Implementation Science: Translating Discoveries to Medical Applications with Caitlin Allen, PhD

The goal of biomedical research is to move healthcare innovations, like evidence-based programs and interventions, to places where patients can access them for their benefit. But there are often challenges to making this happen. One study estimates that less than half of clinical innovations make it into routine practice. This can be due to the time it takes to translate research into practice, a lack of training on the part of researchers about how to move their work closer to patient care, and because often the setting researchers use doesn't reflect the real-world settings where innovations would be delivered. Luckily, there's a special area of research designed to help improve this process called Implementation Science.

In this episode of Science Never Sleeps, we're joined by Dr. Caitlin Allen, an assistant professor in the Public Health Science Department in the MUSC College of Medicine. Dr. Allen is a social and behavioral scientist with expertise in the implementation of evidence-based research to advance precision public health initiatives. Her overarching research goal is to support the translation of genomics applications to maximize population health impact and improve health equity. Dr. Allen is also a 2024 MUSC Developing Scholar Award recipient.

Read The Transcript

[00:00:01] Gwen Bouchie: From the Medical University of South Carolina, this is Science Never Sleeps. A show that explores the science, the people, and the stories behind the scenes of biomedical research happening at MUSC. I'm Gwen Bouchie.

The goal of biomedical research is to move healthcare innovations, like evidence-based programs and interventions, to places where patients can access them for their benefit. But there are often challenges to making this happen. One study estimates that less than half of clinical innovations make it into routine practice. This can be due to the time it takes to translate research into practice, a lack of training on the part of researchers about how to move their work closer to patient care, and because often the setting researchers use doesn't reflect the real-world settings where innovations would be delivered. Luckily, there's a special area of research designed to help improve this process called Implementation Science.

In this episode of Science Never Sleeps, we're joined by Dr. Caitlin Allen, an assistant professor in the Public Health Science Department in the MUSC College of Medicine. Dr. Allen is a social and behavioral scientist with expertise in the implementation of evidence-based research to advance precision public health initiatives. Her overarching research goal is to support the translation of genomics applications to maximize population health impact and improve health equity. Dr. Allen is also a 2024 MUSC Developing Scholar Award recipient.

Stay with us.

[00:01:38] Bouchie: Dr. Allen, welcome to Science Never Sleeps.

[00:01:40] Caitlin Allen, Ph.D.: Thanks so much for having me.

[00:01:42] Bouchie: We spend a lot of time on this podcast talking with researchers and about science that oftentimes people would think as typical quote unquote science. So, science that involves microscopes, imaging, talking about specific health states. But as a social scientist, you're in a bit of a different category, but your science is essential to how discoveries are moved towards patient impact and patient care. Can you talk a little bit about how you got into this area of science?

[00:02:13] Allen: Sure, so like you said, I was trained as a social behavioral scientist, which basically means that I study why people – or I learned to study why people do the things they do, right, so why are people more likely to eat healthy than to – or exercise more? How do we motivate people to do those things? And I have sort of since evolved that into really thinking about more broadly why organizations and institutions and people within those places do the things they do, right? And that's where this implementation science concept comes in, where I am focused on studying how to get best practices and interventions into different settings.

[00:03:07] Bouchie: And did you encounter that in some specific way when you were coming through your education where you thought, wow, this really piques my interest?

[00:03:15] Allen: So, it's funny because I was actually a biology major when I was an undergrad. And I wasn't super fascinated by the lab portions of it. I did it because we needed to. But I was more and more interested in the human side and thinking about how the work that on the bench, literally, would then be able to be translated to, like, what was the use of this, right? How do we really get it into the hands of the individuals, the doctors, the communities that need the information, need the drug, need the discovery? And so, I think that's always just been how I've leaned a little bit is that I've been curious about science, but I want to get it out and into the world and have that bigger impact.

[00:04:08] Bouchie: Yeah. So I think that's a really great segue to talk about what actually is implementation science. When we say those words, what does that mean?

