Dissemination and implementation science moves research results into real-world settings

Vest: Dissemination and implementation science is defined as “the scientific study of methods to promote the systematic uptake of research findings and other evidence-based practice into routine practice and hence, to improve the quality and effectiveness of health services” (Eccles 2006). In other words, it is the study of how contextual factors, such as setting, culture, organizational structures and individual differences impact whether an innovation becomes regular practice, as well as the systematic study of strategies that effectively address these factors to support successful implementation of innovations in real-world settings.

These are important questions to answer because the average time from the discovery of a new innovation to its regular use in health care is approximately 17 years, and less than 50% of innovations successfully make that leap, meaning many potentially impactful treatments and interventions are left “on the shelf.” Dissemination and implementation science is all about reducing that gap and helping more innovations get off the shelf and into use to improve health, using rigorous, evidence-based strategies that have been tested in real-world implementation projects.

Singh: I think that growing health care costs, with only modest improvements in health, have prompted funders, payers and policymakers to be frustrated about the apparent poor return on their investment. This brings into focus the challenges that Dr. Vest highlighted: Namely that effective treatments and evidence-based programs are not reaching the patients who need them in a timely manner.

The National Institutes of Health’s National Center for Advancing Translational Sciences (NCATS) has as its core mission to “turn research observations into health solutions through translational science.” This starts with translating basic science discoveries into effective treatments. But as we know, that is not enough. NCATS therefore continues to support the development of new treatments but also is strongly pushing for more research on the translation of these discoveries into real-world clinical settings, so that real-world patients can benefit.

Unfortunately, passively waiting for providers and health care systems to adopt published evidence and guidelines does not work. The science of dissemination and implementation has advanced substantially over the past two decades and is now ready to help accelerate this final translational stage, getting evidence-based treatments and programs out into widespread use. As a result, funders are increasingly recognizing dissemination and implementation science as a way to increase the return on their investment by ensuring that effective innovations are actually implemented at scale.

Singh: One of the first areas of focus in the field was the development of strategies to facilitate implementation and the testing of those strategies. The research questions were along the lines of asking, “What is the best strategy to implement a specific treatment into a particular care setting?” A key learning from these kinds of studies was that one size does not fit all. Implementation strategies need to adapt to the setting, taking into account local factors like the team, the organizational infrastructure and the external context.

More recent research is examining how interventions and implementation strategies are iteratively adapted to obtain and maintain a “fit.” Understanding, and even encouraging adaptations (planned and unplanned) is a critical area for future research and may prove important for sustainability. After all, it is not enough to implement a practice; it must be sustained. This sometimes requires ongoing adaptation to an evolving clinical, organizational or policy environment.

Vest: The core is here to support the UB research community in thinking through these issues — regardless of where their work falls on the translational spectrum — by encouraging investigators to consider how their innovation might fit into the somewhat messy, uncontrolled, real-world setting; where it might work and where it might not, and for whom; and what the possible barriers might be. The core then provides support to help investigators develop the knowledge, skills and multidisciplinary teams needed to do this kind of implementation research.

Vest: The core offers a range of resources for researchers, including a new workshop series, access to curated resources and toolkits and individual consultations on dissemination and implementation science projects at any stage of development. We can meet with you one-on-one to learn more about your work and help direct you to appropriate resources, conceptual models and frameworks, and collaborators to help strengthen your project.

Singh: The overarching goal is to introduce dissemination and implementation science methods, including the fit into the translational science spectrum, and how researchers might integrate dissemination and implementation into their studies at any stage of translation. We will introduce key theories, models and frameworks that guide dissemination and implementation research, as well as commonly used study designs, strategies and outcome measures.

Singh: We aim to continually improve our consultations and workshops based on experience and feedback. In addition, we are developing tools to help learners and researchers explore these topics on their own and to make sense of the growing literature in the field. We are excited to be launching our first tool — an AI chatbot (built using the Google platform NotebookLM) that allows users to interact with a curated set of scientific articles on the theories, models and frameworks in dissemination and implementation science. Another tool focused on dissemination and implementation science study design is also available. Information on the new toolkits can be found here.