DII Science at UCLA: Launching a New Initiative (October 25, 2013) Presented by: Brian Mittman, Moira Inkelas, Stefanie Vassar, Ibrahima Sankare, Arturo Martinez, Arleen Brown The UCLA CTSI Dissemination, Implementation and Improvement (DII) Science Initiative has three main goals. 1) Expand UCLA’s competitiveness for DII funding and publication opportunities 2) Position UCLA CTSI for future renewal 3) Enhance societal impact and benefits of UCLA research and improve health care quality, health behaviors and health outcomes in Los Angeles County and beyond The DII vision is to ensure that: - Results of clinical studies are put into practice in Southern California to benefit diverse populations - Local providers take part in studies of how to implement, spread and scale findings and innovations - Research, implementation and dissemination occur seamlessly by design - Delivery systems can work with researchers to develop system solutions - Researchers can find delivery systems and/or provider networks with which to partner on implementation-oriented funding proposals and studies

1. Strengthening Dissemination, Implementation
and Improvement (DII) Science at UCLA:
Launching a New CTSI Initiative
Strategy presented by:
Brian Mittman, Moira Inkelas, Stefanie Vassar,
Ibrahima Sankare, Arturo Martinez, Arleen Brown
October 25, 2013

2. Background and motivation, national
• “Translational roadblocks”: IoM Clinical Research
Roundtable, NIH Roadmap, NIH CTSA Program
• “Quality chasm”: IoM Reports, add’l US and non-US
reports documenting significant gaps in the quality,
outcomes, equity, safety, value and patientcenteredness of health care and public health
• Affordable Care Act, de-implementation and
“affordability”: Significant growth in pressure and
interest in improving value and efficiency

3. Background and motivation, local
• UCLA CTSI Mission:
Accelerating Discoveries Toward Better Health
• Changes in funding agency priorities and
opportunities: NIH, AHRQ, PCORI, foundations, etc.
• UCLA Health System, Los Angeles County Department
of Health Services, other CTSI stakeholder priorities,
needs

4. Background and motivation, local
UCLA CTSI External Advisory Board Report, June 4, 2012:
“Explore the role of Community Engagement and
Research Program (CERP) in the dissemination and
implementation of evidence-based interventions;
transferring knowledge from all forms of CTSA
research to benefit community stakeholders and
population health in a sustainable manner.”

5. Research responses to these challenges
Dissemination science is the study of communication
strategies to increase awareness and understanding of
innovative, effective policies and practices to facilitate their
widespread adoption.
Implementation science is the study of contextual
influences, organizational and professional characteristics,
and specific interventions that impede or facilitate the
adoption of effective practices.
Improvement science is the study of factors and strategies
for improving the quality, performance and outcomes of
healthcare and public health systems and services.

6. UCLA CTSI Dissemination, Implementation and
Improvement Science Initiative
Goals: Expand UCLA capacity and activity in dissemination,
implementation, and improvement (DII) research to:
1. Enhance UCLA competitiveness for DII funding and
publication opportunities;
2. Position the CTSI for future renewal, based on
expected NCATS review criteria (local impact, unique
contributions to CTSA consortium);
3. Enhance societal impact and benefits of UCLA research
and improve health care quality, health behaviors and
health outcomes in Los Angeles County and beyond.

7. The vision
• Results of clinical studies are put into practice in Southern
California, and benefit diverse populations
• Local providers take part in studies of how to implement,
spread and scale findings and innovations
• Research, implementation and dissemination occur seamlessly,
by design
• Delivery systems can find researchers to help them develop
system solutions
• Researchers can find delivery systems and/or provider networks
to partner on implementation-oriented funding proposals and
studies

