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March 1, 2017

Implementation Science for the Frontline Clinician

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JoAnn E. Kirchner, MD; Eva N. Woodward, PhD; and Mark S. Bauer, MD

Central Arkansas Veterans Healthcare System, North Little Rock (Drs Kirchner, Woodward, & Bauer); University of Arkansas for Medical Sciences, Little Rock (Drs Kirchner & Woodward); and Harvard Medical School, Cambridge, and US Department of Veterans Affairs, Boston, Massachusetts (Dr Bauer)​​

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Most clinicians want to, or are expected to, improve their clinical practice. Instead of asking clinicians to work faster or longer, implementation science offers another option by providing frontline practitioners, clinical managers, and policy makers with tools, processes, and strategies that can assist them in improving their practice. When we have made presentations about implementation science to frontline practitioners and managers, we have found vibrant interest in the topic but uncertainty as to how it would be applicable in nonresearch settings.

The study of evidence-based practice (EBP) implementation emerged from the recognition of a significant time delay between a new practice showing efficacy and effectiveness in research trials and the uptake of that EBP into routine clinical care. Of the EBPs that even make it into routine care, the length of time estimated for this uptake is reportedly 17 years, although the research determining that number is somewhat elusive. Regardless, agreement exists that the gap between the establishment of evidence for a new practice and routine uptake of it is far too long.

Many clinicians have helped to implement new EBPs through conducting quality improvement initiatives. Quality improvement initiatives are not new; they can be found in commercially available programs such as those from the Institute for Healthcare Improvement or through local staff who focus on quality improvement (eg, Lean, Six Sigma). Yet, although these programs are designed to target intervention uptake, implementation science extended the field of quality improvement by promoting rigorous study of what strategies should be used in which setting, for what group of providers and managers, and for what practice.

Implementation science is an emerging, interdisciplinary field dedicated to studying how research findings or EBPs are best adopted into routine care, especially ones that rely on more than a single provider or team of providers. Just as there is a science that supports rigorous testing of new clinical interventions (eg, clinical trials), the emerging field of implementation science consists of a growing portfolio of rigorously tested implementation strategies, or highly specified activities that seek to improve uptake of EBPs by targeting barriers faced by providers or health care organizations, usually through partnerships between clinical and research teams. Specifically, implementation science aims to:

  1. Develop effective strategies for improving health-related processes and outcomes;
  2. Produce generalizable knowledge regarding these strategies by creating an understanding of effective implementation processes, barriers, and facilitators; and
  3. Develop, test, and refine the theories, frameworks, strategies, and measures that inform implementation strategies.

In its earliest stages, implementation science focused on identifying the barriers and facilitators to an EBP’s uptake—for example, surveying providers and leaders about reasons why evidence-based psychotherapy was not being adopted. These survey results led researchers to develop potential implementation strategies and study them to document their effectiveness. As part of these studies, the tools and processes that support the implementation of new EBPs are developed. As an example, the implementation of a certain EBP might require that providers not only receive outreach and education but also shadow skilled clinicians, build alliances with leadership, and receive data about their performance or patients.

The field of implementation science is at a critical juncture. Researchers must ensure that implementation practitioners (eg, quality improvement leads, systems efficiency engineers) are aware of this work and are provided with tools that emerge from these studies. The Society for Implementation Research Collaboration (SIRC) encourages participation of implementation practitioners, including clinicians, managers, and policy makers who are involved in implementation activities.

We encourage those interested in learning more about implementation science to explore the SIRC website as well as other resources described in our recent article in The Primary Care Companion for CNS Disorders. These resources include the US Department of Veterans Affairs Quality Enhancement Research Initiative, the Training Institute on Dissemination and Implementation Research , and the Implementation Research Institute.

Financial disclosure:Drs Kirchner, Woodward, and Bauer have no relevant personal financial relationships to report.

Category: Implementation Science
Link to this post: https://www.psychiatrist.com/blog/implementation-science-for-the-frontline-clinician/
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