A Model for Advancing Scale-Up of Complex Interventions for Vulnerable Populations: the ALACRITY Center for Health and L
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Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; 2Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA; 3Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; 4Sheppard Pratt Health System, Baltimore, MD, USA; 5Department of Kinesiology, Towson University, Towson, MD, USA; 6Department of Anesthesiology and Critical Care and Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore, MD, USA; 7Department of Psychiatry & Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA; 8Health Services Research and Development Service, Veterans Health Administration, US Department of Veterans Affairs and Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MD, USA.
Many of the most pressing health issues in the USA and worldwide require complex, multi-faceted solutions. Delivery of such solutions is often complicated by the need to reach and engage vulnerable populations facing multiple barriers to care. While the fields of quality improvement and implementation science have made valuable gains in the development and spread of individual strategies to improve evidence-based practice delivery, models for coordinated deployment of numerous strategies to simultaneously implement multiple evidence-based interventions in vulnerable populations are lacking. In this Perspective, we describe a model for this type of comprehensive research-practice translation effort: the Johns Hopkins ALACRITY Center for Health and Longevity in Mental Illness, which is focused on reducing premature mortality in the population with serious mental illness. We describe the Center’s conceptual framework, which is built upon an integrated set of quality improvement and implementation science frameworks, provide an overview of the Center’s organizational structure and core research-practice translation activities, and discuss our vision for how the Center may evolve over time. Lessons learned from this Center’s efforts could inform models to address other critical health issues in vulnerable populations that require multi-component solutions at the policy, system, provider, and patient levels. J Gen Intern Med DOI: 10.1007/s11606-020-06137-x © Society of General Internal Medicine 2020
INTRODUCTION
Many of today’s pressing health issues are what Charles West Churchman termed “wicked problems.”1 Wicked problems Received September 1, 2019 Accepted August 11, 2020
have interacting causes, involve multiple decision-makers and clients with conflicting priorities and values, and require coordinated solutions across various systems and actors.1, 2 While the interrelated fields of quality improvement and implementation science have made important gains in the development and spread of individual strategies to improve evidence-based practice delivery, for example, the quality improvement approaches LEAN and Six Sigma3 and facilitation implem
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