Implementation Science Principles Research Articles

Series on The Lancet Oncology Commission on Global Cancer Surgery-Action 1: Clinical Care and Access to Cancer Surgery.

The second Lancet Oncology Commission on Global Cancer Surgery was conceived to develop a roadmap of pragmatic solutions to address inequities and propel improvements in access to cancer surgery on the global stage. This Commission included nine solutional domains and eight Actions to help catalyze improvements in access to cancer surgery. The Annals of Surgical Oncology series on The Lancet Oncology Commission on Global Cancer Surgery will highlight these eight Actions individually with additional refinements. The first article will highlight the Action of clinical care and access to cancer surgery. To increase the likelihood of success in implementing the recommendations within this Action, we incorporated the principles of implementation science taken from the Consolidated Framework for Implementation Research (CFIR). The CFIR identifies several steps to implementing new changes in health care that include the intervention, outer setting, inner setting, people involved, and the process. We enhanced this framework by including two additional steps: barriers and time to implement the new change. Cascading along the CFIR pathway, we outline initiatives and other details to improve access to and address inequities in access to cancer surgical care. The Annals of Surgical Oncology Series on the second Lancet Oncology Commission on Global Cancer Surgery hopes to enhance the visibility of the eight critical Actions within this important Commission to the primary stakeholders, the surgeons. We hope this article of the Series will help to amplify the message and serve as a catalyst for implementing efforts to improve cancer surgical care on the global stage.

Direct to psychology for sleep disorders: Innovating models of care in the hospital and health service.

A 'Direct to Psychology Insomnia' pathway was developed for implementation within a multidisciplinary sleep disorders service in a tertiary hospital in Brisbane, Australia. The project was informed by implementation science principles and methodology to re-design the model of care (MoC). A consensus group workshop using the Nominal Group Technique (NGT) with 12 multidisciplinary staff was undertaken to develop the new MoC. The workshop explored inclusion and exclusion criteria for a Direct to Psychology pathway including patient flow and enablers. The team endorsed a MoC that was acceptable to stakeholders and addressed service-level imperatives. The findings highlighted that patient inclusion or exclusion should be overseen by the Sleep Physician team and an Advanced Psychologist with behavioural sleep medicine expertise. Continuum of care for patients referred via primary care providers was considered. Barriers and risks to the MoC changes were identified which informed the refinement of the MoC.

Improving Diabetes Equity and Advancing Care (IDEA) to optimize team-based care at a safety-net health system for Black and Latine patients living with diabetes: study protocol for a sequential, multiple assignment, randomized trial

BackgroundDiabetes is the eighth leading cause of death in the USA. Inequities driven by structural racism and systemic oppression have led to racial/ethnic disparities in diabetes prevalence, diagnosis, and treatment. Diabetes-self management training (DSMT), remote glucose monitoring (RGM), and tailored support from a community health worker (CHW) have the potential to improve outcomes. This study will examine the implementation of these interventions in a safety-net healthcare setting.MethodsUsing implementation science and racial equity principles, this study aims to (1) evaluate the appropriateness; (2) measure fidelity; and (3) compare the effectiveness of varying the combination and sequence of three interventions. An exploratory aim will measure sustainability of intervention adherence and uptake. This mixed-methods trial employs a sequential, multiple assignment randomized trial (SMART) design, patient focus group discussions, and staff interviews. Eligible Black/Latine patients will be recruited using patient lists extracted from the electronic medical record system. After a detailed screening process, eligible patients will be invited to attend an in-person enrollment appointment. Informed consent will be obtained and patients will be randomized to either DSMT or RGM. At 6 months, patients will complete two assessments (diabetes empowerment and diabetes-related distress), and HbA1c values will be reviewed. “Responders” will be considered those who have an HbA1c that has improved by at least one percentage point. “Responders” remain in their first assigned study arm. “Nonresponders” will be randomized to either switch study arms or be paired with a CHW. At 6 months participants will complete two assessments again, and their HbA1c will be reviewed. Twelve patient focus groups, two for each intervention paths, will be conducted along with staff interviews.DiscussionThis study is the first, to our knowledge, that seeks to fill critical gaps in our knowledge of optimal sequence and combinations of interventions to support diabetes management among Black and Latine patients receiving care at a safety-net hospital. By achieving the study aims, we will build the evidence for optimizing equitable diabetes management and ultimately reducing racial and ethnic healthcare disparities for patients living in disinvested urban settings.Trial registrationClinicalTrials.gov: NCT06040463. Registered on September 7, 2023.

