January 11, 2024: BeatPain Utah Study Team Uses Implementation Mapping Approach to Plan Hybrid Trial

In a new article from the NIH Pragmatic Trials Collaboratory, the BeatPain Utah study team describes the "implementation mapping" they used to plan for trial implementation. The comprehensive, systematic approach enabled the team to craft an implementation plan for a complex telehealth intervention and to identify outcomes for evaluating the success of the implementation strategies.

The article was published this month in Implementation Science Communications.

BeatPain Utah, an NIH Collaboratory Trial, is studying real-world implementation of a telehealth physical therapy strategy for patients with chronic back pain in primary care clinics of federally qualified health centers. During the 1-year planning phase described in the article, the study team developed a logic model, based in part on the Consolidated Framework for Implementation Research (CFIR), to identify contextual factors across several domains that could influence e-referral and telehealth implementation in the trial.

In this ongoing type 1 hybrid effectiveness-implementation trial, the implementation strategies developed through the mapping exercise are being evaluated as part of the trial.

BeatPain Utah is supported within the NIH Pragmatic Trials Collaboratory through the NIH HEAL Initiative under an award administered by the National Institute of Nursing Research. Learn more about BeatPain Utah.

November 29, 2023: NIH Offers Methods Webinar on Implementation Science With Insights From Behavioral Economics

The NIH Office of Disease Prevention will continue its Methods: Mind the Gap webinar series on Friday, December 8, with "Supercharging Implementation Science With Insights From Behavioral Economics." Rinad Beidas, chair and Ralph Seal Paffenbarger Professor of Medical Social Sciences at the Feinberg School of Medicine at Northwestern University, will lead the webinar.

The Methods: Mind the Gap series explores research design, measurement, intervention, data analysis, and other methods of interest in prevention science. The December 8 session will describe efforts to use tools from implementation science and behavioral economics to improve implementation of evidence-based practices.

Register in advance to join the online presentation. Registration is required.

August 3, 2023: NCI’s David Chambers Discusses Role of Implementation Science in Pragmatic Research

This year’s Annual Steering Committee Meeting for the NIH Pragmatic Trials Collaboratory featured implementation science as one of the topics of focus. In an interview after his keynote presentation, Dr. David Chambers, deputy director for implementation science at the National Cancer Institute, shared his thoughts on opportunities for implementation science in the context of pragmatic trials.

Why Implementation Science Is Important in Pragmatic Research

Chambers described the overlap between implementation science and pragmatic research and how this creates several benefits. Implementation science gives a heightened focus on how to get interventions to be as accessible, well used, and beneficial as possible to populations within the systems and communities in which people are seeking and receiving healthcare.

“The earlier researchers can think about their interventions being used beyond the trial, the better,” Chambers explained. “Implementation science helps to provide a lens for multiple levels of change that may be needed, including supports for patients and families, clinicians, clinics, systems, policymakers, and other key decision-makers.”

Furthermore, implementation science methods can save time in identifying barriers and facilitators for delivering interventions with high quality-knowledge which can be applied toward the ultimate use of interventions.

Chambers encourages researchers to embrace the dynamism that is reflected in our health systems, which is particularly apt for research conducted in the setting of routine care. “It is a given that there will be deviations from the design of an intervention and its implementation, so how can researchers learn from this?” he said.

In terms of sustaining an intervention, a more dynamic approach is needed to how the intervention and the context will change over time, he explained. “Too often we think of sustainment in terms of fixing things in their original state. Sustainment needs to think about how to build in evolution-medicine and our practices are evolving.”

Role of the NIH Pragmatic Trials Collaboratory

According to Chambers, the NIH Pragmatic Trials Collaboratory provides a natural setting for implementation activities because of the close partnerships between the investigative teams and the health systems and community settings where the research occurs. As a result, the program is poised for ongoing learning from the strategies health systems are using to implement a range of different interventions.

There is also an opportunity for pooling lessons across the NIH Collaboratory Trials, such as common measures that can be used to better characterize adaptation, understanding perspectives and needs of patients and clinicians, and approaches related to long-term sustainment or deimplementation of interventions.

