Too much theory and not enough practice? The challenge of implementation science application in healthcare practice

BACKGROUND The past 30 years have witnessed such significant progress in the prevention and treatment of HIV/AIDS that an AIDS-free generation and the end to the global AIDS epidemic are ambitious, but achievable, national and global goals. Despite growing optimism, globally, youth living with HIV are markedly less likely to receive antiretroviral therapy than adults (23% vs 38%). Furthermore, marked health disparities exist regarding HIV infection risk, with young men of color who have sex with men disproportionately affected. A large body of research has identified highly impactful facilitators of and barriers to behavior change. Several efficacious interventions have been created that decrease the rate of new HIV infections among youth and reduce morbidity among youth living with HIV. However, full benefits that should be possible based on the tools and interventions currently available are yet to be realized in youth, in large part, because efficacious interventions have not been implemented in real-world settings. Scale It Up (SIU) primarily aims to assemble research teams that will ultimately bring to practice evidence-based interventions that positively impact the youth HIV prevention and care cascades, and in turn, advance the fields of implementation science and self-management science. OBJECTIVE This paper aims to describe the structure of the U19-SIU and the effectiveness-implementation hybrid trials, as well as other center-wide protocols and initiatives, implemented within SIU. METHODS SIU will achieve its aims through 4 individual primary protocols, 2 center-wide protocols, and 3 cross-project initiatives. RESULTS SIU was funded by National Institute for Child Health and Human Development (U19HD089875) and began in October 2016. As of November 2018, 6 SIU protocols have launched at least the first phase of work (ATN 144 SMART: Sequential Multiple Assignment Randomized Trial; ATN 145 YMHP: Young Men’s Health Project; ATN 146 TMI: Tailored Motivational Interviewing Intervention; ATN 153 EPIS: Exploration, Preparation, Implementation, Sustainment model; ATN 154 CM: Cascade Monitoring; ATN 156 We Test: Couples' Communication and HIV Testing). Further details can be found in the individual protocol papers. CONCLUSIONS To date, the youth HIV research portfolio has not adequately advanced the important care area of self-management. SIU protocols and initiatives address this broad issue by focusing on evaluating the effectiveness and implementation of self-management interventions. SIU is highly innovative for 5 primary reasons: (1) our research framework expands the application of “self-management”; (2) the 4 primary protocols utilize innovative hybrid designs; (3) our Analytic Core will conduct cost-effectiveness analyses of each intervention; (4) across all 4 primary protocols, our Implementation Science Core will apply implementation scales designed to assess inner and outer context factors; and (5) we shall advance understanding of the dynamics between provider and patient through analysis of recorded interactions. INTERNATIONAL REGISTERED REPOR DERR1-10.2196/11204

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Best Practices for Data Visualization: Creating and Evaluating a Report for an Evidence-Based Fall Prevention Program (Preprint)

10.2196/preprints.12801 ◽

2018 ◽

Author(s):

Srijesa Khasnabish ◽

Zoe Burns ◽

Madeline Couch ◽

Mary Mullin ◽

Randall Newmark ◽

...

Keyword(s):