Relevance of learning health systems to physiatrists and its synergy with implementation science: A commentary.

As health care attempts to bridge the gap between evidence and practice, the concept of the learning health system (LHS) is becoming increasingly relevant. LHS integrates evidence with health systems data, driving health care quality and outcomes through updates in policy, practice, and care delivery. In addition, LHS research is becoming critically important as there are several initiatives underway to increase research capacity, expertise, and implementation, including attempts to stimulate increasing numbers of LHS researchers. Physical Medicine & Rehabilitation (PM&R) physicians (physiatrists), nurses, therapists (physical therapists, occupational therapists, speech therapists, clinical psychologists), and scientists are affiliated with LHSs. As LHS research expands in health care systems, better awareness and understanding of LHSs and LHS research competencies are key for rehabilitation professionals including physiatrists. To address this need, the Agency of Healthcare Research and Quality (AHRQ) identified 33 core competencies, grouped into eight domains, for training LHS researchers. The domains are: (1) Systems Science; (2) Research Questions and Standards of Scientific Evidence; (3) Research Methods; (4) Informatics; (5) Ethics of Research and Implementation in Health Systems; (6) Improvement and Implementation Science; (7) Engagement, Leadership, and Research Management; and the recently added (8) Health and Healthcare Equity and Justice. The purpose of this commentary is to define LHS and its relevance to physiatrists, present the role of implementation science (IS) in LHSs and application of IS principles to design LHSs, illustrate current LHS research in rehabilitation, and discuss potential solutions to improve awareness and to stimulate interest in LHS research and IS among physiatrists in LHSs.

Impact of a multi-disciplinary team-based care model for patients living with diabetes on health outcomes: a mixed-methods study

BackgroundIndividuals facing socioeconomic hardship experience higher than average rates of chronic disease, such as diabetes, with less access to evidence-based treatment. One solution to address these inequities is a team-based care (TBC) model, defined as one in which at least two providers work collaboratively with a patient and their caregiver(s) to make healthcare decisions. This paper seeks to describe the implementation of a TBC model within a safety-net healthcare setting and determine the extent to which it can be an effective, patient-centered approach to treating individuals with diabetes.MethodsSemi-structured interviews were conducted with staff (n = 15) and patients (n = 18). Clinical data were extracted from the electronic medical record of patients (n = 1,599) seen at a safety-net health system in Chicago, Illinois, United States. The mixed methods study was guided by implementation science and participatory research principles. Staff interviews were 60 min and covered patient care activities, work flow, perceived patient experience, and facilitators/barriers to care coordination. Patient interviews were 60 min and covered satisfaction, attitudes about diabetes management, quality of life, and technology. Patient interviews were co-analyzed by research staff and members of a patient advisory committee. Clinical data were collected at an index visit, two years prior and at one-year follow up (n = 1,599).ResultsFour themes emerged from the interviews: (1) patients perceived the TBC model to be patient centered and of high quality; (2) technology can be an innovative tool, but barriers exist; (3) diabetes management is a complex process; and (4) staff communication enhances care coordination, but misinterpreting roles reduces care coordination. From pre-enrollment to the follow-up period, we found a statistically significant increase in missed visits, decrease in hemoglobin A1c (HbA1c), decrease in body mass index, and decrease in the percent of patients with high blood pressure. We found that each medical visit during the follow-up period was associated with an HbA1c decrease of 0.26 points.ConclusionsA TBC model is a patient-centered approach to providing care to patients with complex health needs, such as diabetes, patients were satisfied with the care they were receiving, and the model was associated with an improvement in clinical outcomes.

Incorporating implementation science principles into curricular design.

Implementation science (IS) is an approach focused on increasing the application of evidence-based health interventions into practice, through purposive and thoughtful planning to maximize uptake, scalability, and sustainability. Many of these principles can be readily applied to medical education, to help augment traditional approaches to curriculum design. In this paper, we summarize key components of IS with an emphasis on application to the medical educator.

Implementation outcomes of the Philadelphia Police School Diversion Program: A school-based alternative-to-arrest initiative

ABSTRACT Evaluations of juvenile and criminal legal system programs typically focus on outcomes related to program impacts, or effectiveness. However, implementation outcomes – which relate to the processes underlying program execution – are equally as critical to determining program success. Adding to the burgeoning interest in applying implementation science principles to legal system interventions, the current study examined implementation outcomes of the Philadelphia Police School Diversion Program – a school-based, alternative-to-arrest program that has already demonstrated promising effectiveness outcomes. Through qualitative analysis of semi-structured interviews with 11 school and police stakeholders and quantitative analysis of police data for 2,047 school-based arrests in Philadelphia that occurred during the first five years of program operation, we explored outcomes related to Diversion Program adoption, appropriateness, acceptability, fidelity, penetration/reach, and sustainability, as well as stakeholder thoughts about program expansion and replication. Results revealed several important components of program implementation that contributed to its widespread adoption and sustained operations.

