Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

UCSF CTSI Implementation Science Training and Support: Activities and Impacts

255 views

Published on

Dr. Margaret Handley (UCSF) provides the learning goals for this webinar, which are the following: 1) Understand Background ideas that informs the UCSF Implementation Science Training Program, 2) identify components of the conceptual model for Implementation science have been applied to course development, and 3) understand variations of learner experience, ranging from curriculum and examples of completed work.

For more information and to see other dissemination and implementation content, please visit: http://ctsi.ucla.edu/patients-community/pages/dissemination_implementation_improvement

Published in: Education
  • Be the first to comment

  • Be the first to like this

UCSF CTSI Implementation Science Training and Support: Activities and Impacts

  1. 1. UCSF Training Program in Implementation Science (ImS) Activities and Impacts Margaret Handley PhD MPH Professor, Dept. Epidemiology and Biostatistics and Department of Medicine, University of California San Francisco Center for Vulnerable Populations, ZSFGH Co-Director UCSF Training Program in Implementation Science
  2. 2. Learning Objectives 1. Understand Background ideas that informs the UCSF Implementation Science Training Program 2. Identify components of the conceptual model for ImS have been applied to course development 3. Understand variations of learner experience, ranging from curriculum and examples of completed work
  3. 3. I. Background
  4. 4. What is implementation science? Implementation research is 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. -Eccles MP, Mittman BS. Implementation Science 2006
  5. 5. What is the ‘science’ part? Implementation science research is 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. Eccles MP, Mittman BS. Implementation Science 2006
  6. 6. Implementation Challenge 1: Often, we don’t know what to do with our ‘evidence’
  7. 7. …and we realize there are persistent Evidence Gaps “Many evidence-based innovations fail to produce results when transferred to communities in the global south, largely because their implementation is untested, unsuitable or incomplete” “Scientists have been slow to view implementation as a dynamic, adaptive, multi-scale phenomenon that can be addressed through a research agenda” T. Madon et al .2007
  8. 8. “We had this great tool here called the grinder, which we knew could grind peanuts into peanut butter very, very well. But when we got over to those countries, we found out they didn’t make a lot of peanut butter.” “What they needed was a peanut sheller.” http://www.pbs.org/newshour/bb/inventing-new-efficient-kitchen-tools-developing-world/ Implementation Challenge 2: What constitutes the ‘best’ research evidence? ???
  9. 9. “We had this great tool here called the grinder, which we knew could grind peanuts into peanut butter very, very well. But when we got over to those countries, we found out they didn’t make a lot of peanut butter.” “What they needed was a peanut sheller.” http://www.pbs.org/newshour/bb/inventing-new-efficient-kitchen-tools-developing-world/ Implementation Challenge 2: What constitutes the ‘best’ research evidence? ? What about evidence related to local context and knowledge? ???
  10. 10. A goal of Implementation Science (ImS) is to ensure that the knowledge and materials produced by health research actually lead to improved population health by: 1) Reaching the people for whom they are intended 2) Being implemented safely, efficiently, equitably, and in a patient-centered manner (IOM) 3) Being co-developed and co-implemented through partnerships that enhance relevance and sustainability Goals of Implementation-Informed Research in Community Settings
  11. 11. Types of implementation science research • Identify barriers and facilitators to behavior change through community engagement with stakeholders • Tailor outreach efforts to encourage use of effective health services or reduce access to unhealthy products • Identify strategies to promote the integration of evidence into policy and program decisions (study the process and outcomes) • Adapt interventions according to population and setting • Design an impact evaluation for a population-based intervention • Evaluate different implementation strategies to improve clinician screening behaviors, targeting across staffing groups and leadership
  12. 12. SOCIAL SCIENCES Anthropology Economics Psychology Public Policy Sociology Social Work Education Who does implementation science? Just a start! POPULATION SCIENCES Biostatistics Epidemiology Health Policy ENGINEERING SCIENCES Computer Science Logistics Operations Management Implementation Science CLINICAL SCIENCES Dentistry Medicine Nursing Pharmacy
