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Chapter 1 : Why is D&I important?

The promises and challenges

“We know from the Institute of Medicine that :… the stark reality [is] that we invest billions in research to find appropriate treatments, we spend more than $1 trillion on health care annually, [and] we have extraordinary knowledge and capacity to deliver the best care in the world, but we repeatedly fail to translate that knowledge and capacity into clinical practice. This is why implementation science is so vitally important to achieve our national health goals.”
— Elaine Morrato, DrPH, MPH
Associate Professor of Health Systems Management and Policy,
Colorado School of Public Health | Collaborative Scientific Lead,
Center for Research in Implementation Science and Prevention (CRISP)
"There is a big gap between what we could accomplish in the area of prevention and what we are currently accomplishing in primary care practice in this country. Preventive services that work are not reaching many people who need them. Out mission is to advance the understanding of how to get preventive services that have been shown to be effective to be widely implemented. Simply put, to learn how to get the right preventive care to the right people at the right time."
— Allison Kempe, MD, MPH
Professor of Pediatrics, University of Colorado School of Medicine
Director, Children's Outcomes Research (COR), Children's Hospital Colorado
Director, Center for Research in Implementation Science and Prevention (CRISP)

Learning Objective:

To understand the importance of dissemination and implementation research and practice in achieving a healthy America, and its challenges.

What national organizations are saying...

Closing the gap between research discovery and clinical and community practice is both a complex challenge and an absolute necessity if we are to ensure that all populations benefit from the Nation's investments in scientific discoveries

— National Institutes of Health,
Dissemination and Implementation Research in Health PAR-10-038

[A national] Comparative Effectiveness Research (CER) Program should promote rapid adoption of CER findings and conduct research to identify the most effective strategies for disseminating new and existing CER findings to health care professionals, consumers, patients, and caregivers and for helping them to implement these results in daily clinical practice.

— Institute of Medicine,
Initial National Priorities for Comparative Effectiveness Research (2009)

A research priority... Efficiency: Transform[ing] research into practice to facilitate wider access to effective health care services and reduce unnecessary costs

— Patient-Centered Outcomes Research Institute,

National Priorities for Research (2012)

A focus area….. Efficiency: Transform[ing] research into practice to facilitate wider access to effective health care services and reduce unnecessary costs.

— Agency for Healthcare Research and Quality,
Focus and Strategic Goals

[D&I] models help to bridge the gap between research and practice by providing the structure that can be used to spread evidence-based approaches that prevent disease, promote health, and improve health services.

— Centers for Disease Control and Prevention,
Prevention Research Centers

Implementation research is a new, dynamic, evolving area of inquiry. It is closely linked to the work of implementation, although there are key differences between doing implementation—actually putting into practice new policies, procedures, or approaches—and doing research on implementation. . . Studying how implementation is done can lead to new insights to improve implementation practice.

— Veteran’s Administration,
Quality Enhancement Research Initiative (QUERI)
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A Fundamental Transformation is on its way.


Historically, dissemination and implementation has not been a research priority.

However, there has been increasing recognition of the need to invest in translating research into practice in order to achieve the promised benefits.

National funding in dissemination and implementation-ready research is being spearheaded by PCORI…

…and the Healthcare Systems Research Collaboratory funded by the NIH Common Fund.

Funds, totaling approximately $11.3 million, will support the first year of the Collaboratory, which will engage health care systems as research partners in conducting large-scale clinical studies.

