In this course synthesis and wrap-up session, we will discuss challenges in implementation research and strategies for addressing them. Students will be asked to share challenges they are facing in their own work for this interactive session.
This lecture examines the role of Implementation Science methods and frameworks in the advancement of health equity. It opens the conversation about how scholars can use IS to promote health equity in their own work as well as encourages scholars to think about how inequities may be exacerbated without careful implementation
Readings:
The methodological toolkit for implementation science research is large. Potential trial designs may involve randomization or quasi-experimental methods. Endpoints may focus on clinical effectiveness, implementation, or both. The unit of randomization is often a key decision point. Newer methods may aim to develop adaptive treatment strategies. This session will review these designs and ask the class to offer alternative designs to address implementation of a common evidence-based practice.
Required readings:
Bernstein SL, Dziura J, Weiss J, Miller T, Vickerman KA, Grau LE, Pantalon MV, Abroms L, Collins LM, Toll B. (2018). Tobacco Dependence Treatment in the Emergency Department: A Randomized Trial Using the Multiphase Optimization Strategy. Contemp Clinical Trials. 66: 1-8. https://doi.org/10.1016/j.cct.2017.12.016
Edelman EJ, Porter E, Dziura J, Yager J, Sigel K, Bernstein SL. (2021). A SMART approach to treating tobacco use disorder in persons with HIV (SMARTTT): Rationale and design for a hybrid type 1 effectiveness-implementation study. Contemp Clinical Trials. 110:106379. https://doi.org/10.1016/j.cct.2021.106379
Optional readings:
Brown et al. (2017). An overview of research and evaluation designs for dissemination and implementation research. Annual Review of Public Health. 38: 1-22. https://doi.org/10.1146/annurev-publhealth-031816-044215
Collins LM, Nahum-Shani I, Almirall D. (2014). Optimization of behavioral dynamic treatment regimens based on the Sequential, Multiple Assignment, Randomized Trial (SMART). Clinical Trials 11:426–34. https://doi.org/10.1177%2F1740774514536795
Lei H, Nahum-Shani I, Lynch K, Oslin D, Murphy SA. (2012). A “SMART” design for building individualized treatment sequences. Annual Review Clinical Psychology 8:21–48. https://doi.org/10.1146/annurev-clinpsy-032511-143152
Murphy SA, Lynch KG, Oslin D, McKay JR, TenHave T. (2007). Developing adaptive treatment strategies in substance abuse research. Drug Alcohol Depend. May, 88(Suppl 2): S24-S30. https://doi.org/10.1016/j.drugalcdep.2006.09.008
This session will discuss Leadership Saves Lives, a 2-year organizational-level intervention directed at fostering changes in hospital organizational culture that might contribute to reductions in risk standardized mortality rates for patients with acute myocardial infarction. Challenges and strategies in study design and implementation will be explored. The case studies for this session will review two quality improvement projects implemented in the Yale New Haven Hospital Emergency Department.
Readings:
Curry LA, Linnander EL, Brewster AL, Ting H, Krumholz HM, Bradley EH. (2015). Organizational culture change in U.S. hospitals: a mixed methods longitudinal intervention study. Implementation Science 10:29, PMCID: PMC4356105. https://doi.org/10.1186/s13012-015-0218-0
Coughlin RF, Peaper D, Rothenberg C, Golden M, Landry MG, Cotton J, Parwani V, Shapiro M, Ulrich A, Venkatesh AK. (2019). Electronic health record-assisted reflex urine culture testing improves emergency department diagnostic efficiency. Am J of Med Quality, July 11. https://doi.org/10.1177%2F1062860619861947
Sather J, Rothenberg C, Finn EB, Sheth KN, Matouk C, Pham L, Parwani V, Ulrich A, Venkatesh AK. (2018). Real-time surveys reveal important safety risks during interhospital care transitions for neurologic emergencies. Am J of Med Quality, July 10. https://doi.org/10.1177%2F1062860618785248
The electronic health record (EHR) is a ubiquitous part of healthcare in high income countries. The EHR may greatly facilitate implementation of evidence-based practice through clinical decision support systems, but can also present important new barriers to implementation. A critical step is engagement with end-users, and ensuring their participation and leadership in implementation projects. This session will review the principles and practice of user-centered design, with a focus on recent work in this area at Yale.
Required readings:
Montori VM, Breslin M, Maleska M, Weymiller AJ. (2007). Creating a Conversation: Insights from the development of a decision aid. PLoS Med. Aug; 4(8): e233. https://dx.doi.org/10.1371%2Fjournal.pmed.0040233
Ray JM, Ratwani RM, Sinsky CA, Frankel RM, Friedberg MW, Powsner SM, Rosenthal DI, Wachter RM, Melnick ER. (2019). Six habits of highly successful health information technology: powerful strategies for design implementation. JAMIA. Oct.; 26(10): 1109-1114. https://doi.org/10.1093/jamia/ocz098
Mann DM, Chokshi SK, Kushniruk A. (2018). Bridging the gap between academic research and pragmatic needs in usability: A hybrid approach to usability evaluation of health care information systems. JMIR Human Factors. 5(4): e10721. https://doi.org/10.2196/10721
Optional readings:
Mandel JC, Kreda DA, Mandl KD, Kohane IS, Ramoni RB. (2016). SMART on FHIR: a standards-based, interoperable apps platform for electronic health records. JAMIA. Sept.; 23(5): 899-908. https://doi.org/10.1093/jamia/ocv189
Ray JM, Ahmed OM, Solad Y, Maleska M, Martel S, Jeffrey MM, Platts-Mills TF, Hess EP, D’ Onofrio G, Melnick ER. (2019). Computerized clinical decision support system for emergency department–initiated buprenorphine for opioid use disorder: User-centered design. JMIR Hum Factors. 6(1): e13121. https://doi.org/10.2196/13121
This session will focus on the use of dynamic systems modeling in the design and analysis of implementation research studies. Session held via zoom.
Readings:
Burke JG, Lich KH, Neal JW, Meissner HI, Yonas M, Mabry PL. (2014). Enhancing dissemination and implementation research using systems science methods. Int J Beh Med, 22:283-291. https://link.springer.com/article/10.1007%2Fs12529-014-9417-3
Nagoski E, Janssen E, Lohrmann D, Nichols E. (2011). Risk, individual differences, and environment: An agent-based modeling approach to sexual risk-taking. Arch Sex Behav, 41:849-860. https://link.springer.com/article/10.1007/s10508-011-9867-5
This session will highlight the unique contributions of qualitative and mixed methods in implementation science. Given the increasing interest in rapid qualitative analysis, the second part of the session will focus on opportunities for rapid qualitative analysis in implementation science studies, including free lists, cultural consensus analysis, pile sorts, and participatory methods.
Readings:
Palinkas. (2017). Mixed methods evaluation in Dissemination and Implementation Science. In: Dissemination and Implementation Research in Health: Translating Science to Practice Ross C. Brownson, Graham A. Colditz, and Enola K. Proctor. https://www.oxfordscholarship.com/view/10.1093/oso/9780190683214.001.0001/oso-9780190683214-chapter-20?rskey=r4MGij&result=1
McMullen CK, Ash J, Sittig D, et al. (2011). Rapid assessment of clinical information systems in the healthcare setting. Methods of Information in Medicine. 50(04): 299-307. DOI: 10.3414/ME10-01-0042