  13. 13. II. Conceptual Framework for How “New Evidence” is Translated to Improve Health: UCSF Program in ImS
  14. 14. Principle 1: Engagement with stakeholders is essential at all stages Principle 2: Behavior change is inherent to translation of evidence into practice and policy Principle 3: The process of behavior change is iterative, favoring cycles and bidirectional relationships, and a socio-ecological approach. Key Principles: UCSF ImS Program Gonzales, Handley, Ackerman, O-Sullivan 2012. Handley, Gorukanti, Cattamanchi 2016.
  15. 15. Individual or a Socio-Ecological Perspective?
  16. 16. PRACTICE HEALTH A Socio-Ecological View of Improving Practice EVIDENCE • Government Stakeholders • Payors/Insure rs • Societies Delivery • Hospitals Systems • Clinic/Practice s • Health Depts • Providers Individuals • Patients • Public
  17. 17. Key elements: UCSF ImS Training Programs Systematically tackles real-world knowledge-practice gaps Seeks to use and create generalizable knowledge Requires interdisciplinary collaborations and methods Engages stakeholders at multiple levels Uses theory to explain mechanisms & design interventions Includes rigorous multi-level evaluation
  18. 18. • Epi 245. Introduction to Implementation Science Theory and Design • Epi 246. Designing Individual-Level Implementation Strategies • Epi 247. Designing Organizational-Level Implementation Strategies • Epi 248. Community-Engaged Research • Epi 249. Translating Evidence into Policy • Epi 252. Program Evaluation in Clinical/ Public Health Settings UCSF Program in Implementation Science Core Courses
  19. 19. UCSF Program in Implementation Science Core Courses Epi 245. Introduction to Translating Evidence into Practice: E. Geng Course Director http://ticr.ucsf.edu/courses/schedule/translating.html Epi 246. Designing Individual-Level Implementation Strategies: M Handley Course Director http://ticr.ucsf.edu/courses/schedule/translatingii.html
  20. 20. UCSF Program in Implementation Science Core Courses Epi 247. Designing Organizational-Level Implementation Strategies: L. Schmidt Course Director http://ticr.ucsf.edu/courses/schedule/translatingiii.html Epi 248. Community-Engaged Research: K. Grumbach Course Dir. http://ticr.ucsf.edu/courses/schedule/translating_practice.html
  21. 21. UCSF Program in Implementation Science Core Courses Epi 249. Translating Evidence into Policy http://ticr.ucsf.edu/courses/schedule/translating_policy.html B. Hollister Course Director Epi 252. Program Evaluation in Clinical/ Public Health Settings J. Meyers Course Director http://ticr.ucsf.edu/courses/schedule/program_evaluation.html
  22. 22. 1. Design and Implement More Effective Interventions to translate evidence into practice. This will be achieved by identifying community, patient, clinician and organizational factors that serve as barriers and facilitators to translating research results into everyday practice, policy and public health. Learning Objectives for Intensive Course Completion Upon completion of the program, scholars will be able to:
  23. 23. 2. Design More Comprehensive Evaluations of Interventions that translate evidence into practice. This will be achieved by applying the basics of process and outcome evaluation, and by identifying the appropriate qualitative and quantitative measures of effect. Upon completion of the program, scholars will be able to:
  24. 24. 3. Develop Better Grant Proposals. This will be achieved by making a compelling case for translational research and integrating conceptual frameworks into the intervention design and/or evaluation of your program. Upon completion of the program, scholars will be able to:
  25. 25. PRACTICE HEALTH An Ecological View of Improving Practice: Intervention Design and EvaluationEVIDENCE Epi 246: Designing Individual-Centered Implementation Strategies Ex. Design a community education campaign to promote colon cancer screening among adults age > 50 years. • Providers Individuals • Patients • Public Epi 252: Evaluation Strategies
  26. 26. PRACTICE HEALTH An Ecological View of Improving Practice: Intervention Design and EvaluationEVIDENCE Epi 247: Designing System Implementation Strategies Ex. Promote public report cards of health plans for cancer screening rates Delivery • Hospitals • Clinic/Practices Systems • Health Depts • Providers Individuals • Patients • Public Epi 252: Evaluation Strategies
  27. 27. PRACTICE HEALTH An Ecological View of Improving Practice: Community and PolicyEVIDENCE Epi 249: Advocacy & Policy Strategies Epi 248: Community-Engaged Strategies Ex. Community Advisors co-create intervention with research team and also embed structural targets community has prioritized (e.g. social marketing to venues that promote teen smoking) • Government Stakeholders • Payors/Insurers • Societies Delivery • Hospitals Systems • Clinic/Practices • Health Depts • Providers Individuals • Patients • Public Ex. Create legislation to make cancer screening free for Medicare beneficiaries