Resources

AHRQ

The first website has links to AHRQ’s portfolio for research in: comparative effectiveness, health information technology, innovations & emerging issues, patient safety, prevention & care management, and value. The second website lists grant announcements from AHRQ for supporting research to improve the quality, effectiveness, accessibility, and cost effectiveness of health care. New funding announcements have been appearing regularly in the area of dissemination and implementation research.
Click For Source 1Click For Source 2

PCORI

This report describes how PCORI’s national research priorities were developed from earlier comparative effectiveness research prioritization efforts and from stakeholder input. Five priority areas were identified: (1) assessment of prevention, diagnosis, and treatments; (2) improving healthcare systems; (3) communication and dissemination research; (4) addressing disparities; and (5) accelerating patient-centered outcomes research and methodological research.
Click For Source

NIH

This paper addresses D&I terminology, provides examples of successful research, and highlights directions and opportunities for future advances in the field. The authors discuss the need for research testing approaches to scaling up and sustaining effective interventions. They also propose that the research field focus on five core values: (1) rigor and relevance, (2) efficiency, (3) collaboration, (4) improved capacity, and (5) cumulative knowledge.
Click For Source

QUERI

This paper is part of a series which discusses the Quality Enhancement Research Initiative (QUERI) within the U.S. Veterans Health Administration (VA). QUERI was created to generate research-driven initiatives that directly enhance health care quality within the VA and, simultaneously, contribute to the field of implementation science. The article describes the underlying change framework and implementation strategy used to operationalize QUERI. It discusses a unique form of funding and study focused to encourage action-oriented improvement research.
Click For Source

New and Future Directions in Implementation Science

Russell Glasgow, PhD
Borsika Rabin, PhD, PharmD, MPH
 Slides Video

This seminar offers learnings from Dr. Glasgow and Rabin’s strategic planning meetings with NIH and PCORI, and insights on how to significantly increase the competitiveness and scores of applications to pragmatic research groups such as NIH Dissemination and Implementation, PCORI, and other new pragmatic research RFAs.

AHRQ

The first website has links to AHRQ’s portfolio for research in: comparative effectiveness, health information technology, innovations & emerging issues, patient safety, prevention & care management, and value. The second website lists grant announcements from AHRQ for supporting research to improve the quality, effectiveness, accessibility, and cost effectiveness of health care. New funding announcements have been appearing regularly in the area of dissemination and implementation research.
SourceSource 2

NIH

This paper addresses D&I terminology, provides examples of successful research, and highlights directions and opportunities for future advances in the field. The authors discuss the need for research testing approaches to scaling up and sustaining effective interventions. They also propose that the research field focus on five core values: (1) rigor and relevance, (2) efficiency, (3) collaboration, (4) improved capacity, and (5) cumulative knowledge.
Source

PCORI

This report describes how PCORI’s national research priorities were developed from earlier comparative effectiveness research prioritization efforts and from stakeholder input. Five priority areas were identified: (1) assessment of prevention, diagnosis, and treatments; (2) improving healthcare systems; (3) communication and dissemination research; (4) addressing disparities; and (5) accelerating patient-centered outcomes research and methodological research.
Source

QUERI

This paper is part of a series which discusses the Quality Enhancement Research Initiative (QUERI) within the U.S. Veterans Health Administration (VA). QUERI was created to generate research-driven initiatives that directly enhance health care quality within the VA and, simultaneously, contribute to the field of implementation science. The article describes the underlying change framework and implementation strategy used to operationalize QUERI. It discusses a unique form of funding and study focused to encourage action-oriented improvement research.
Source

Key Takeaways

Click To Reveal Flipcard Answer

How does D&I Intend to Create Value?

  • D&I is about implementing proven services, especially preventive.

  • We know there is a delay in translating research into practice; we aim to address this and more.

According to many National Organizations,

what can D&I do, and for whom?

  • Benefits the population it serves, and helps organizations/individuals do so (greater efficacy, greater outcomes, better population health)

  • It increases the efficiency of health services and health service providers (reduced costs)

  • Leads to new insights!

How can this e-book help you get familiar with D&I?

  • Recommended readings

  • Descriptions of various research areas

  • Terminology, examples of success, opportunities for new projects

  • Priority setting

Checklist To Get Started

  • Who else is working in D&I research in my field of interest?

  • What are emerging topics in the field?

  • What are the unique challenges and opportunities in my field of interest?

  • Is there anyone with whom I can collaborate?

Read Chapter 2