Literature Review ◽

Best Practices ◽

Implementation Science ◽

Data Visualization ◽

Systematic Literature Review ◽

Fall Prevention ◽

Prevention Program ◽

Evidence Based ◽

Data Display ◽

Fall Prevention Program

BACKGROUND Data visualization experts have identified core principles to follow when creating visual displays of data that facilitate comprehension. Such principles can be applied to creating effective reports for clinicians that display compliance with quality improvement protocols. A basic tenet of implementation science is continuous monitoring and feedback. Applying best practices for data visualization to reports for clinicians can catalyze implementation and sustainment of new protocols. OBJECTIVE To apply best practices for data visualization to create reports that clinicians find clear and useful. METHODS First, we conducted a systematic literature review to identify best practices for data visualization. We applied these findings and feedback collected via a questionnaire to improve the Fall TIPS Monthly Report (FTMR), which shows compliance with an evidence-based fall prevention program, Fall TIPS (Tailoring Interventions for Patient Safety). This questionnaire was based on the requirements for effective data display suggested by expert Stephen Few. We then evaluated usability of the FTMR using a 15-item Health Information Technology Usability Evaluation Scale (Health-ITUES). Items were rated on a 5-point Likert scale from strongly disagree (1) to strongly agree (5). RESULTS The results of the systematic literature review emphasized that the ideal data display maximizes the information communicated while minimizing the cognitive efforts involved with data interpretation. Factors to consider include selecting the correct type of display (e.g. line vs bar graph) and creating simplistic reports. The qualitative and quantitative evaluations of the original and final FTMR revealed improved perceptions of the visual display of the reports and their usability. Themes that emerged from the staff interviews emphasized the value of simplified reports, meaningful data, and usefulness to clinicians. The mean (SD) rating on the Health-ITUES scale when evaluating the original FTMR was 3.86 (0.19) and increased to 4.29 (0.11) when evaluating the revised FTMR (Mann Whitney U Test, z=-12.25, P<0.001). CONCLUSIONS Best practices identified through a systematic review can be applied to create effective reports for clinician use. The lessons learned from evaluating FTMR perceptions and measuring usability can be applied to creating effective reports for clinician use in the context of other implementation science projects.

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Feasibility of Using Electronic Health Records (EHR) for cascade monitoring and cost estimates in implementation science studies in the Adolescent Trials Network for HIV/AIDS Interventions (ATN) (Preprint)

10.2196/preprints.25483 ◽

2020 ◽

Author(s):

Tyra Dark ◽

Kit N. Simpson ◽

Sitaji Gurung ◽

Amy L Pennar ◽

Marshall Chew ◽

...

Keyword(s):

Electronic Health Records ◽

Data Management ◽

Implementation Science ◽

Science Studies ◽

Selection Process ◽

Health Records ◽

Electronic Health ◽

Access To Data ◽

Youth Living With Hiv ◽

Hiv Aids

UNSTRUCTURED Objective. The proportion of youth living with HIV/AIDS (YLH) on ART and virally undetectable is low, highlighting significant challenges for reaching the Joint United Nations Program on HIV targets. Increased attention to measurement and monitoring of care engagement highlights a needed framework for assessing progress across the care continuum. To this end, the Cascade Monitoring (CM) study was designed to assess the feasibility of using electronic health records (EHR) for cascade related implementation science outcomes. Methods. EHR data was systematically obtained from multiple clinical sites and utilized to capture the CDC’s four continuum of care measures. Results. The use of EHR data works well for assessing patterns of completed visits. Sites with access to data management resources work more efficiently for CM study purposes. Conclusions. Site data management resources should be a part of the selection process when identifying site partners for clinical studies that plan to use EHR data.

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Adaptation in Dissemination and Implementation Science

10.1093/oso/9780190683214.003.0017 ◽

2017 ◽

Cited By ~ 19

Author(s):

Ana A. Baumann ◽

Leopoldo J. Cabassa ◽

Shannon Wiltsey Stirman

Keyword(s):

Implementation Science ◽

Implementation Research ◽

Implementation Strategies ◽

Dissemination And Implementation ◽

Research And Practice ◽

Implementation Outcomes ◽

Dissemination And Implementation Science ◽

Dissemination And Implementation Research

This chapter focuses on adaptations in the context of dissemination and implementation research and practice. Consistent with the existing literature, the authors recommend that adaptations be proactively and iteratively determined, strongly informed by a variety of stakeholders, and that efforts be made to carefully describe and document the nature of the adaptations and evaluate their impact on desired service, health, and implementation outcomes. While this chapter focuses on adaptations to interventions and the context of practice, the authors also note that adaptations may need to be made to implementation strategies. Following the call by Proctor and colleagues for further precision in defining and operationalizing implementation strategies, and based on evidence that scholars are not necessarily reporting what and how they are adapting the interventions, scholars are urged to define and evaluate the adaptations they are making not only to the interventions and context of practice but also to the implementation strategies.

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