Increasingly for NIH Collaboratory trials, issues related to implementation are baked into both the design of interventions and the approach used to test the interventions, which is a testament to the program’s ongoing progress in encouraging the use of implementation science concepts and methods.

Learn more about the NIH Collaboratory’s Implementation Science Core.

How NIH Is Advancing Implementation Science

For over 20 years, NIH has recognized the gaps in knowledge needed for successful implementation of evidence-based interventions. Across NIH institutes, centers, and offices, they have discussed the common challenges observed when investigators saw a positive result in their trial and were frustrated that it could not be replicated and scaled up in the real world.

NIH funds dissemination and implementation research grants and has a standing review panel, the Science of Implementation in Health and Healthcare, focused on this area where any applicant to NIH can suggest that their grant be reviewed. In addition, NIH supports training opportunities in the field and cohosts an annual scientific conference in partnership with AcademyHealth.

NIH continues to explore the interface between effectiveness and implementation, think about deimplementation, and work on tackling misinformation, all towards advancing how to better apply the evidence generated in research to optimize population health and healthcare.

July 5, 2023: This Week’s PCT Grand Rounds to Highlight IMPLEMENT-HF Study

Headshot of Dr. Ankeet Bhatt
Dr. Ankeet Bhatt

In this Friday’s PCT Grand Rounds, Ankeet Bhatt of the Kaiser Permanente Northern California Division of Research will present “Implementing Virtual Strategies Across an Integrated Healthcare System: The IMPLEMENT-HF Study.”

The Grand Rounds session will be held on Friday, July 7, 2023, at 1:00 pm eastern.

Dr. Bhatt is an associate physician at the Kaiser Permanente San Francisco Medical Center and a research scientist at the Kaiser Permanente Northern California Division of Research. The IMPLEMENT-HF study tested the implementation of a virtual care team guided strategy to optimize guideline-directed medical therapy for hospitalized patients with heart failure with reduced ejection fraction.

Join the online meeting.

May 15, 2023: EMBED Offers Lessons for Intervention Adoption, Implementation, and Maintenance

EMBED logoOrganizational culture, clinician training and support, the ability to link patients to ongoing treatment, and the ability to tailor implementation to each clinical site were key determinants of successful implementation of an intervention to promote buprenorphine initiation in emergency departments, according to a qualitative study conducted as part of the EMBED pragmatic clinical trial.

The study’s findings were published recently in Implementation Science Communications.

EMBED, an NIH Collaboratory Trial, was a cluster randomized trial across 21 emergency departments in 5 healthcare systems in the United States. The trial tested the effectiveness of a clinical decision support tool integrated into the electronic health record in improving rates of buprenorphine initiation in the emergency department for the treatment of opioid use disorder. The intervention led to a modest increase in buprenorphine initiation and little impact on patient outcomes.

A secondary aim of the study was to identify determinants of adopting, implementing, and maintaining the clinical decision support tool at the trial sites. Among the key determinants were:

  • establishing buprenorphine initiation as a cultural norm within healthcare organizations;
  • organizational commitment to implementing and sustaining the intervention;
  • clinician training and support on opioid use disorder and buprenorphine initiation in emergency departments;
  • availability of referral resources to link patients who were initiated on buprenorphine in the emergency to ongoing treatment; and
  • the ability to tailor the intervention to clinic workflows that fit the resources and characteristics of the local clinic.

EMBED was supported within the NIH Collaboratory by a cooperative agreement from the National Institute on Drug Abuse and received logistical and technical support from the NIH Collaboratory Coordinating Center. Read more about EMBED in the Living Textbook, and learn about the other NIH Collaboratory Trials.

Read the full report.

