Hot Topic – Future Directions of Implementation Science

George Jackson, PhD, MHA

George Jackson, PhD, MHA

Posted by George L. Jackson, Ph.D., MHA*

VA HSR&D-DGIM Implementation Science Series: UNC’s Bryan Weiner Talks about the State of Implementation Science

On Tuesday, September 8, Bryan J. Weiner, Ph.D. from the Department of Health Policy and Administration and Sheps Center for Health Services research at UNC-Chapel Hill delivered the latest in a series of joint Durham VA Health Services Research & Development (HSR&D) Center of Innovation and Duke Division of General Internal Medicine (DGIM) talks on implementation and improvement science and practice. Dr. Weiner discussed opportunities to use implementation science to move evidence-based strategies for providing access to efficient, high quality care while enhancing the experiences of patients and health system staff from the research setting into every day practice.

Dr. Weiner stated that

Implementation science is the study of methods to promote the use of research findings in healthcare, community, and policy contexts. As a multidisciplinary field, it examines how these findings are disseminated, implemented, and sustained by targeted audiences.

This talk by Dr. Weiner was part of a series of presentations organized by the Durham VA HSR&D Center of Innovation and DGIM designed to encourage expansion of collaboration in the areas of implementation science and practice that take advantage of the significant clinical, research, and management experience within the Division and HSR&D.

Even hand washing is an example

Hand washing can be used to demonstrate the gap between evidence and implementing the evidence into practice. We have known that hand washing reduces infection rates for 150 years. Yet, we still have trouble getting clinicians to wash their hands at appropriate times. Implementation science can inform ways to better implement the evidence-based practice of hand washing. Strategies to do this might include physicians modeling the behavior for other team members, putting hand sanitizer or sinks outside of patient rooms, or having observers report back to clinicians about their hand washing habits (i.e., audit and feedback).

Dr. Weiner discussed how implementation scientists are systematically studying the effectiveness of strategies designed to encourage the implementation of evidence-based interventions such as audit-and-feedback to clinicians or quality improvement facilitation to better understand implementation outcomes (e.g. fidelity of newly implemented programs to what were studies in clinical trials), service outcomes (e.g. program effectiveness and efficiency) and patient outcomes (e.g. morbidity and mortality).

Implementation science informs practice

The evidence from these implementation science studies can hopefully then inform the process of implementation practice and quality improvement in the way clinical research seeks to inform clinical practice. To do this however, Dr. Weiner identified important gaps in the science that should be addressed to increase its ability to informbridging_the_gap implementation practice. These include:

  1. The need to better understand how to optimize implementation strategies to the needs of specific settings. For example, how do we best use audit-and-feedback strategies for providers in different clinical or organizational situations? He suggested used of novel clinical trial methods to help address this gap, including the multiphase optimization strategy (MOST) and Sequential Multiple Assignment Randomized Trial (SMART) trial methods.
  2. The need to understand how to best implement programs in low-resource settings.
  3. Testing multi-level implementation strategies that may address barriers to implementation at the individual, interpersonal, organizational, community and polity levels.
  4. Spreading and sustaining successful programs.
  5. Understanding how to “de-implement” practice that the evidence suggests are not as effective as previously thought.
  6. Enhancing the use of theories to inform implementation science.
  7. Developing measures of implementation context, process, and outcomes that can be practically used by managers.

More information

More information on the potential uses of implementation science can be found in the following articles.

Curran GM, Bauer M, Mittman B, Pyne JM, Stetler C. Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact. Med Care. Mar 2012;50(3):217-226. [Link]

Jackson GL, Williams JW, Jr. Does PCMH “Work”?-The Need to Use Implementation Science to Make Sense of Conflicting Results. JAMA Intern Med. Aug 1 2015;175(8):1369-1370. [Link]

 

[Post-doctoral fellowship training in health services research is available, a collaboration of DGIM with the Center for Health Services Research in Primary Care in the Durham VA Medical Center.Training grants are funded by the VA Office of Academic Affairs (OAA). Learn more here.]

*George Jackson, PhD, MHA is Associate Professor of Medicine, a healthcare epidemiologist with the Center for Health Services Research in Primary Care and the Cooperative Studies Program Epidemiology Center at the Durham, NC Veterans Affairs Medical Center.