Strengthening healthcare delivery in Rwanda: Implementation science training for reproductive health researchers

BackgroundAddressing the gap between research and practice is crucial for enhancing reproductive healthcare outcomes. In Rwanda and other low- and middle-income countries, bolstering health researchers’ implementation science (IS) capacity is essential. We present a pre-post-intervention study assessing the influence of an intensive IS training program on Rwandan reproductive health researchers’ perceived IS knowledge and self-efficacy in applying IS in their own research. MethodsTo introduce IS principles, we held a one-day training for a diverse cohort of 25 sexual and reproductive health researchers in Rwanda. The training encompassed modules on IS concepts, methodologies, and practical applications. Pre- and post-training assessments gauged changes in participants’ perceived IS knowledge and self-efficacy in applying IS in their own work. ResultsThe study revealed a significant improvement in self-efficacy related to performing IS related tasks. Researchers reported heightened confidence in designing and implementing evidence-based interventions. In terms of perceived knowledge, participants retained what they learned at 4 months. The training fostered a collaborative learning environment, encouraging participants to exchange ideas and experiences. ConclusionTargeted training in IS appears to enhance reproductive health researchers’ capacity to translate research into practice, potentially leading to improved healthcare outcomes in Rwanda. Moving forward, we advocate for the Ministry of Health to establish structures for IS research agenda-setting, particularly for sexual and reproductive health and rights. Ideally, universities, health systems, and research institutions will incorporate IS capacity strengthening into their routine activities. Ongoing training is crucial to reinforce and expand IS knowledge. Our findings are expected to inform future interventions and guide policy development.

Using implementation science to operate as a learning health system to improve outcomes in early psychosis.

Early interventions are well understood to improve psychosis outcomes, but their successful implementation remains limited. This article introduces a three-step roadmap for advancing the implementation of evidence-based practices to operate as a learning health system, which can be applied to early interventions for psychosis and is intended for an audience that is relatively new to systematic approaches to implementation. The roadmap is grounded in implementation science, which specializes in methods to promote routine use of evidence-based innovations. The roadmap draws on learning health system principles that call for commitment of leadership, application of evidence, examination of care experiences, and study of health outcomes. Examples are discussed for each roadmap step, emphasizing both data- and stakeholder-related considerations applicable throughout the roadmap. Early psychosis care is a promising topic through which to discuss the critical need to move evidence into practice. Despite remarkable advances in early psychosis interventions, population-level impact of those interventions is yet to be realized. By providing an introduction to how implementation science principles can be operationalized in a learning health system and sharing examples from early psychosis care, this article prompts inclusion of a wider audience in essential discourse on the role that implementation science can play for moving evidence into practice for other realms of psychiatric care as well. To this end, the proposed roadmap can serve as a conceptual guiding template and framework through which various psychiatric services can methodically pursue timely implementation of evidence-based interventions for higher quality care and improved outcomes.

Implementation of a Clinical Vessel Wall MR Imaging Program at an Academic Medical Center.

