Browsing by Subject "innovation"

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    Diffusion of excellence: evaluating a system to identify, replicate, and spread promising innovative practices across the Veterans health administration.
    (Frontiers in health services, 2023-01) Jackson, George L; Fix, Gemmae M; White, Brandolyn S; Cutrona, Sarah L; Reardon, Caitlin M; Damschroder, Laura J; Burns, Madison; DeLaughter, Kathryn; Opra Widerquist, Marilla A; Arasim, Maria; Lindquist, Jennifer; Gifford, Allen L; King, Heather A; Kaitz, Jenesse; Jasuja, Guneet K; Hogan, Timothy P; Lopez, Jaifred Christian F; Henderson, Blake; Fitzgerald, Blaine A; Goetschius, Amber; Hagan, Danielle; McCoy, Carl; Seelig, Alex; Nevedal, Andrea

    Introduction

    The Veterans Health Administration (VHA) Diffusion of Excellence (DoE) program provides a system to identify, replicate, and spread promising practices across the largest integrated healthcare system in the United States. DoE identifies innovations that have been successfully implemented in the VHA through a Shark Tank style competition. VHA facility and regional directors bid resources needed to replicate promising practices. Winning facilities/regions receive external facilitation to aid in replication/implementation over the course of a year. DoE staff then support diffusion of successful practices across the nationwide VHA.

    Methods

    Organized around the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework, we summarize results of an ongoing long-term mixed-methods implementation evaluation of DoE. Data sources include: Shark Tank application and bid details, tracking practice adoptions through a Diffusion Marketplace, characteristics of VHA facilities, focus groups with Shark Tank bidders, structured observations of DoE events, surveys of DoE program participants, and semi-structured interviews of national VHA program office leaders, VHA healthcare system/facility executives, practice developers, implementation teams and facilitators.

    Results

    In the first eight Shark Tanks (2016-2022), 3,280 Shark Tank applications were submitted; 88 were designated DoE Promising Practices (i.e., practices receive facilitated replication). DoE has effectively spread practices across the VHA, with 1,440 documented instances of adoption/replication of practices across the VHA. This includes 180 adoptions/replications in facilities located in rural areas. Leadership decisions to adopt innovations are often based on big picture considerations such as constituency support and linkage to organizational goals. DoE Promising Practices that have the greatest national spread have been successfully replicated at new sites during the facilitated replication process, have close partnerships with VHA national program offices, and tend to be less expensive to implement. Two indicators of sustainment indicate that 56 of the 88 Promising Practices are still being diffused across the VHA; 56% of facilities originally replicating the practices have sustained them, even up to 6 years after the first Shark Tank.

    Conclusion

    DoE has developed a sustainable process for the identification, replication, and spread of promising practices as part of a learning health system committed to providing equitable access to high quality care.
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    Estimating the Effects of Regulation on Innovation: An International Comparative Analysis of the Pharmaceutical Industry
    (1978) Grabowski, HG; Vernon, JM; Thomas, LG
    INNOVATION in the U.S. ethical drug industry in recent years has been characterized by a number of adverse developments. In particular, there has been a sharp decline in the rate of new product introductions and the incentive for engaging in research and development (R & D) activity has been negatively influenced by rapid increases in the costs and risks of developing new products. While there is little debate about the existence of these adverse trends, there is considerable controversy about the factors producing them. Briefly, we list below five hypotheses that have been discussed as explanations for the declining rate of innovation.`
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    Substitution laws and innovation in the pharmaceutical industry.
    (1979) GRABOWSKI, HG; VERNON, JM
    The pharmaceutical industry has been among the most innovative while being one of the most highly regulated industries in the United States. Government regulation of pharmaceutical product quality started in 19061 and has evolved into a stringent system of premarket controls over new drug development and introduction. Several recent studies have examined the effects of these regulatory controls on the costs and development periods for new drug entities, the quantity of drug innovation, and delays in new drug therapies available to consumers.2 Government laws and regulations indirectly affect the innovation process through the distribution and marketing of pharmaceuticals. In contrast to other products, drugs can be dispensed to an individual only with a physician's prescription. This is true unless the Food and Drug Administration (FDA) has approved the drug for self-medication (i.e., over-the-counter us-age). Historically, state antisubstitution laws for prescription drugs have prohibited pharmacists from dispensing a different brand of a drug than the one prescribed by the physicians. A major structural change taking place in the pharmaceutical industry to-day is the repeal of state antisubstitution laws. Over forty states have passed product selection or drug substitution laws.3 While the state-enacted laws have significant differences, essentially all enable pharmacists to substitute generic products (some mandate substitution) unless a physician prevents substitution by checking a preprinted box or writing "dispense as written" (DAW) on the prescription form.