[00:04:16] Allen: Yeah, so put really simply, implementation science is the study of how we do things, right? So how do we put interventions or put ideas, put discovery, that's the “thing”, into practice. And practice can be defined as literally a clinical practice. It can be defined as a community organization. But how do we take all of the wonderful discoveries and ideas that are generated by scientists and get them into real world settings? And so implementation science gives us the methods and the tools to really study the best way to do that, and then be able to replicate that for maximizing our impact.

[00:05:05] Bouchie: And when we look at this type of science, we can talk about implementing something. It can be both at an individual level, like you mentioned, exercise, or it can be all the way out to a population level, which is where your particular interests lie.

[00:05:21] Allen: Yeah, and it can be anywhere in between, right? So it could – implementation science is, if you think about it, at the population level – how do we have an entire, how do we sort of tailor an intervention or a new innovation or a new discovery for a population so that they would really want to adopt it and they would want to use it, right? Or if you think about in a more clinical setting, maybe there's new guidelines, right? There's new guidelines that have come about around mammograms or colonoscopies, right? How do we make sure that those guidelines are what is being used in clinical practice? So you can really think about it across the spectrum from the individual level all the way through organization or population level.

[00:06:22] Bouchie: So you mentioned mammography and colonoscopy guidelines or the screening recommendations and how those change. What are some other examples of ways that we might be using implementation science that we might not realize it?

[00:06:39] Allen: Yeah, I think that's a great question. So one of the things that comes to mind is a lot of what we see, let's say, when you go to the doctor, right? You go to your primary care doctor, and they are asking you about family history. Let's just use that as an example. That's standard of care. And you can think about that from an implementation science lens because we probably didn't, you know, we weren't necessarily always collecting family history or always collecting it in the same way. And so implementation science would allow for us to figure out, for example, the best way to collect family history. So, Is it better to ask those questions of an individual right when they walk in? Or is it better to ask them at the end of the visit or in the middle of the visit? You could also think about it as, is it better to ask family history on a piece of paper or on an app, right? So those are different modalities and that's sort of at the individual level. And then if you think about this from kind of the clinician level or the practice level, There might be variations in what we call implementation strategies. So, what are the ways that we can motivate our clinicians to ask those questions or to use that information and incorporate it into their practice? So, there's all sorts of different kind of elements at, again, that individual level, as well as more at the implementation strategy level, which is thinking about more of the providers and the clinical settings.

[00:08:33] Bouchie: And that is really such a great example too, because even within that, you know, you talked about paper versus an app, but we didn't start out with an app. So even once we adopted collecting family history as a best practice within standard of care, there were... there were changes and innovations that came to that process. And one of those was you might be handed a tablet now when you walk into your doctor, or you might get a link on your phone through a text message that says, complete this before you arrive. And so, it really does seem like there's so many things, even as things that have already been implemented are changing that you can look into through an implementation science lens.

[00:09:13] Allen: Yeah, and I think that's exactly right. It's like the speed at which we're able to do science, quote unquote science, like we sort of traditionally think of, is so much faster than ever before. We have this amazing technology and resources to just iterate and innovate so quickly. And implementation science lets us, you know, let's that happen, but then get it into practice faster so that we're not still collecting family history on a piece of paper when we could do it much more efficiently on an app or on a tablet or whatever else. And so, the same is true for drugs, the same is true for just incorporating genetic information. It's being able to use the best evidence and the best science at the point of care if you're in a clinical setting, or in a community setting, being able to deliver the most evidence-based intervention.

[00:10:11] Bouchie: And so, when we look at that, what are some of the barriers that you often encounter when you think about implementation of a thing? Implementation is, like you said, doing a thing. So, what are some of the barriers to sometimes doing the thing?