The slow adoption of new advanced imaging techniques into clinical practice has been a long-standing challenge. Principles of implementation science and the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework were used to build a clinical vessel wall imaging program at an academic medical center. Six phases for implementing a clinical vessel wall MR imaging program were contextualized to the RE-AIM framework. Surveys were designed and distributed to MR imaging technologists and clinicians. Effectiveness was measured by surveying the perceived diagnostic value of vessel wall imaging among MR imaging technologists and clinicians, trends in case volumes in the clinical vessel wall imaging examination, and the number of coauthored vessel wall imaging-focused publications and abstracts. Adoption and implementation were measured by surveying stakeholders about workflow. Maintenance was measured by surveying MR imaging technologists on the value of teaching materials and online tip sheets. The Integration dimension was measured by the number of submitted research grants incorporating vessel wall imaging protocols. Feedback during the implementation phases and solicited through the survey is qualitatively summarized. Quantitative results are reported using descriptive statistics. Six phases of the RE-AIM framework focused on the following: 1) determining patient and disease representation, 2) matching resource availability and patient access, 3) establishing vessel MR wall imaging (VWI) expertise, 4) forming interdisciplinary teams, 5) iteratively refining workflow, and 6) integrating for maintenance and scale. Survey response rates were 48.3% (MR imaging technologists) and 71.4% (clinicians). Survey results showed that 90% of the MR imaging technologists agreed that they understood how vessel wall MR imaging adds diagnostic value to patient care. Most clinicians (91.3%) reported that vessel wall MR imaging results changed their diagnostic confidence or patient management. Case volumes of clinical vessel wall MR imaging performed from 2019 to 2022 rose from 22 to 205 examinations. Workflow challenges reported by MR imaging technologists included protocoling examinations and scan length. Feedback from ordering clinicians included the need for education about VWI indications, limitations, and availability. During the 3-year implementation period of the program, the interdisciplinary teams coauthored 27 publications and abstracts and submitted 13 research grants. Implementation of a clinical imaging program can be successful using the principles of the RE-AIM framework. Through iterative processes and the support of interdisciplinary teams, a vessel wall MR imaging program can be integrated through a dedicated clinical pipeline, add diagnostic value, support educational and research missions at an academic medical center, and become a center for excellence.

Bridging the gap: Implementation science, knowledge translation, and innovation for advancing maternal health sustainable development goals

Background: Maternal health remains a critical global concern, with sustainable development goal 3 aiming to reduce the maternal mortality ratio and ensure universal access to reproductive healthcare by 2030. According to a 2023 report, a woman dies from preventable causes related to pregnancy and childbirth every 2 minutes, and almost 70% of maternal deaths occur in sub-Saharan Africa. The reduction of maternal mortality and promotion of maternal health and well-being are complex tasks. Objective: To understand how a synergistic approach integrating complex interventions’ research, implementation science principles, knowledge translation, and innovative solutions can be leveraged to achieve sustainable improvements in maternal health outcomes in different contexts. Methods: This study employed sequential and iterative critical interpretive synthesis (CIS), integrative literature (ILR) review with multiscale analysis of extant literature on maternal health starting with the landmark Lancet series on “Maternal Survival” 2006 (5 papers); 2016 “Maternal Health” series (6 papers); the 2023 Series – “Maternal health in Perinatal period and Beyond” (4 papers); and health sector strategic plans. Results: Despite knowledge that healthcare is a complex adaptive system (CAS), whereas interventions for maternal health are considered complex interventions, the predominant implementation approaches assume a linear cause-effect approach, leading to the observed stagnation in maternal health. Conclusion: The effectiveness of complex interventions and their success in reaching relevant populations is critically influenced by their implementation in each context. A linear understanding of evidence translation, from ‘bench to bedside’, is naïve. This is because those who deliver, manage, and receive healthcare, negotiate multiple forms and sources of evidence, which complement and compete within a complex system of institutional logics.

Food is Medicine and implementation science: A recipe for health equity.

Diet-related chronic diseases such as Type II diabetes, cardiometabolic diseases, and cancer are among the leading causes of death in the USA. Nutrition security has emerged as a target outcome and a national priority for preventative medicine and the treatment of diet-related chronic diseases. Food is Medicine (FIM) initiatives encompass programs and interventions to meet priority population's needs across food and nutrition security continuums as a mechanism to address persistent food and nutrition inequities. In this position statement, we draw on implementation science, specifically the Exploration, Preparation, Implementation, and Sustainment (EPIS) Framework and health equity principles to provide guidance on FIM initiatives. As the FIM evidence base continues to grow, we encourage the EPIS framework be applied as one lens through which we can improve our understanding of FIM implementation among multiple contexts to understand what works, for whom, and under what circumstances. Ultimately, this position statement aims to call to action the incorporation of implementation science and equity principles into FIM efforts.

Integrating design thinking and implementation science principles in delivering a medication review service in the community pharmacy setting-An implementation testing study.

