Key lessons include the need to develop skills to understand program mechanisms and contexts, recognize multiple models of causality, apply mixed method designs, and ensure the successful scaling up and spread of an intervention.
Health care systems struggle to scale-up and spread effective practices across diverse settings.
We describe the background, evidence-based changes, and testing, scale-up, and spread strategy that are part of the design of the Creating Age-Friendly Health Systems initiative.
Failures in scale-up and spread (SUS) are often attributed to a lack of consideration for variation in local contexts among different health care delivery settings.
To implement this transformation, innovative community-based approaches that result in must involve local governance, mobilize all sectors of society with diverse stakeholders, be well funded, scaled up and spread to meet these goals and to chart a course towards health for all Americans.
Furthermore, this model could be scaled up and spread at pace because its reach is not overly reliant on the input of academic specialists or limited by time constraints imposed on nursing staff, and consequently it may be a more feasible and acceptable model to implement into routine care.
Fortunately, research interest in scale-up and spread is increasing [ 21, 42].
Many innovative solutions to promote aging in place exist, but work remains to be done on "scaling up" and spreading these strategies in communities nationwide.
Fig. 8 The comparisons between scale up and scale out.
Even though SCALE-UP has spread widely across departments and institutions, within most departments, this mode of teaching is not the status quo.
