L7: Implementation science Flashcards
what is implementation science?
Scientific discipline which focuses on how to integrate and apply research findings into real-world settings.
Bridging the gap between research and clinical settings.
70% fail to translate into clinical settings
Either sustenance of that in routine clinical settings or move away from it
Gaining an understanding of what, why, and how interventions (evidence-based practices) work in real-world settings and testing novel improvement approaches
why does implementation science matter?
The majority of evidence-based practices fail to be successfully implemented into healthcare settings.
Implementation science can be used:
To improve patient outcomes
Successfully applied evidence-based practices improve patient care, outcomes, and experience
To optimise health resource utilisation
IS ensures optimisation of use of finite resources such as time, finances, personnel
To address healthcare disparities
IS ensures evidence-based practices can be applied across diverse populations and settings
To the right population and across the whole population
To promote continuous quality improvement
IS provides methodologies to continually assess, adapt and refine implementation of evidence-based practices over time
proms?
An evidence-based practice which is not yet implemented successfully into clinical practice:
Routine clinical collection of patient-reported outcome measures (PROMs).
What are PROMs? (self reported questionnaires of their own health related quality of life and symptomology effected by treatment like might ask about nausea with chemotherapy
What benefit can PROMs offer in clinical practice?
How can we implement the routine clinical collection of PROMs locally?
Finding out about things that cant be measured with biomarkers like pain.
Generally only used in rct setting and secondary outcome
Improve communication between patients and clinical teams
Gives clinician insight into how patient is feeling
May predict prognosis. Lower quality of life reported by patients on anxiety and depression died quicker.
But barriers to implement these proms
implementation frameworks?
Developed to provide a theoretical basis for approaching implementation and
Guide researchers from early feasibility testing through to longer term sustainability.
What are you using implementation science to accomplish?
Per Nilsen’s schema sorts implementation theories, models, and frameworks into five categories:
Process Models
Determinant Frameworks
Classic Theories
Implementation Theories
Evaluation Frameworks
process model?
Process model (type of implementation framework)
Describing/guiding the process of translating research into practice.
Step by step guide or roadmap that shows how a series of activities are supposed to be carried out.
Understanding of the sequence of actions.
Example:
EPIS Model
Four-phase implementation model (Exploration, Preparation, Implementation, Sustainment)
Address implementation in public service sector contexts
(and process models)
determinant frameworks, classic theories and implementation theories?
Describe or understand the factors that influence implementation outcomes.
Identify and understand factors that influence whether an intervention will be successful in each situation.
(barriers or facillitaors)
Example:
Consolidated Framework for Implementation Research
Deep dive into this Determinant Framework to follow..
Need to come up with strategies that are generalisable
evaluation frameworks?
Frameworks which provide structure for evaluating implementation endeavours
E.g:
- proctors implementation outcomes frameworks
Toaxnomomgy of 8 discrete implementation outcomes e.g: how feasible, cost associated with it?
Distinct from clinical and service outcomes - clinical outcomes: something like overall survival, progression free survival. (how long are they surviving for, how long between getting diagnosis and recurring of cancer?)
Indications of impkementation success
CFIR?
Consolidated framework for implementation research (CFIR)
DETERMINANT FRAMEWORK. Five interrelated domains which support the identification and exploration of determinants which may be identified during an implementation process. Determinants- barriers and facilitators.
Established by Damschroder et al in 2009.
Aligning terminologies and definitions existing throughout landscape of implementation theories.
Comprised of five domains:
The intervention
Inner setting
Outer setting
Individuals involved
Process by which intervention is accomplished
List of selectable constructs which can be used to verify what works where, and why, across contexts.
Use it to identify barriers and facilitators in a setting where wea re trying to implement something
innovation domain?
The “thing” being implemented.
Routine clinical collection of patient-reported outcome measures.
CFIR constructs include:
“The innovation has robust evidence supporting its effectiveness”
“The innovation can be tested or piloted on a small scale and undone”
“The innovation can be modified, tailored, or refined to fit local context or needs”
outer setting domain?
Higher level stting in which implementation events are taking place
The setting in which the Inner Setting exists, e.g., the hospital trust (Guy’s and St Thomas’ NHS Foundation Trust).
There may be multiple Outer Settings and/or multiple levels within the Outer Setting (e.g., the Southeast London community which GSTT serves).
CFIR constructs include:
“Funding from external entities is available to implement and/or deliver the innovation”
“Economic, environmental, political, and/or technological conditions enable the Outer Setting to support the implementation and/or delivery of the innovation”
“Sociocultural values and beliefs encourage the Outer Setting to support the implementation”
