Symposium 1 – May 17, 2013
Note: This is a video of all the morning sessions. You will need to scroll forward to view the presentations listed below.
Implementation Science in an Era of Health Reform & Patient-Centered Comparative Effectiveness Research: New Threats, New Expectations, New Opportunities
Presenter: Brian S. Mittman, PhD
Author: Brian S. Mittman, PhD, VA Greater Los Angeles Healthcare System & Kaiser Permanente Southern California
Author: The field of implementation science is enjoying a surge of attention and interest throughout the world, driven by increasing recognition of gaps in the quality and outcomes of health services (and other social services) – and gaps in the appropriate use of effective practices and innovations – as well as by economic pressures and additional policy initiatives (e.g., health reform in the US). This new attention offers the promise of increased funding and other support, but accompanied by heightened expectations and scrutiny. This presentation begins with a brief overview of these and other trends in the field of health research (e.g., the rise of patient-centeredness and engagement as a dominant value in clinical, health services and health behavior research), and then identifies several specific threats and opportunities they pose for implementation science. Possible responses are suggested, including suggested actions by individual implementation scientists, research program leaders and funding agencies, and other key stakeholders.
Synthesis of Findings from 3 Lifestyle Behavior Change Program Implementations in the VA
Presenter: Laura J. Damschroder, MS, MPH
Authors: Laura J. Damschroder, MS, MPH, Julie C. Lowery, PhD, VA Ann Arbor Healthcare System
Abstract: There is urgent need to implement evidence-based lifestyle change interventions more widely in healthcare settings. However, evidence supporting multi-dimensional, complex implementation strategies and techniques consistently shows mixed results with repeated calls for needed research into “context.??? Research on context has been dominated by single or small sample case studies without using a theoretical structure to promote comparison across studies. We used the Consolidated Framework for Implementation Research (CFIR), a theory-based taxonomy of contextual constructs, in a series of 3 implementation studies of lifestyle behavior change programs for Veterans. Some contextual factors were influential regardless of the program, such as nature and quality of networks and communications, though specific behaviors varied by program. Other contextual factors varied; e.g., the group-based program implementation was heavily influenced by stakeholder perceptions of the relative advantage of the new program compared to other options but this construct did not influence success for the other programs. Insights into why and how these constructs manifest differently based on differences in intervention characteristics, settings, and processes will be presented. Use of a common theoretical framework allowed this synthesis to take place, demonstrating how a knowledge-base can be more readily built to help accelerate implementation of evidence-based lifestyle behavior change interventions.
Racial/Ethnic Disparities & the Implementation of Evidence-Based Practices in Public Youth-Serving Systems
Presenter: Antonio R. Garcia, PhD
Authors: Antonio R. Garcia, PhD, School of Social Policy & Practice, University of Pennsylvania, Lawrence A. Palinkas, PhD, School of Social Work, University of Southern California, Lonnie Snowden, PhD, School of Public Health, University of California-Berkeley, Lisa Saldana, PhD, Patricia Chamberlain, PhD, Center for Research to Practice, Eugene, Oregon
Abstract: Much of the disparities in the delivery and outcomes of child welfare services can be attributed to differences in the implementation of high-quality evidence-based practices (EBPs). However, no research to date has identified socio-environmental and organizational barriers to and facilitators of successful implementation of EBPs among high and low minority concentrated areas (MCAs). To address this gap and understand the role of research evidence use in bringing EBPs to scale, the current study utilized data from a larger randomized trial comparing the use of Community Development Teams (CDTs) versus standard implementation strategies to implement Multidimensional Treatment Foster Care to scale in California and Ohio. While findings point to no differences in the number of implementation activities completed, multi-group path analyses revealed that there are significant differences in which socio-ecological and organizational factors significantly predict implementation outcomes between high and low MCAs. Study findings highlight that more attention should be devoted to improving the organizational social context in preparing for and actively implementing EBPs to scale to disrupt structural disparities. Further implications for practice innovation and research to improve implementation outcomes will be discussed.