Methods for care
Les 1: making research findings more powerful for
clinical use
Overzicht
1. Setting the scene:
Example: A failed adoption of Proteus digital health, a promising technology
2. Basics of Implementation science:
Some methodological considerations
The Basel Heptagon of Implementation Science
3. Doing implementation science:
Example: SMILe
The leaky research pipeline
Leaky research pipeline. Showing issues in research.
Implementation science is the focus on the translation of evidence in clinical practice. In the
end the goal is to translate results and have a much more performed research pipeline.
Waste 1: There are a number of flaws being described.
- 50% is designed without a syst. Review.
- 50% avoidable research flaws/biases; wrong methods? Small samples?
- 50% is not published in full; waste of patient times, money,…
- 50% is unusable or incompletely reported or both
Waste 2:
- As little as 14% of evidence is ever implemented
- Only a fraction is sustainable.
- It takes much too long to get research findings into clinical settings
- IS is focused on the translation of evidence in clinical practice
- The methodology of IS can be used very early on in the research pipeline to speed up
the performance of the research pipeline. Making this time between the start of the
study and the implementation shorter. We need to keep in mind that in the end the
, goal to reduce research phase, to increase translation of results and to have a much
for performing research pipeline.
Example: Delay between evidence that is available (benefits!) but there is huge gap between
discovery and implementation (vitamin C).
The challenge of the bridge
IS is the methodology that we use and apply to get evidence from the trial world into real
world settings. Implementation science addresses the gap between evidence &
implementation.
To get from trial world, best evidence to the real-world settings.
For example: HPV vaccination. Variation in the successful implementation
For example: Proteus project
- Iedereen was eerst heel enthousiast, maar vanaf men het begon te testen waren er
toch een heleboel problemen. Dus men heeft iets ontdekt en wil het implementeren
in de real world. Het was dus geen succesvolle implementatie. Dus op het moment
dat je over de brug ging, was er geen succesvolle implementatie.
- Er was geen reflectie over de implementatie in the echte wererld (RCT VS clinical
world)
- Het zou de gamechanger moeten zijn geweest, maar dat was het niet.
The valley’s of death refer to the gaps under de bridge.
Een nieuwe technologie, die wordt gemaakt in een universiteit etc, wil je dat dit in daily
clinical practice terecht komt. Je moet dan 2 valleys of death overwinnen.
Valley 1: between the research institute & the industry and technology transfer
Valley 2: between the industry technology transfer & clinical implementation going into the
chaotic real-world settings of clinical practice.
How can we make research findings more powerful?
We must invest in implementation science methodologies. In this course, we want to learn
to implement, apply implementation science & understand implementation science.
Definition
The scientific study of methods to promote the systematic uptake of research findings and
other evidence- based practices into routine practice, and, hence, to improve the quality
and effectiveness of health services and care”
The goal is to improve the quality & effectiveness of health services and care.
,Translation in the chaos, on the other side of the bridge. It is not quality improvement. It is
scientific methods that we apply with also the goal to target the gap, trying to make the
research pipeline smaller.
“Real-world”: pragmatic trials = je laat meer variabiliteit toe, meer een reflexie verkrijgen
van de normale wereld.
“Daily clinical practice”: BOTH Effectiveness outcomes (does it work & when?) +
implementation. We want an implementation science study to know how the intervention
works, why it works, implementation outcomes. We want to know does it work and
why/how does it work?
At the end of the study we will be smart. We will know it works or not and we will also have
information of what made the intervention land in the clinical setting, know factors influence
success of failure?
§ The intervention/practice/innovation is THE THING
§ Effectiveness research looks at whether THE THING works
§ Implementation research looks at how best to help people/place DO THE THING
§ Implementation research goes beyond the typical type of research, also gives
attention to the people who work in those places to really roll out this
intervention.
§ Implementation strategies are the stuff we do to try to help people/places DO THE
THING
§ The package that you will bring over the bridge. You are interested in the
impact to get this intervention going in the real-world settings.
§ Evaluate strategies, looking at the outcomes.
§ Main implementation outcomes are HOW MUCH and HOW WELL they DO THE
THING
, Usual: the intervention (7p’s: programs, practices, principles, procedures, products, pills and
policies; effectiveness research looks at these) and they do a study if this intervention works
and they look at the effectiveness outcomes. Does the intervention work? If you find out
that you have a negative outcome (no difference). Is it correct to say that the intervention
does not work in real life settings? It might also be that your implementation is failed. Why?
No co-creation of the intervention with the nurses. No attention at all of implementation
strategies, helping people and places to do the thing.
IS: The thing is our intervention, and we add the stuff (strategies). We also look at more
proximal implementation outcomes. We start to assess already early on. We don’t wait until
we have the distal outcomes. It gives us a sign if the intervention takes of or not?
The implementation pathway: the stuff is there; the thing is there. We will not only have the
effectiveness outcomes but also the implementation outcomes (why and why not and how
the intervention works). Vaak missend bij RCT.
Je hebt dus al die evidentie maar er is geen info beschikbaar om de implementation over de
brug te brengen.
The Basel Heptagon IS
If we want to go to real world settings:
- Strength of evidence of intervention: How strong the level of evidence is of the
intervention of interest. Important for choosing your design.
- Transdisciplinary approach: you need all the expertise to get over the bridge
IS theories/frameworks/models
- Contextual analysis: the foundation you build for you IS study. The basis of every IS
project. It not done in a clinical trial.
- Understand facilitators and barriers for implementation as well as practice
patterns (How are the clinical)
- Inform intervention development and choice of implementation strategies.
- Know where and how you best plant your ‘seeds’.