Grand Rounds April 7, 2023: A Nudge Towards Cardiovascular Health: Incorporating Insights From Behavioral Science to Improve Cardiovascular Care Delivery (Srinath Adusumalli, MD, MSHP, MBMI, FACC)

Speaker

Srinath Adusumalli, MD, MSHP, MBMI, FACC
Adjunct Assistant Professor of Medicine, Perelman School of Medicine
Adjunct Professor of Healthcare Management, The Wharton School
Affiliated Faculty, Center for Health Incentives and Behavioral Economics
Staff Cardiologist, Hospital of the University of Pennsylvania and Philadelphia VAMC University of Pennsylvania
Senior Medical Director, Enterprise

Keywords

Pragmatic trials, cardiovascular medicine, cardiovascular care delivery, behavioral science, electronic health records, implementation science

Key Points

  • A nudge is a subtle change in design that is intended to impact human behavior. They are intended to remind, guide, or motivate a decision, and they should be transparent. Dr. Srinath Adusumalli described a nudge as something that helps make the right choice an easier choice.
  • Nudges and other behavioral interventions are prevalent in industries like business and entertainment, but there is an opportunity for nudges in medicine and health care delivery.
  • Launched in 2016, the Penn Medicine Nudge Unit is the world’s first behavioral design team embedded within a health system. It works to improve health care value and outcomes, advance the science of designing interventions to change behavior and evaluate and disseminate the impact of interventions. The team then worked to incorporate an implementation science lens for designing interventions for scale to the health system.
  • The health behavior is supported by a technology backbone, including the Penn Medicine EHR and other systems that bring insight and nudge within workflows. The context and stakeholder input have been key in developing and implementing nudges.
  • Useful nudge principles are limitations of information provisions, inertia or status quo bias, choice overload, loss aversion or framing, social ranking and the limits of willpower.
  • Implementing the nudge tool within the Penn Medicine revealed several positive impacts, including referral rates increasing significantly via the implementation of a default pathway.
  • The PRESCRIBE trial revealed the value of active choice as well as peer decision-making to prompt decision-making.
  • Key considerations for developing and implementing a nudge include the right information and guidelines, the right individual to receive the nudge, the right intervention format, the best channel for the nudge and the best time in a provider’s workflow to receive the nudge.
  • Key learnings from the studies highlighted included the need for more transparency as to the reason for a nudge, limiting the number of choices in CDS intervention, passive CDS is often ineffective and it is critical to provide the path for the individual to immediately act.
  • New frontiers in nudging include integrating nudges and behavioral science with applied machine learning, phenotyping patient and clinician behavior to more precisely target single or combination nudges, the simplification and automation of downstream actions, and the alignment of incentive and behaviors across health care actors, including systems and payers.

Discussion Themes

In the last few years, there has been great reception to the value of behavioral science and implementation science in the field of cardiology. There is opportunity for more evidence to be developed and to implement lessons that have been learned.

Behavioral science tools, such as these EHR-integrated nudges, must be modified to fit within different settings and EHR systems, but they often provide a strong foundation for other contexts. Customizing existing tools to different systems can save significant time and resources in developing behavioral health tools.

Tags

#pctGR, @Collaboratory1

April 5, 2023: This Friday’s PCT Grand Rounds Highlights Applications of Behavioral and Implementation Science in Cardiovascular Medicine

Headshot of Dr. Srinath AdusumalliIn this Friday’s PCT Grand Rounds, Srinath Adusumalli of the University of Pennsylvania will present “A Nudge Towards Cardiovascular Health: Applications of Behavioral and Implementation Science in Cardiovascular Medicine.” The Grand Rounds session will be held on Friday, April 7, 2023, at 1:00 pm eastern.

Dr. Adusumalli is an adjunct assistant professor of medicine and an adjunct professor of healthcare management at the University of Pennsylvania. He is the senior medical director of enterprise virtual care and retail health for CVS Health, where he drives clinical initiatives to support the company’s virtual strategy.

Join the online meeting.

November 3, 2022: Pragmatic Trials Workshop at 2022 D&I Science Conference Open for Registration

AcademyHealth and NIH logosThe NIH Pragmatic Trials Collaboratory will offer a full-day workshop at the 15th Annual Conference on the Science of Dissemination and Implementation in Health in Washington, DC. The workshop, “Dissemination & Implementation Research Methods and Embedded Pragmatic Trials: Strategies for Designing Studies That Inform Care for Diverse Populations,” will introduce concepts in the design, conduct, and implementation of pragmatic clinical trials embedded in healthcare systems.

