Advancing Scientific Discovery, Accelerating Impact

Implementation Science

Your research has proven to be an important discovery. But how do you move the discovery into real-world practice? If the goal of research is to generate new evidence-based practices that will have a positive impact on individual outcomes and population health, then translation to practice is key. Dissemination and implementation (D&I) research aims to accelerate the timely translation of evidence-based research findings to practice and policy by designing studies to better understand how interventions, practices, and innovations are launched and executed in specific settings. 

SCTR’s Dissemination and Implementation Science Collaborative (DISC) program brings together experts in the field of D&I research to provide investigators, trainees, and community partners with consultations, education, and resources focused on D&I methods and frameworks.  DISC’s Program Manager, Stephanie Oppenheimer, served as the facilitator of a recent discussion with DISC leadership to produce the following Q&A as an introductory resource for anyone interested in learning more about D&I research. The questions and their responses are divided into two parts.  Part I is presented here and is focused on defining D&I research, designing a D&I research study, and selecting a study team.  Part II will be presented in a future post and will focus on lessons learned and ways to connect with the DISC team and other D&I resources to advance your own D&I research study.

How would you define D&I research?

Katherine R Sterba
Implementation science is the umbrella term for a field focused on advancing the timely translation of research findings into practice to impact patient outcomes. It focuses on two broad areas. The first is dissemination research, which looks at how to use planned strategies to get innovations, new practices, or interventions adopted. Our other focus is implementation research, which looks at barriers and facilitators to optimize implementation outcomes.

The goal is to better understand the mechanisms through which interventions make their way into practice so that you can develop implementation strategies to accelerate that process. An additional area, sustainability, is an advancing field that looks at how to maintain innovations and practices over time.

National agencies fund great research, but often our innovations sit on the shelf because of a gap in our knowledge about how to best disseminate and implement these innovations.

Dee Ford
The D&I field is working to understand how we get well-established evidence-based best practices into routine patient care and health policy. We invest a lot in basic and translational research to better understand how we can improve human health, but unfortunately, a lot of those really important findings don't have good uptake. Even if there is uptake, it may take many years before a finding reaches people on a significant scale. Dissemination and implementation science seeks to understand how we can better accelerate that translational pathway.

“National agencies fund great research, but often our innovations sit on the shelf because of a gap in our knowledge about how to best disseminate and implement these innovations.” -- Dr. Katherine R. Sterba

Caitlin Allen
Implementation science focuses on finding ways to close the gap between what we know in research and what we do in practice. It addresses the question of how to enhance the uptake of evidence-based practices and interventions that we know work.

How did you get involved with D&I Research?

Dee Ford
I often say I came into this area of research through the back door, meaning I wasn't formally trained in implementation science, but recognized its importance in the context of Quality Improvement (QI) activities, which is largely about improving adherence to established best practices.

D&I science applies a rigorous methodology to better understand, at a high level, the factors I was grappling with in QI such as stakeholder engagement, intervention feasibility, and so forth. In our critical care research, we discovered applying D&I models and methods could provide important insights into our goal of adherence to ICU best practices.

Katherine R Sterba
I trained in public health. We were always taught to do strong process evaluations because if you're testing interventions and you don't track how it went, how it was delivered, whether it was adopted, its acceptability, and all these important implementation outcomes, in the end, you don't know what happened. If it didn't work, you don't know why or how it didn't work.  If it does work, you're excited, but you still don't know why or how it worked. So, these strong process models are something I've always built into my studies. Like many behavioral scientists, I have always been frustrated at how long it takes to get good interventions into practice. As the field of implementation science took hold, I was excited to jump into this new field to plan for dissemination and implementation.

Caitlin Allen
I was introduced to D&I research when I was working in the College of Medicine at Boston University. We had just established a Center for Implementation Improvement Science and we were talking more about quality improvement (QI) and thinking about ways to improve clinical outcomes at the hospital. We were interested in slowly shifting away from improvement science to implementation science and evaluation.

The focus of that center is similar to ours. We were educating clinicians and stakeholders about the distinctions between QI and implementation science.

Can you give an example of an Implementation Science conceptual model?

Katherine R Sterba
Implementation science is a field that values conceptual frameworks that can be used to guide all aspects of your research, from developing your research question to thinking through those different stakeholders whose perspectives are important to capture in your study, as well as to help guide the examination of determinants and processes that impact implementation outcomes. There are more than 100 of these models.

In the field, there are some great tools to help you narrow your focus based on the characteristics of your research question. We have some information about models on our website and would be happy to help investigators identify which model would be a good fit for a specific project during a consultation.

Can you give an example of one of your implementation science studies and how you arrived at your research question?

Dee Ford
I developed a program called ICU Innovations, which was an educational and training program for clinicians in smaller, rural hospitals in South Carolina.