- Interpret your findings
- Without contextual analysis, you will have no co-creation
Les 1: making research findings more powerful for
clinical use
Overzicht
1. Setting the scene:
Example: A failed adoption of Proteus digital health, a promising technology
2. Basics of Implementation science:
Some methodological considerations
The Basel Heptagon of Implementation Science
3. Doing implementation science:
Example: SMILe
The leaky research pipeline
Leaky research pipeline. Showing issues in research.
Implementation science is the focus on the translation of evidence in clinical practice. In the
end the goal is to translate results and have a much more performed research pipeline.
Waste 1: There are a number of flaws being described.
- 50% is designed without a syst. Review.
- 50% avoidable research flaws/biases; wrong methods? Small samples?
- 50% is not published in full; waste of patient times, money,…
- 50% is unusable or incompletely reported or both
Waste 2:
- As little as 14% of evidence is ever implemented
- Only a fraction is sustainable.
- It takes much too long to get research findings into clinical settings
- IS is focused on the translation of evidence in clinical practice
- The methodology of IS can be used very early on in the research pipeline to speed up
the performance of the research pipeline. Making this time between the start of the
study and the implementation shorter. We need to keep in mind that in the end the
, goal to reduce research phase, to increase translation of results and to have a much
for performing research pipeline.
Example: Delay between evidence that is available (benefits!) but there is huge gap between
discovery and implementation (vitamin C).
The challenge of the bridge
IS is the methodology that we use and apply to get evidence from the trial world into real
world settings. Implementation science addresses the gap between evidence &
implementation.
To get from trial world, best evidence to the real-world settings.
For example: HPV vaccination. Variation in the successful implementation
For example: Proteus project
- Iedereen was eerst heel enthousiast, maar vanaf men het begon te testen waren er
toch een heleboel problemen. Dus men heeft iets ontdekt en wil het implementeren
in de real world. Het was dus geen succesvolle implementatie. Dus op het moment
dat je over de brug ging, was er geen succesvolle implementatie.
- Er was geen reflectie over de implementatie in the echte wererld (RCT VS clinical
world)
- Het zou de gamechanger moeten zijn geweest, maar dat was het niet.
The valley’s of death refer to the gaps under de bridge.
Een nieuwe technologie, die wordt gemaakt in een universiteit etc, wil je dat dit in daily
clinical practice terecht komt. Je moet dan 2 valleys of death overwinnen.
Valley 1: between the research institute & the industry and technology transfer
Valley 2: between the industry technology transfer & clinical implementation going into the
chaotic real-world settings of clinical practice.
How can we make research findings more powerful?
We must invest in implementation science methodologies. In this course, we want to learn
to implement, apply implementation science & understand implementation science.
Definition
The scientific study of methods to promote the systematic uptake of research findings and
other evidence- based practices into routine practice, and, hence, to improve the quality
and effectiveness of health services and care”
The goal is to improve the quality & effectiveness of health services and care.
,Translation in the chaos, on the other side of the bridge. It is not quality improvement. It is
scientific methods that we apply with also the goal to target the gap, trying to make the
research pipeline smaller.
“Real-world”: pragmatic trials = je laat meer variabiliteit toe, meer een reflexie verkrijgen
van de normale wereld.
“Daily clinical practice”: BOTH Effectiveness outcomes (does it work & when?) +
implementation. We want an implementation science study to know how the intervention
works, why it works, implementation outcomes. We want to know does it work and
why/how does it work?
At the end of the study we will be smart. We will know it works or not and we will also have
information of what made the intervention land in the clinical setting, know factors influence
success of failure?
§ The intervention/practice/innovation is THE THING
§ Effectiveness research looks at whether THE THING works
§ Implementation research looks at how best to help people/place DO THE THING
§ Implementation research goes beyond the typical type of research, also gives
attention to the people who work in those places to really roll out this
intervention.
§ Implementation strategies are the stuff we do to try to help people/places DO THE
THING
§ The package that you will bring over the bridge. You are interested in the
impact to get this intervention going in the real-world settings.
§ Evaluate strategies, looking at the outcomes.
§ Main implementation outcomes are HOW MUCH and HOW WELL they DO THE
THING
, Usual: the intervention (7p’s: programs, practices, principles, procedures, products, pills and
policies; effectiveness research looks at these) and they do a study if this intervention works
and they look at the effectiveness outcomes. Does the intervention work? If you find out
that you have a negative outcome (no difference). Is it correct to say that the intervention
does not work in real life settings? It might also be that your implementation is failed. Why?
No co-creation of the intervention with the nurses. No attention at all of implementation
strategies, helping people and places to do the thing.
IS: The thing is our intervention, and we add the stuff (strategies). We also look at more
proximal implementation outcomes. We start to assess already early on. We don’t wait until
we have the distal outcomes. It gives us a sign if the intervention takes of or not?
The implementation pathway: the stuff is there; the thing is there. We will not only have the
effectiveness outcomes but also the implementation outcomes (why and why not and how
the intervention works). Vaak missend bij RCT.
Je hebt dus al die evidentie maar er is geen info beschikbaar om de implementation over de
brug te brengen.
The Basel Heptagon IS
If we want to go to real world settings:
- Strength of evidence of intervention: How strong the level of evidence is of the
intervention of interest. Important for choosing your design.
- Transdisciplinary approach: you need all the expertise to get over the bridge
IS theories/frameworks/models
- Contextual analysis: the foundation you build for you IS study. The basis of every IS
project. It not done in a clinical trial.
- Understand facilitators and barriers for implementation as well as practice
patterns (How are the clinical)
- Inform intervention development and choice of implementation strategies.
- Know where and how you best plant your ‘seeds’.
- Interpret your findings
- Without contextual analysis, you will have no co-creation
