported by patients were massage (27%), strengthening exercises (23%), flexibility exercises (18%), and heat/ice (14%). The most frequently advocated treatments by the 76 physical therapists included flexibility (87%), stabilization (86%) and strengthening exercises (83%), followed by heat/ice (76%), acupuncture (63%) and joint mobilization (62%). CONCLUSIONS: These results can guide both clinical research priorities and standards of care for physical therapy treatments of LSS. Based on the results of this study, future research foci should include massage, flexibility and strengthening exercises, stabilization techniques and heat/ice treatments.