“The research question became, what were the characteristics specific to the hospitals that had better uptake, dissemination, and engagement as compared to hospitals that didn’t.” -- Dr. Dee Ford

We wanted to help organizations that may not have access to expertise and new best practices implement clinical changes in their home institutions to improve patient care and outcomes. As I commented above, we initially grounded this in QI frameworks meaning we relied on local champions, asked sites to set their priorities, and determined what/how local adaptations were needed and so forth.  As we moved forward with our programming, we came to realize that some hospitals were well equipped for good uptake – they were engaged, committed, and disciplined – while some hospitals were not. We set about characterizing factors driving uptake and that’s where implementation science came into play. 

The research question became, what were the characteristics specific to the hospitals that had better uptake, dissemination, and engagement as compared to hospitals that didn't? We studied this through qualitative interviews, surveys, and program tracking logs. We kept documentation of the interactions and all the activities we asked hospitals to complete. That was my first foray from the quality improvement to the implementation science space.

Caitlin Allen
One of my first D&I research projects at MUSC was the In Our DNA initiative. From its inception, we had support from leadership to be integrating implementation science into the ways that we're thinking about the evaluation outcome. We have specific aims and a group, which includes Katie and others across campus, focused exclusively on the evaluation of the program. There are big-picture evaluation metrics that are important to the health system and important to MUSC. Knowing what those were, we worked backward and put together an implementation research logic model.

“Health care is being delivered here at MUSC in an academic Medical Center, but also, we’re now this larger system across the state that serves diverse patient populations that have different challenges and assets.” -- Dr. Dee Ford

We're also collecting data that can inform modifications and changes to the program in real-time as well as collecting some data that would hopefully contribute to broader implementation science methodologies. It's been a really fun and unique opportunity to be able from the very beginning to incorporate some of the implementation science frameworks.

Dee Ford
The Regional Health Network is another nice example and is relevant right now for implementation science questions. 

Health care is being delivered here at MUSC in an academic Medical Center, but also, we’re now this larger system across the state that serves diverse patient populations that have different challenges and assets. We can now think about the delivery of guideline-based care and disseminating best practices and interventions through the greater variety within the system.

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Stay tuned for Part II

The second feature with DISC’s experts will provide some examples of how D&I science addresses health disparities and insight on how to identify partners and stakeholders. Additionally, the team shares lessons learned to help you navigate common pitfalls and provides recommendations for how to prepare for a consultation with the DISC team to best address your specific questions and challenges.

Dissemination & Implementation Research Interest Group

The Dissemination & Implementation Research Interest Group brings together researchers interested in learning more about implementation science. Participation is open to those new to the field, as well as those who may already be engaged in implementation research. The group is fortunate to have outstanding members, several of whom are outside of MUSC. All meetings are held via Zoom, the 2nd Friday of the month at 1 p.m. If you are interested in participating, please register here. You only need to register once. Questions can be emailed to Rochelle Hanson.

2023-2024 Overview Schedule

Meet Our Experts

Dee Ford, M.D., MSCR
Program Director

Dee Ford, MD, MSCR is Division Director and Professor of Pulmonary and Critical Care Medicine.  She is the Program Director for DISC and a physician scientist with expertise in health services research, health professional education, and quality improvement.  She has 17 years of research experience, primarily focused on issues related to critical care, with uninterrupted extramural funding.  She is also a national leader in telehealth and serves as Program Director for MUSC’s federally recognized Telehealth Center of Excellence. 

 

Katherine Sterba Ph.D.

Associate Program Director

 

Katherine R. Sterba, Ph.D., MPH, is an implementation scientist in the Department of Public Health Sciences at MUSC. She received training in behavioral science, theory-driven intervention development, and scale development. Her research centers on creating novel platforms for scalable, technology-enabled supportive care interventions to address unmet needs and promote positive care transitions in cancer survivors and their caregivers. Her research concurrently focuses on understanding the determinants of the adoption of digital and telehealth interventions within diverse healthcare settings.

 

Caitlin G. Allen, Ph.D., MPH

Assistant Program Director

 

Caitlin G. Allen, PhD, MPH is a social and behavioral scientist with expertise in the implementation of evidence-based research to advance precision public health initiatives. She is a thought leader in the field of precision public health, with her work highlighted in Nature and Harvard Public Health Magazine. Her overarching research goal is to support the translation of genomics applications to maximize population health impact and improve health equity. To achieve this goal, Dr. Allen focuses on contributing to the field in three key areas: 1) participatory implementation science to support community engagement in genomics and precision public health research, 2) workforce diversity through the training of community health workers in genomics research competencies, and 3) novel approaches to communicating genomic information among diverse populations (e.g., risk communication, results disclosure, family health history). Dr. Allen is also a dedicated mentor who is passionate about training the next generation of scientists in the field of precision public health.