Using Implementation and Dissemination Concepts to Spread 21st-Century Well-Child Care at a Health Maintenance Organization

Background: Twenty-first Century WCC is a parent-centered, team-based, primary care model that combines online previsit assessments completed by parents and caregivers regarding clinic-based weight, growth, and development assessments, and anticipatory guidance. Nurses, nurse practitioners, developmental specialists, and pediatricians all play roles in the WCC model. Patient and clinician interaction, health records, and resources are all facilitated through a Web-based diagnostic, management, tracking, and resource information tool. Methods: We describe here the use of a conceptual framework for implementing and disseminating in a Health Maintenance Organization an evidence-based model of WCC that includes developmental and preventive services recommended by the American Academy of Pediatrics. Our subsequent goal is dissemination of the model to pediatric practices within other KP regions and to other non-KP health care settings such as safety-net clinics. Our work was guided by selected components of the PRISM framework for implementation that focuses on organizational characteristics of the recipients, organizational perspective, implementation and sustainability infrastructure, and how these factors are known to influence the adoption, implementation, and maintenance of the intervention. Results: We present results from our work, focusing on findings from social network maps that depict who seeks advice from whom about pediatric-care improvements and from focus groups that identify barriers to and facilitators of implementation and help in the design of the 21st-century WCC model. Conclusion: Implementation and dissemination concepts and their attendant practices and tools can reliably be used to augment strategic decisions about how to best disseminate and implement innovations in health care delivery. Unlike innovations that are embedded only in technical systems, validated models of team-based health care have multiple components that must be made compatible with complex socio-technical systems. Interpersonal communication, work, coordination, and judgment are key processes that affect implementation quality. Implementation can involve tailoring to a particular site and customizing either the model or the organizational context to accommodate it.We believe that the use of an implementation and dissemination conceptual framework augmented with focus group and social network mapping methods provides valuable data that have helped develop a detailed and tailored implementation plan for 21st-century WCC, facilitating the implementation process and improving our chances of success in spreading and sustaining WCC in our pediatric practices.