8. The strategy
• Establish DII as a focus area within the CTSI, to promote use of
existing CTSI infrastructure that supports increased DII research, and
identify potential synergies across CTSI programs
• House the organizing efforts for the DII focus area within CERP, while
identifying DII opportunities and needs involving other CTSI programs
(such as Education, and Regulatory)
• Priorities are to:
– Increase awareness by investigators of DII supports available through CERP
– Support training and learning opportunities in DII, including methods and
undertaking DII research with community partners (shared strategy of CERP
and the CTSI Education program)
– Identify value added opportunities for increasing DII research within CTSI
partner organizations

9. DI&I Science Initiative goals and components
• Education, Training & Capacity Building
– Enhance DII skills within the UCLA academic research workforce
– Build CTSI institution and community partner capacity to conduct and use
DII research
• Consultation
– Provide expertise in DII study design, conduct and publication
– Facilitate successful responses to DII FOAs (NIH, PCORI, CMS, foundations)
• Tools and Resources
– Create and provide links to DII tools and resources
– Create templates for DII funding applications, IRB applications
• Interface with CTSI and other CTSI programs
– Support dissemination of UCLA research, targeting health care delivery
– Develop measures and track activities and impact with Evaluation program
– Collaborate with RRT’s environmental scanning of DII funding opportunities

10. Education, training & capacity building
• Establish new Master of Science in Improvement and
Implementation Science
–New courses in the School of Public Health, in advanced
improvement science methods and in implementation science
research methods
–Offered in Winter and Spring 2013
• Offer DII content/modules within array of content offered for
clinician researchers in training
• Identify additional curriculum expansion needs and
opportunities, including the possibility of new training
programs/tracks

11. Education, training & capacity building
• Develop DII research components/supplements in
ongoing/planned clinical research
• Identify DII opportunities linked with quality improvement
departments and efforts within CSTI institutions
– UCLA Health, Harbor, CSMC Medical Delivery Network
• Identify DII opportunities involving community partners
– e.g., Los Angeles Department of Health Services

12. Integrating Patient Voice into
Quality and Process Improvement
A prototype of consumer involvement in quality
improvement in the Los Angeles County Department of
Health Services, Harbor-UCLA Medical Center
Daniel Castro, MD, Moira Inkelas, PhD, Joslyn Levy,
BSN, MPH, Jane Taylor, Ed D

13. Goals
Patient=Consumer
• Partner with the Los Angeles County Department of
Health Services (DHS) to identify and respond to patient
priorities for improving care processes
• Bring consumer perspective into quality and process
improvement activities
• Standardize a methodology to integrate consumer
perspective into quality and process improvement
• Implement consumer input into LA County DHS quality
and process improvement activities, through a future
spread strategy (practice based research network, PBRN)

14. Context for This Research
• Large evidence base for understanding the patient experience
– Multiple methods of modeling the patient experience, such as
clinic walk-throughs
– Extensive use of surveying
• Increasing appreciation of the value of explicit involvement of
patients/consumers in how care is designed and delivered
– Examples include the NIH-funded Collaborative Chronic Care
(C3N) Transformative grant
• This perspective is now reflected in:
– federal research funding (e.g., PCORI)
– models of care (e.g., Medical Home Index supported by
HRSA/Maternal and Child Health Bureau)
• The current research is a novel application of the “N=1”
clinical method, for care innovation and improvement

15. Education, training & capacity building
• Future strategies
– Improve data capture and reporting capacity within CTSI institutions
and community partners to facilitate more efficient research
– Identify practice-level incentives for participating in expanded DII
activity
– Identify opportunities for continuing education programs for local
practicing health care professionals in improvement science
– Identify collaboration opportunities with professional organizations
(e.g., CAFP, AAP, CCALA, CPCA)

16. Consultation
• Facilitate successful DII funding applications, projects and
publications, through expert consultation in DII study design,
conduct and publication
– Increase awareness of CERP consulting service

17. Tools and resources
• Make available opportunities in DII training, and methods
– Posting on UCLA CTSI website
• Offer templates for components of proposals and projects
– Dissemination plans, and/or other components

18. Other institutional support and dissemination
• Future strategies:
– Strengthening dissemination infrastructure within the UCLA CTSI