The learning objectives of the workshop include:

  • To identify key areas of synergy between pragmatic trials and implementation research
  • To introduce attendees to the unique characteristics and challenges of designing, conducting, and implementing pragmatic clinical trials embedded within diverse health care systems, and to describe opportunities for integrating implementation research methods into pragmatic trials
  • To increase the capacity of health services researchers to address important clinical questions with pragmatic clinical trials and share lessons from implementation science for increasing engagement of diverse participants

The theme of this year’s D&I conference is “(Re)Building Better Systems: Being Proactive, Nimble, and Responsive.” The annual conference is cohosted by the NIH and AcademyHealth.

WORKSHOP DETAILS AND REGISTRATION
Sunday, December 11, 8:00 am-4:45 pm
Walter E. Washington Convention Center, Washington, DC

September 22, 2022: Registration Opens for Pragmatic Trials Workshop at AcademyHealth Dissemination & Implementation Conference

AcademyHealth and NIH logosThe NIH Pragmatic Trials Collaboratory will offer a full-day workshop at the 15th Annual Conference on the Science of Dissemination and Implementation in Health in Washington, DC. The workshop, “Dissemination & Implementation Research Methods and Embedded Pragmatic Trials: Strategies for Designing Studies That Inform Care for Diverse Populations,” will introduce concepts in the design, conduct, and implementation of pragmatic clinical trials embedded in healthcare systems.

The learning objectives of the workshop include:

  • To identify key areas of synergy between pragmatic trials and implementation research
  • To introduce attendees to the unique characteristics and challenges of designing, conducting, and implementing pragmatic clinical trials embedded within diverse health care systems, and to describe opportunities for integrating implementation research methods into pragmatic trials
  • To increase the capacity of health services researchers to address important clinical questions with pragmatic clinical trials and share lessons from implementation science for increasing engagement of diverse participants

The theme of this year’s D&I conference is “(Re)Building Better Systems: Being Proactive, Nimble, and Responsive.” The annual conference is cohosted by the NIH and AcademyHealth.

WORKSHOP DETAILS AND REGISTRATION
Sunday, December 11, 8:00 am-4:45 pm
Walter E. Washington Convention Center, Washington, DC

December 8, 2021: NIH Collaboratory and IMPACT Collaboratory Offer Workshop on Dissemination and Implementation Research and Pragmatic Trials

Logo for AcademyHealthThe NIH Collaboratory is partnering with the IMPACT Collaboratory to offer a pre-conference workshop on December 13 at AcademyHealth’s 14th Annual Conference on the Science of Dissemination and Implementation in Health.

The workshop, Convergence of Dissemination & Implementation Research Methods and Embedded Pragmatic Trials, will provide an introduction to investigative opportunities for pragmatic clinical trials embedded in healthcare systems, along with strategies for conducting clinical trials that provide real-world evidence necessary to inform both practice and policy.

The workshop is being offered free to conference attendees but requires a separate registration. The workshop will provide strategies for integrating implementation research methods in the design and conduct of ePCTs. Speakers will share firsthand experiences and case studies from the NIH Collaboratory and the IMPACT Collaboratory.

The learning objectives of the workshop include:

  • To identify key areas of synergy between ePCTs and implementation research
  • To introduce attendees to the unique characteristics and challenges of designing, conducting, and implementing ePCTs within diverse healthcare systems, and to describe opportunities for integrating implementation research methods into ePCTs
  • To increase the capacity of health services researchers to address important clinical questions with ePCTs and implementation research methods

CONFERENCE DETAILS AND REGISTRATION
14th Annual Conference on the Science of Dissemination and Implementation in Health: Broadening Horizons for Impact: Incorporating Multisectoral Approaches into D&I Science
December 13, 2021