Translational Science Highlight
- An NCATS-supported program fosters research on the dissemination and clinical implementation of therapies, interventions and policies to ultimately improve human health.
Researchers around the country are developing and testing innovative therapies and interventions to help patients. But those efforts, no matter how promising, are not always easily adopted into the clinic.
To address this clinical implementation challenge across the translational science spectrum, the Washington University in St. Louis Institute of Clinical and Translational Sciences (ICTS) — a Clinical and Translational Science Awards (CTSA) Program-supported hub — launched the Dissemination and Implementation Research Core (DIRC). In the following Q&A, DIRC Director Enola Proctor, Ph.D., breaks down the science of dissemination and implementation and discusses how the unique services at the DIRC are making a difference.
What is implementation and dissemination research?
Dissemination research is the study of how we can effectively convey evidence and information. Implementation research addresses the challenge of how we can move effective programs, guidelines, interventions and policies into real-world settings so that their potential health benefit for patients and the public at large can be realized.
Can you provide examples of what researchers in these fields study?
An example of dissemination research might be the study of how we can best explain the benefits of a new vaccine to the general public or to a targeted group such as parents. For example, would narratives and stories work better than data?
In implementation research, we may ask how we can help health care providers change habitual care and turn a new procedure into routine practice.
Why do we need dissemination and implementation research?
I’ve heard many people say, “If there is a new treatment, why don’t people just deliver it?” If it were that easy, we wouldn't’t have such frequent reports of a lower quality of care than we desire.
There was a landmark study recently on the quality of health care in America. The authors showed that we are delivering the recommended medical treatment about 40 percent of the time. For some indicators, such as appropriate use of antibiotics, we’re stuck at 50 percent. There are many areas where real-world practice lags behind the evidence for the most appropriate care.
That sounds pretty daunting. Is there an example of a DIRC project that resulted in an improved clinical practice?
One example was a project with colleagues at St. Louis Children’s Hospital. We know that babies and small children in intensive care units often become anemic because too much blood is drawn for tests. And yet there are safe and effective guidelines for minimal blood draw.
So we asked, “How do we change practice to reduce the rates of blood overdraw?” We were successful by using a multipronged approach that included provider training, using smaller vials to draw blood, and changing habits, such as bundling several orders for blood measurements so they can be accomplished with one draw.
How did DIRC come about, and what kinds of services do you provide?
The DIRC started 10 years ago with CTSA Program pilot funding. Implementation research is a newer field that requires a distinct methodology and set of research tools. Our CTSA Program hub recognized this and established the DIRC as a research methods core. Our focus is on providing guidance and consultation to investigators affiliated with our hub who are preparing to conduct dissemination or implementation research. You can read more about it in a recent paper we published.
For example, we meet one-on-one with investigators to discuss the research design, measures and overarching framework for their studies. Our team, which includes doctoral students and postdocs, helps investigators find literature and funding announcements. And we review and provide critical feedback for grant proposals.
We have also developed toolkits, such as how to write aims for this research field, measure implementation outcomes and choose what implementation strategies to test.
What kind of impact have these services had on the CTSA Program hub and university research community?
We’ve grown in more than a decade from just a handful of people involved in this field at the university to 60 to 70 people who now are doing some kind of implementation science through actively funded grants. And our demand is steadily increasing. We’ve really built our core of implementation researchers to become a solid part of the CTSA Program hub.
The DIRC is building the community and also strengthening their grant proposals so they can secure funding to conduct this important research, with the ultimate goal of improving health care.
Implementation science is really a team science, so we have worked to forge collaborations. We have regular meetings of our implementation science community where people come together from all parts of our campus that are involved in our CTSA Program hub.
That’s been really rewarding because we’ve seen terrific collaborations form and contribute to our success in developing rigorous proposals. It’s a beautiful fit with the CTSA Program goals, and I’m thrilled that the response has been so positive.
You have championed the idea of “design for dissemination.” Can you explain what that means?
Our DIRC co-director Ross Brownson, Ph.D., pioneered this concept. There is a gap between the “care that could be” and the “care that is,” and we know one reason for that is that interventions can be burdensome if they are developed in the lab without an eye to how they will be delivered and used in practice.
We can interact with clinical investigators during the process of treatment discovery and development. For example, a really important question for people who are developing treatments in the lab could be, “How would this particular drug be delivered to infants?” Asking those kinds of questions early on may mean that our treatment discoveries won’t be so cumbersome and will be more readily adopted.
Given the DIRC’s success, do you think more CTSA Program hubs will adopt a similar approach?
I think this is a great model for all CTSA Program hubs and beyond. There is an appetite among investigators for this kind of work because it’s high-impact work. It’s also creative, challenging and feasible because NIH is soliciting proposals.
We haven’t really completed our translational challenge until each and every CTSA Program hub has also made progress in the later stages of the translational pipeline.
Posted December 2017