[00:10:29] Allen: I think some of the barriers are things that we might just think of kind of ad hoc, right? If you think about people wanting to change, it's tough, right? So, if we come in with this new idea, this new innovation, you might think about some of the barriers around perceptions and hesitation about that new idea or about that new thing. And so again, implementation science and the implementation strategies can help us overcome those or address them sort of proactively. So, we might ask about people's hesitations or perceptions before we bring in the thing to help reduce that. I think some of the other barriers and challenges are, will this new innovation be better than current practice, current state? So, we sort of call this like a tension for change, right? So, are we, as an organization or as a clinic or as whatever sort of level, are we really hurting so much with doing what we're doing right now in order to mandate or require that change? Or are things okay as they are? So those are just some examples and there's tons of different sort of implementation science theories that would help us think about those barriers and also facilitators, things that might help implement.

[00:12:02] Bouchie: So then how is your field working to address some of these barriers and maybe that's through facilitators too. You also mentioned facilitators as the other side of that coin.

[00:12:11] Allen: So, some of the kind of tools that we have in our toolkit as implementation scientists are really asking questions of the people who might be adopting the new thing. So it could be as simple as prior to trying to get an site or organization to adopt something, conducting surveys with the end users, whether that's patients or providers, and asking them their thoughts about that new tool or resource, and then tailoring your approach based on what you learned from them. You could also do a lot of qualitative work, and that's sitting down and doing interviews with individuals. And then you could... if you didn't necessarily have an implementation scientist at the table when trying to get people to adopt your new innovation, then you could do it at the end, right? Maybe things didn't go as well as you expected when trying to implement a new app or have people use a new vaccine or something like that. And you could sort of retrospectively go to the people that used it and also to people that didn't and ask similar questions about why they did or did not use that through surveys, through interviews, or combination thereof, and get that information for the next attempt to implement.

[00:13:44] Bouchie: And it's really so fascinating because it really is person-centered. It's really a person-centered thing, where it's the more you know about the people that you are trying to, let's just say, serve, the better your outcome can potentially be for the thing you're trying to implement. I mean, it starts maybe sometimes with the thing, but really the place it should start is with the people.

[00:14:08] Allen: Yeah, I think you're right, where... I think with... we're all, as scientists, right? We're really motivated to solve a problem. And I think oftentimes can get pretty siloed into that specific issue because you have to be right? You have to be really thinking about and honing in on a particular drug that you're trying to discover or a particular cure for whatever disease you're trying to discover and can sometimes lose sight of that side, of the person like who... as I said in the beginning, I've always been attracted to this idea of like, well who is going to use this, right? And so, I think what how you framed it is right where it's kind of starting with that... who is doing or who are we trying to reach and working backwards from there. And you know, meeting in the middle really, I think of myself oftentimes as a bridge between the bench and the “who”, the human or the people that we're trying to get the innovations to.

[00:15:15] Bouchie: Yeah. Within all of this, your research goal is about supporting the translation of genomics maximize population health impact and to improve health equity for all. Can you tell us a little bit about what you mean when you are talking about genomics applications and how they maximize population health impact? Let's just start with that.

[00:15:43] Allen: Yeah. So my particular interest as an implementation scientist is, as you said, to really implement all of this amazing innovation we have in the genomic space. And I mentioned earlier that we are now efficient and rapid at discovery. And I think genomics is a great example of how fast and how much information is constantly coming at us and how much information is available for individuals, for providers. And genomic information can be so critical prevention as well as treatment, right? So, in my mind, it's a great sort of case study or use case for implementation science because not only do we have things right now that are ready to be implemented, but we also constantly are discovering and need to re-implement. And so, a specific sort of example or idea around this is, that if we're getting genetic tests, right? How do we make sure that the information from those genetic tests are available to clinicians when they're making decisions about patients, right? Because the information from your genetic information can have an impact on recommendations that you might have or you might receive as a patient for screening, right? It might increase the amount of mammograms you need to get per year. And it also could have an impact on treatment decisions, so impact on the drugs that you might receive for a cancer treatment, for example. And so, there are very direct kind of benefits to having that information, and implementation science can help us to make sure that in those cases, the providers have the information in real time, or as real time as possible, to then make some of those decisions with the patients.

