1. Design and Critique of Grants for Implementation Research

2. Opportunity
PAR : Dissemination and Implementation Research in Health
Study Section: DIRH

3. Implementation research: a field of health services research that addresses the gaps between what we know and what we are doing.

4. I have been impressed with the urgency of doing
I have been impressed with the urgency of doing. Knowing is not enough; we must apply. Being willing is not enough; we must do.
Leonardo da Vinci

5. The implementation gap
What we know
What we are doing
CRC screening reduces CRC morbidity and mortality
HPV vaccination reduces the rate of cervical cancer
The Diabetes Prevention Program can reduce the risk of diabetes by 40-50%
High-risk women should be screened for BRCA mutations
~50% of patients > 50 are UTD with CRC screening
Kansas ranks 51st out of 50 states in HPV vaccination
There is no standardized application of the DPP at KUMC
Many high risk women remain unscreened

6. Purpose of Research Identify INNOVATIVE approaches To
Answer SIGNIFICANT questions
What?
Why?
How?

7. What constitutes a good research idea?
Feasible2
Subjects readily available
Technical expertise
Affordable (time/money) – Fundable
Manageable in scope
Interesting1
Investigator
Novel1
New, extends, refutes, or confirms prior findings
Ethical2
Relevant1
Scientific knowledge
Patient care
Public policy
Future research
1Is it exciting?
2Can you do it?

8. NIH Review Criteria Overall Impact 1Is it exciting? 2Can you do it?
Significance1
Investigator(s)2
Innovation1
Approach2
Environment2
1Is it exciting?
2Can you do it?

9. Characteristics of reviewers
Implementation methodologists
Clinicians
Physicians, PT, OT, social workers, psychologists, nutritionists
Community engagement
2 of 3 reviewers will have strong opinions about your problem and how it should be addressed

10. What makes an implementation research project significant?
The problem? OR
The solution (innovation)?
The implementation methodology?
What is the ‘implementation problem?

12. Significance: Common failings
Only talk about the significance of the problem
One-off innovations
Don’t address evidence base of how the innovation may have been used elsewhere
e.g. patient navigators for cervical cancer screening
Separate ‘scientific premise’ section?

13. Addressing the scientific premise
What is the evidence base for addressing the problem?
How does your ‘innovation’ build on this evidence base?
What is known about the problem of implementing the innovation?
How does your ‘implementation strategy’ build on what is known?

14. Innovation This is the first project to… Problem Innovation
Address this problem
Innovation
Test this innovation
Apply this innovation to this problem
Implementation
Use this implementation strategy
Apply this strategy to this problem/setting
Analysis
Apply a new theoretical framework to the analysis

15. Innovation – Common problems
Simply repeat the significance setting
Don’t frame issues as innovative
Too many randomized clinical trials*
*personal opinion

16. Step-wedged design

17. Investigators Setting Problem Implementation process
Primary care physicians if working in primary care
Problem
e.g oncologists to work with survivorship care plans
Implementation process
Experience with implementation resarch
Measurement and analysis
Statistics
Qualitative methods

18. Investigators – Common problems
Lack of experience (they can’t do it)
Poor approach
They don’t understand:
The setting
Implementation research
Analysis

19. Approach Preliminary studies (can they do the work)
Theoretical framework (intervention/innovation)
Big picture overview
Lay out the workflow
Measures relate to theoretical framework
Framework for implementation assessment

20. Approach – Common failings
Don’t understand the setting – have not thought through the workflow or how the innovation will work
Not implementation research (all work done centrally with passive target institution
Theoretical framework presented but then not incorporated into approach/evaluation
Fail to link the innovation/implementation strategies to previously identified barriers
Dump of measures
Not paying attention to who is asked to be doing what
Fidelity assessments missing (adoption)

21. Approach – Common failings
Inadequate data from pilot or pilot data not published
Data from prior studies presented inaccurately
Implementation models misapplied/misinterpreted
Poorly specified cost analyses
Measures not clearly justified
Confusing

22. Theory/Evidence-based Intervention Design and Implementation

23. Intervention Mapping – 6 steps

25. RE-AIM Evaluation methods
Reach: number, proportion, and representativeness of participants
Effectiveness: impact of intervention on outcomes (positive and adverse)
Adoption: number, proportion, and representativeness of settings willing to adopt then intervention
Implementation: fidelity of implementation to the effective protocol; consistency of delivery as intended
Maintenance: extent to which the intervention, program, or policy becomes institutionalized

26. Environment Experience in the setting
Able to recruit/track participants
Data readily available

27. Impact Advance management of the problem
Advance the field of implementation research

28. Proctor EK Implementation Science 2012; 7:96

29. Questions?