Medication review (MR) services are evidenced-based practices in which a systematic assessment of a patient's medication is conducted, primarily aiming to optimize drug therapy and minimize adverse drug events through pharmacist interventions. Although studies show that MR services are effective, the implementation of MR services in Malaysia has been challenging due to several barriers. An MR services blueprint was developed to be adapted to the Malaysian community pharmacy setting as part of tailoring strategies. Through utilizing the design thinking triple diamond model and implementation science principles, a powerful guide for healthcare researchers and stakeholders to assist with effective service implementation, this study aimed to evaluate the implementation testing and observe the effectiveness of the developed MR service blueprint. The study utilizes an effectiveness-implementation Type 3 hybrid implementation science framework conducted from May 2021 to April 2022. Employing a qualitative ethnographic approach, researchers observed pharmacy study sites during the implementation of MR services. Both qualitative and quantitative data were collected across exploration, preparation, testing, and operational phases. Implementation outcomes evaluated include phases, reach, fidelity, acceptability, as well as implementation barriers and strategies. MR intervention outcomes included service characteristics and the number and type of drug-related problems and interventions offered. 17 community pharmacists were invited to pilot the MR service blueprint for six months in their setting. Of this, 78.5% (n = 11) of the pharmacies reached the testing phase, and 36% (n = 4) reached the implementation phase. Fifty-four patients were in the study, giving an implementation reach of 70%. The majority of surveyed patients expressed satisfaction with the service. The total DRP identified was 133, and 64 interventions were provided by the pharmacists. Facilitation strategies such as "Engage stakeholders by creating ownership of the change" and "Equip stakeholders with training" are needed to overcome the barriers. This study marked the beginning of successful MR service implementation at Malaysian community pharmacies. Future studies with multi-level partnered strategies are required to reach full implementation and sustainability.

Advancing the Science and Application of Implementation Science to Promote Health Equity: Commentary on the Symposium.

There has been an increasing focus on making health equity a more explicit and foundational aspect of the research being conducted in public health and implementation science. This commentary provides an overview of five reviews in this Annual Review of Public Health symposium on Implementation Science and Health Equity. These articles reflect on and advance the application of core implementation science principles and concepts, with a focus on promoting health equity across a diverse range of public health and health care settings. Taken together, the symposium articles highlight critical conceptual, methodological, and empirical advances in the study designs, frameworks, and approaches that can help address equity considerations in the use of implementation science in both domestic and global contexts. Finally, this commentary highlights how work featured in this symposium can help inform future directions for rapidly taking public health to scale, particularly among systemically marginalized populations and communities.

TRANSLATING SCIENCE INTO PRACTICE: APPLYING IMPLEMENTATION SCIENCE TO STREAMLINE FUTURE HIH ROLL-OUT

Abstract The delay between establishing evidence-based practice and translating effective practices is well documented. This presentation will focus on the application of implementation science principles to the Department of Veterans Affairs (VA) Hospital-In-Home program using a staged approach. The stages are: 1) assessing current program implementation, 2) measuring organizational readiness with new sites, 3) developing tools and resources to assist new HIH sites, and 4) working with new sites interested in adopting the HIH program using a participatory implementation planning process guided by system dynamics. In this session we will profile our use of theories, models and frameworks including the Consolidated Framework for Implementation Research (CFIR) and Reach Effectiveness Adoption Implementation Maintenance (REAIM) framework. The CFIR Expert Recommendation for Implementing Change (ERIC) Mapping Tool will be introduced as useful to identifying strategies to overcome barriers to implementation. We will apply the participatory approaches for implementation planning, including Implementation Mapping, development of Implementation Logic Models, and Group Model Building to plan for the implementation of HIH in prospective sites. Key implementation science concepts and techniques will be introduced, along with a description of how participatory approaches will facilitate informed planning and stakeholder engagement in future implementation, adaptation, and roll-out of an evidence-based systemic program. Key anticipated outputs include a framework for the core components of HIH intervention, a catalog of important determinants of HIH implementation success, a profile of existing strategies to enhance implementation and sustainability, and a roadmap for the participatory planning of HIH implementation in future contexts.

IMPLEMENTATION SCIENCE IN THE DEVELOPMENT OF RECRUITMENT PROCEDURES AND MATERIALS: A CASE STUDY

Abstract Recruiting long-term care organizations, administrators, and direct-care staff to participate in research has become increasingly challenging after the pandemic due to staffing shortages, limited resources, and numerous competing priorities. In light of these challenges, it is especially important to develop recruitment procedures and materials that are fine-tuned to the participant group based on best practices. This presentation will describe the use of implementation science principles and an expert focus group in the design of recruitment procedures and materials for a NIA-funded clinical trial “Evaluating a National Person-Centered Training Program to Strengthen the Dementia Care Workforce.” The project is especially well-suited to employ and critique best practices given that recruitment is at both the organizational-level (assisted living communities) and the person-level (staff within those communities). Recruitment materials were designed in accordance with the Considering Determinants of Diffusion, Dissemination, and Implementation of Innovations in Health Service Delivery and Organization conceptual model, which emphasizes highlighting the advantages of the training, how the training fits into existing systems, the process of training, the endorsement of organizational leaders, and the transfer of the knowledge conveyed by the training into practice. Best practices from the literature were discussed with a focus group of assisted living experts to evaluate the draft procedures and materials. This presentation will share the resulting procedures and materials and explain their evolution to their final form; the process and results are widely applicable to other clinical trials and other studies. Funded by a grant from the National Institute on Aging (R01 AG079124).

