Do you know what dissemination and implementation research is? If not, you can now refer to a book edited by Ross Brownson, Graham Colditz, and Enola Proctor, Dissemination and Implementation Research in Health: Translating Science into Practice. This recently available text provides a useful overview of the origins, frameworks and current approaches to this evolving domain of research. Did you know that NIH sponsors this type of research and has an annual conference on the topic? When the 5th Annual NIH Conference on the Science of Dissemination and Implementation convened in Maryland on March 19-20, a session organized by AcademyHealth highlighted the increasingly important role delivery system-based health services researchers are playing in creating greater value for health care organizations, patients and society. Because these researchers work on the front-lines of health care delivery, they are able to produce evidence that is highly relevant to practitioners. AcademyHealth President and CEO Lisa Simpson moderated the panel, “Proximity of Research to Practice: What Does Delivery System-Based Health Services Research Teach Us About Implementation?” and four delivery system-based health services researchers discussed this trend and presented recent examples. Lucy A. Savitz, senior scientist at Intermountain Healthcare’s Institute for Health Care Delivery Research, provided an overview of the science of quality improvement (QI). Because health care providers want to avoid implementing innovations that are of poor quality, sound analytic methods are required. However, the fast-paced delivery system setting often cannot wait for the years-long process of traditional research methods. The emerging science of QI can provide a way of evaluating change that is both rigorous and practical. Dr. Savitz pointed out that because delivery settings already require some forms of QI, these preexisting structures might be adapted to include methodologically sound practices. If a system is able to develop QI programs that incorporate a clear and measurable process, have a basis in evidence, are subject to iterative testing, apply appropriate analytic methods, and document results, it can often enhance the quality of services it provides. Dominick Frosch, associate investigator in the Department of Health Services Research at the Palo Alto Medical Foundation Research Institute (PAMFRI), focused on the evolving role of the patient in health care decision-making. His recent work at PAMFRI has examined patient decision support interventions, or DESIs, to improve the decision-making process. The Partners in Medical Decision Making project (PMDM) aims to “make the provision of decision support to eligible patients routine, habitual and meaningful.” By providing eligible patients with brochures and posters containing information options regarding prostate cancer screenings, for example, the Research Institute hopes to disseminate information directly to the patient, who can then implement their own decisions over medical care. Electronic medical records are utilized both to determine who is eligible for this targeted outreach, and to track subsequent patient activity. Frosch concluded that tools such as PMDM can help to supplement physicians engaged in a busy clinical setting who might not be able to successfully deliver sufficient information. Edward P. Havranek, director of health services research at Denver Health, described an analysis at Denver Health using electronic health records to identify, understand, and address disparities in health care delivery outcomes. Physicians have levels of implicit bias that can be reflected in their relationships with patients. This bias is often identified and influences the behavior of patients, and can alter the amount of trust and communication in the relationship. Previous studies have shown that individuals with high levels of bias may defensively increase their level of bias when provided with information about the harm of such judgments. Havranek provided an interesting example in which the dissemination of certain information may have an adverse effect on the implementation of quality care. Michael Seid, director of health outcomes and quality of care research at the James M. Anderson Center for Health Systems Excellence at Cincinnati Children’s Hospital Medical Center, provided a unique view from his work. Seid began his presentation by noting that American patients receive only 50 percent of recommended care, and typically perform only about half of the self-management procedures and behavior necessary to keep them healthy, which leads to about a 25 percent success rate in care. Seid and others have created Collaborative Chronic Care Networks (C3N) in an attempt to create a culture of collaboration and camaraderie that can help build morale and confidence in the fight against chronic disease. C3Ns cast a wide participatory net, hoping to utilize resources such as smartphone applications, mentoring programs, and participatory care blogs across groups that include patients, parents, researchers and clinicians. These presentations reflect the growing recognition that health services research must pay attention to how innovations are implemented in the health care process if patients and society are to realize their benefits. This theme was reinforced in the conference’s closing plenary. Panelists, including Simpson, reflected on the most important aspects of the conference and reiterated the value of innovation and timeliness in dissemination and implementation. One important point was repeatedly raised: in order for the research presented at the conference to have any impact, the science of dissemination and implementation must itself be disseminated and implemented. AcademyHealth and health services researchers have the opportunity to connect more effectively with this community and the behavioral and social science researchers who are active in it. This post was written by AcademyHealth Research Assistant Bryan Kelley, who is currently involved in our work in delivery systems innovation.  

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