[00:17:54] Bouchie: Right, and this is another example of that idea of like, a thing that's been implemented, so if we think about the electronic health record as that “thing”, which, you know, came about in the last, I don't know, 20 years maybe, trying to get electronic health records up, and so now, how do you make sure that all of the information that is necessary for patient care is implemented into that electronic health record. And not just done but done in a way that is useful for the providers who are on the end of it who are going to be using it.

[00:18:30] Allen: Yep. Yeah. Yeah, because we can have tons and tons of information about someone. And if it's not available in a user-friendly way, then it's just information sitting in a record, right? So, optimizing that is a great example.

[00:18:53] Bouchie: And at the end of the day, you're really talking about improving lives and health because it's making that information as available as quickly as possible so that medical decisions can be made that could save people's lives ultimately.

[00:19:10] Allen: Yeah, and I think making... because the innovations are happening so rapidly, it's also making sure that everything's up to date, right? So, something that we might have known a year ago, it could be very different today, right, in this space. And so, we want to not only make sure that, to make sure that we're really up to speed and in real time as much as possible, providing all of that information. to help with prevention and treatment.

So, one of the things that you mentioned that I think is really important in this space is around the health equity side of this and implementing genomic medicine in a way that is not only keeping up with sort of the real time needs, but also that is doing so in an equitable way, right? And so, making sure that we're providing all of these resources to all populations that people are understanding the information. So, we're providing health information in a way that is appropriate from a literacy perspective. And also that these innovations are not just available in clinical settings like MUSC, which is a well-resourced academic medical center, but also that any sort of community type of clinic could also be using genetic information, right? So how do we sort of optimize and make sure that everything is accessible and available across the board.

[00:20:50] Bouchie: So, I'm going to ask you to take out your crystal ball for a second and talk a little bit about where you think the future of implementation science is going from here.

[00:21:00] Allen: I wish I had a crystal ball and predict a lot of things. But as far as the field of implementation science... you know I think there has been so much interest in the space growing interest sort of nationally, as well as locally at MUSC, for the past like 15 or 20 years. And we've oftentimes talked about implementation science as being this new field, it's developing, it's growing. But I do think we're at a point where like we can call ourselves a science, right? Like this is the science of how to do the “thing” in real world settings. So, I'm simplifying it. But you know, so kind of that mentality shift as a field to saying like, we actually do have a toolkit, we do have methods, we do have theories that are really, really beneficial to getting interventions and innovations into practice. So, I think that's one piece of it. I also think that there's a lot of movement in the field toward studying adaptations. And so we kind of talked about that earlier where as things are evolving so much more rapidly, as implementation scientists, we need to be thinking about the changes that are inherently going to be happening in the field, and how do we plan for those so that we're not just implementing a thing once and assuming it's working forever, but plan for the inevitable changes and modifications that are going to come. And then I think the last area I'll say within the implementation science space is really around sustainability, right? So, the sustainability of an intervention long-term, and similar to what I mentioned around adaptations, where we're sort of planning for change, but sustainability is, I think, a bit broader, where we want to make sure that we're studying the best practices, the best ways to sustain a new idea, a new intervention so that we can have it for the long term.

[00:23:17] Bouchie: Dr. Allen, thanks for joining us.

[00:23:19] Allen: Thank you so much.

[00:23:21] Bouchie: We've been talking to Dr. Caitlin Allen about implementation science and its critical role in helping to get medical discoveries to patients. Have an idea for a future episode of Science Never Sleeps? Click on the link in the show notes to share with us. Science Never Sleeps is produced by the Office of the Vice President for Research at the Medical University of South Carolina. Special thanks to the Office of Instructional Technology for production support on this episode.