Competency-Based Education: The Need to Debunk Misconceptions and Develop a Common Language

Competency-based education (CBE) dates back to the early 1900s. A renewed interest in CBE in health professions education has been sparked by the recommendations that emerged from the 2017 Josiah Macy Jr Foundation conference on CBE. These recommendations urge changes in structure and pedagogy to address gaps between societal needs, health care practice, and health professions education. Despite widespread interest, there is significant variability in what constitutes CBE. This variability has challenged the development of an evidence base in the literature and has led to widespread misconceptions regarding CBE. Implementation science principles outline the need to develop a common language to inform effective and sustained implementation of an innovation. By misusing or overusing similar words and using different concepts interchangeably without first developing a common, widely understood language around CBE, we cannot expect that CBE will be among the tools successful in closing gaps between health care practice and education.

Stir-up Regimen After General Anesthesia in the Postanesthesia Care Unit: A Nurse Led Stepped Wedge Cluster Randomized Control Trial

To implement a standardized Stir-up Regimen (deep breathing, coughing, repositioning, mobilization [moving arms/legs], assessing and managing pain and nausea) within the first 30minutes of arrival in the postanesthesia care unit (PACU), with a goal of decreasing recovery time in the immediate postanesthesia period (Phase I). A pragmatic stepped wedge cluster randomized control trial. Initially, data were collected on time in Phase I in three PACUs (control). Subsequently, the same three units were randomized to sequentially transition to the Stir-up Regimen (intervention). A stepped wedge cluster randomized control trial design was used to implement a standardized Stir-up Regimen in three PACUs in an academic hospital for adult patients who received at least 30minutes of general anesthesia. The measured outcome was the PACU time in minutes from patient arrival to when the patient met Phase I discharge criteria. Differences between intervention and control groups were evaluated using a generalized mixed-effects model. Nurses were educated about the Stir-up Regimen in team huddles, in-services, video demonstrations, email notifications and reminders, and immediate feedback at the bedside. Implementation science principles were used to assess the adoption of the Stir-up Regimen through a presurvey, postsurvey and spot-check observations in all three PACUs. A total of 5,809 PACU adult patient admissions were included: control group (n=2,860); intervention group (n=2,949); males (n=2,602), and females (n=3,206). The intervention was associated with a reduction in overall mean Phase I recovery time of 4.9minutes (95% CI: -8.4 to -1.4, P=.007). One PACU decreased time by 9.6minutes (95% CI: -15.3 to -4.0, P<.001). The other units also reduced Phase I recovery time, but this did not reach statistical significance. The spot-check observations confirmed the intervention was adopted by the nurses, as most interventions were nurse-initiated versus patient-initiated during the first 30minutes in PACU. Standardization of a Stir-up Regimen within 30minutes of patient PACU arrival resulted in decreased Phase I recovery time.

Applying Implementation Science Principles to Design the ACR Peer Learning Pathway: A Case Study

Applying Implementation Science Principles to Design the ACR Peer Learning Pathway: A Case Study

Embedding implementation science in the research pipeline.

Clinical and health services researchers seek to discover effective programs, practices, and interventions to improve people's health. The current paradigm for evidence generation is incremental and misaligned to translate evidence-based discoveries into real-world settings. This persistent challenge are "valleys of death" that represent missed opportunities and preventable missteps to actually use scientific advancements in real-world clinical settings where they can improve health and well-being (De Geest S, Zúñiga F, Brunkert T et al. Powering Swiss health care for the future: implementation science to bridge "the valley of death". 2020;150:w20323). Only one in seven of evidence-based interventions is ever implemented. It is after an average of 17 years. We propose embedding the principles of implementation science throughout the research pipeline, from discovery to adoption, to efficiently translate discoveries into real-world contexts (Balas EA, Boren SA. Managing clinical knowledge for health care improvement. 2000;9:65-70). We outline implications for capacity building, including composition of the research team, study design, and competencies that could bolster the value proposition of implementation science. We describe a research paradigm that recognizes scientists' responsibility to ensure their discoveries be translated into real-world settings.