  28. 28. Available formats for the UCSF Training Programs UCSF-Based Training- In-Person Options (credit towards degrees available) N Classes Offered N people Completed to date (since 2010) 1) ImS Track Within Existing Master’s Program Training in Clinical Research (TICR) 6* 31 2) Certificate Program in Implementation Science 6 39 3) Electives within other programs in Department of Epidemiology and Biostatistics or as elective w/o program affiliation 6 156 Target Audience: Post-doctoral and junior faculty clinicians in research fellowships, public health/public policy post-doctoral trainees, senior faculty, doctoral students, practitioners and quality improvement officers or other staff engaged in the development, implementation or evaluation of strategies to promote health and health care quality. * A series of ImS-specific courses, complemented by a series of related methods courses from several departments.
  29. 29. • Health Disparities Research Methods • Clinical Performance and Health Outcomes Measurement • Qualitative Research Methods • Decision and Cost Effectiveness Analysis • Medical Informatics Examples of ImS Track Electives
  30. 30. UCSF Training Programs in ImS UCSF-Based Training – Other Formats (not credit bearing) Format N people to date (Fall,2016) 1) On-Line: Certificate Program in Implementation Science or a la carte ( on-line courses also offered individually) 6 classes on line, two per quarter Starting this Fall ! 2) Summer Training Institute: RISE (Research in Implementation Science for Equity)* 2 week intensive/+ small groups/WIP 22 3) International ImS Training Institutes** 1 week intensive/+small groups 60 *MPI: Bibbins-Domingo, Fernandez, Handley (09/15/2014 – 05/31/2018 ). The UCSF Research in Implementation Science for Equity (RISE) two-week program is part of NIH-NHLBI Program to Increase Diversity among Individuals Engaged in Health-Related Research (PRIDE) and recruits junior faculty. The UCSF RISE program consists of a Summer Institute on both Implementation Science (ImS) and Careers- In-Progress, distance mentoring and works in progress, and return immersion/sharing with new group. **Fogerty Funded Programs in Uganda (Davis, Reingold, Cattamanchi, Kamya), and others with WHO collaborators in Region 9 (E. Europe/N. Africa) involving modified versions of the 2 week programs (Rutherford, Handley, Bozicevic).
  31. 31. UCSF On-LineProgram in Implementation and Dissemination Science Fall 2016 Winter 2017 Spring 2017 Translating Evidence into Practice Organization- Centered Implementation Strategies Translating Evidence into Policy : Individual- Centered Implementation Strategies Program Evaluation Community-Engagement Overview Six online courses (2 each in Fall, Winter and Spring) designed to train health professionals to 1) design, adapt, and evaluate more effective strategies to facilitate implementation of health interventions; and 2) produce high-quality funding proposals. All six courses are required for the Certificate Program.
  32. 32. Examples of research from UCSF ImS Controlled Intervention trials • Can community-based TB screening vans increase TB case finding? (Davis) • Does adapted Diabetes Prevention Program (DPP) reduce diabetes risk factors in high risk pops? (Handley) Implementation trials • What strategies are most effective in linking TB patients to care and retaining them to the end of treatment? (Cattamanchi) • Which medical home referral program best engages psychiatrists in managing cardiometabolic outcomes in severely mentally ill pts? (Mangurian) • What is the effectiveness of referral to home- vs. center- based cardiac rehab after hospitalization for myocardial infarction, coronary bypass surgery, or percutaneous revascularization? (Whooley)
  33. 33. Alumni Survey- 2016 For those graduating 2010-2016 • Training Survey Focused on ImS-related Productivity and Current Positions • Competency Survey Focused on ImS-related Competencies Surveys targeted alumni of the two more intensive programs – the ImS track in Masters Degree in Clinical Research and ImS Certificate Program (completed 4-6 ImS intensive courses) • Surveys sent via SurveyMonkey in Winter-Spring 2015-2016 • Surveys were not not anonymous but were de-identified
  34. 34. Training Alumni Survey Results (preliminary) Overall Participation Rate 54/70 (77%). Not different for the two groups
  35. 35. Alumni Survey Results (preliminary)
  36. 36. Alumni Survey Results (preliminary)
  37. 37. 1. See us on-line https://accelerate.ucsf.edu/training/implementation-science-certificate http://ticr.ucsf.edu/courses/implementation_research.html 2. Contact us! Margaret Handley, PhD MPH – ImS Program Co- Director margaret.handley@ucsf.edu Adithya Cattamanchi, MD MAS – ImS Program Co- Director adithya.cattamanchi@ucsf.edu For More Information

×