The Science of Dissemination & Implementation: An Important PCORI Focus
PCORI’s primary charge is to support patient-centered research to improve patient care and outcomes. However, conducting studies is not in itself sufficient to improve care. To affect patients’ health, decision makers—patients, caregivers, clinicians, and others—need easy access to the valuable information research produces. In fact, PCORI is required to communicate our research findings to diverse audiences and promote uptake of new evidence and tools.
In developing plans to communicate the results of our studies, we face a number of gaps in the science and understanding of how best to disseminate research results and promote their use in practice. To help close some of these gaps, PCORI funds comparative effectiveness research examining strategies for communicating and disseminating findings to various audiences. These studies are funded through our Communication and Dissemination Research (CDR) program.
As part of the effort to support research in this area, PCORI cosponsored the 8th Annual Conference on the Science of Dissemination and Implementation, which convened researchers to share the evidence they are developing and build the knowledge base on dissemination and implementation. Nearly 1,000 people attended the December conference, which was hosted by the National Institutes of Health and AcademyHealth in Washington, DC.
From Precision Medicine to Local Communities
The conference’s theme, Optimizing Personal and Population Health, reflects twin challenges in dissemination and implementation. First, the concept of precision, or personalized, medicine encourages us to think about how to provide health information and services to meet individual needs, preferences, and local environments. One plenary session considered how best to implement precision medicine, which takes into account individual variations in genes, environment, and lifestyle.
Second, new expectations and opportunities have arisen to make large-scale gains in health at a population level. The conference’s keynote speaker, America Bracho, Executive Director of Latino Health Access, adopted this population health viewpoint. She highlighted the importance of context for implementation and dissemination effectiveness, the use of community engagement as a key to improving health, and the necessity of understanding local communities to grasp the challenges of translating research into practice. Bracho also emphasized the need for research partners to put the well-being of the community first, to value the community’s input, and to make research questions relevant to the community—values that align with PCORI’s mission.
Conference presentations described work to reduce health disparities that links data on health and social factors. Also addressed were studies in behavioral health, big data and technology, clinical and primary care settings, implementation and health policy, and prevention and public health.
Patient Centered and Ready for Dissemination
One PCORI contribution to the conference was a session, chaired by one of us (CP), on implementing patient-centered care across diverse health systems. The session demonstrated how PCORI’s focus on involving patients and other stakeholders across a project’s lifespan can orient research toward effective dissemination and implementation of the study’s eventual results.
The three PCORI-funded investigators who formed the panel lead studies that have stakeholders firmly embedded in the research design as a first step toward successful dissemination. In Washington State, Douglas F. Zatzick and colleagues are performing a comparative effectiveness trial involving patients who have experienced traumatic injuries. The team is testing whether making care more responsive to patient-identified concerns and needs affects patient satisfaction, mental health and other health outcomes, as well as systems outcomes, such as patterns of health service use. To encourage dissemination of findings, Zatzick’s team also worked from the start with stakeholders associated with major US trauma networks and societies and the American College of Surgeons, which issues trauma care guidelines and is key in implementing national changes in trauma care.
Michael Jones is also working with trauma patients, but his group in Georgia focuses on improving patients’ transition home from rehabilitation hospitals and on improving patients’ quality of life in the first year after injury. The team is testing a program that provides a patient- and family-centered approach to health education. The program includes peer mentoring and an Internet portal through which patients and families to can access information and support. Jones says that patient input stimulated a redesign of the patient portal and improved the program’s acceptance and effectiveness. The program was developed to fit neatly into clinical workflow and, as such, are ready for implementation should the study results warrant adoption.
The third panelist, Jonathan Tobin, leads an innovative project combining cancer screening with depression care among women in Bronx County, New York, the poorest US urban county. The study aims to determine whether the combined intervention, delivered by specially trained community health center staff, increases rates of cancer screening. The program’s patient partners assist with recruitment of participants, outreach, and dissemination. The study was designed with a readily implemented intervention. It uses research staff to train community health center staff, who in turn train other health center staff and leadership.
PCORI staff contributed to the meeting in other ways, as well. One of us (BG) served on the conference’s planning committee, moderated a well-attended panel on climate, culture, and context of implementation science, and co-chaired one of the meeting’s thematic tracks: Models, Measures, and Methods. This track focused on developing and testing theoretical and evaluation models for dissemination and implementation processes, as well as measures and methods to capture the dynamic evolution of interventions and the contexts in which they are implemented. In a workshop, a member of PCORI’s CDR program (BG) and representatives of other major health research funders advised early- career investigators about preparing proposals for projects on dissemination and implementation of research findings.