Applying Implementation Science to Enhance the Impact of Health Services Research Brian S. Mittman, PhD Senior Social Scientist VA/UCLA/RAND Center for the Study of Healthcare Provider Behavior June 5, 2007 Center for the Study of Healthcare Provider Behavior Quality Enhancement Research Initiative
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Applying Implementation Science to Enhance the Impact of Health Services Research Brian S. Mittman, PhD Senior Social Scientist VA/UCLA/RAND Center for.
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Applying Implementation Science to Enhance the Impact of Health Services Research
Brian S. Mittman, PhDSenior Social Scientist
VA/UCLA/RAND Center for the Study ofHealthcare Provider Behavior
June 5, 2007
Center for the Study of Healthcare Provider Behavior Quality
• How does IS relate to HSR? How can IS enhance HSR?
• What insights, conclusions and guidance does IS offer? How does one plan, conduct, document and use IS?
• What is needed to enhance IS (to further enhance HSR)?
Implementation science definition
• “Implementation research is the scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice, and, hence, to improve the quality and effectiveness of health services and care.”
“This relatively new field includes the study of influences on healthcare professional and organizational behavior.”
Implementation science goals
• Generate new insights and generalizable knowledge regarding dissemination/implementation processes and strategies – and their outcomes and determinants
• Apply, test and refine models, theories and hypotheses
• Improve health-related processes and outcomes within participating settings and groups
• Develop reliable strategies for improving health-related processes and outcomes in other settings and groups
Implementation science and the pipelineIoM Clinical Research Roundtable identified
two “translational roadblocks”
Crowley WF, et al. Clinical Research in the United States at a Crossroads. JAMA. 2004. 291: 1120-1126
IoM CRR translational roadblocks
Basic / Lab Research
Clinical Research
Improved Health
Basic / Lab Research
Clinical Research
Improved Health
Revised depiction of health-relatedresearch / implementation pipeline
Translational,Pre-ClinicalResearch
Basic Science
Improved HealthProcesses,Outcomes
Implemen-tationResearch
Clinical
Health Behavior
Health Services
Revised depiction of health-relatedresearch / implementation pipeline
Translational,Pre-ClinicalResearch
Basic Science
Improved HealthProcesses,Outcomes
Implemen-tationResearch
Clinical
Health Behavior
Basic/Lab Science
Clinical Science
Health Services Research
Health Services
Health Behavior/Promotion Research
Developing, implementing effective practices
• Effective (evidence-based) practices are developed via clinical research, health behavior/promotion research, health services research
• HSR also studies attributes, use and impacts of effective clinical and health behavior/promotion practices
• Implementation research studies strategies and processes related to adoption/update (dissemination, implementation) of effective practices
• Not all research findings are suitable for implementation
• Psychology, sociology, political science, economics
• Health psychology, organization/management theory
• Program evaluation, clinical research
Implementation science foundations: research approaches and frameworks
• Clinical research: RCT, PCT frameworks
• Program evaluation: logic models, designs, measurement
• Health behavior/health promotion research: PBT, etc.
• Pipeline and phase models: IoM CRR, drug trials, complex interventions
• CONSORT-like statements, templates, criteria
Implementation theories and principles
• Organization/management theory vs. psychological theories
– Systems, structures, policies/procedures, norms vs. attitudes and intentions
– Management principles and frameworks
• Multi-level framework (hypothesis)
– Multi-faceted portfolio addressing all levels
– Coordinated campaign
Implementation research frameworks
1. QUERI Six-Step Process
2. QUERI 4-phase implementation research framework
3. QUERI Service-Directed Project template: elements for an implementation research “CONSORT extension”
• To enhance the quality, outcomes and efficiency of VA health care by systematically implementing evidence-based clinical guidelines and innovations into routine clinical practice