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Name of Submitter:
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Shannon Wiltsey Stirman
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Title of proposed idea:
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Implementation Science
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What is the major obstacle/challenge in the biomedical research field? What is needed to overcome this obstacle/challenge?
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The billions of dollars have been spent on research to prevent or treat physical and mental health problems has resulted in a wealth of knowledge regarding effective treatments for a wide range of debilitating conditions. However, many of these interventions and programs are never translated into policy or routine service delivery. For those interventions and programs that are adopted in healthcare settings, the process of implementation requires an average of 17 years. This gap between research and practice is evident across a wide range of diseases and disciplines. The problem is significant enough that some have suggested that implementation science may do more to decrease mortality and morbidity than the development of a new class of drugs, intervention, or medical device (Woolf, 2008; JAMA). The failure to implement effective treatments has a significant public health impact. Consumers who do not have access to effective treatments can experience significant physical and mental health problems, compromised quality of life, and lost wages and productivity. Furthermore, for a return on the investment in biomedical and services research to be fully realized, much more must be learned about how to reduce barriers to implementation and ultimately shorten the time that elapses between the identification of effective interventions and their widespread implementation.
To overcome this obstacle, effective, multilevel strategies and processes to promote implementation and sustainability need to be developed and tested. This requires large scale research, as adequately powered implementation research can be costly. Such research is also necessary to identify the contexts and interventions for which specific implementation strategies are effective. Additionally, it will be critical to identify multi-level measurement strategies that can be applied or tailored for specific interventions, settings, and fields. Proximal measures of the dissemination and implementation process are needed, and a set of common, practical measures need to be developed and shared so that researchers are not constantly reinventing measures (Brownson, Dreisinger, Colditz, & Proctor, 2012). Funding mechanisms to promote the study sustainability are also necessary to increase our understanding of how to ensure that effective interventions remain integrated into healthcare systems and settings over the long-term. The field also needs more investigators who are trained in implementation science, and systems changes are needed in our academic institutions so that implementation research and the time commitments needed to build the requisite knowledge and key relationships with community stakeholders are valued and rewarded (Brownson, Dreisinger, Colditz, & Proctor, 2012). |
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What emerging scientific opportunity is ripe for investment by the Common Fund?
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The field of implementation science is emerging and NIH has recognized the importance of of cross-institute knowledge sharing. In addition, the emphasis in the Affordable Care Act on the importance of comparative effectiveness research and the cost-effective delivery of healthcare represent opportunities. As effective and cost-effective interventions are identified, a more developed field of implementation science can facilitate a more rapid translation from research to practice. |
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What are the potential Common Fund investments that could accelerate scientific progress in this field?
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R01s, Career Development Awards and training programs, and funding mechanisms to study the long-term sustainability of interventions once implemented are essential to accelerating scientific progress. Funding of networks of investigators and transdisciplinary research approaches can also accelerate progress. Funding on research to identify scalable and cost-effective implementation strategies and test them across a variety of settings and interventions can enhance knowledge regarding critical next steps after the identification of effective healthcare interventions and health promotion programs. The development of shared datasets, the identification of testbeds for implementation research, and the development practical measures of key implementation processes and outcomes that are applicable across a variety of fields are critical. |
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If a Common Fund program on this topic achieved its objectives, what would be the impact?
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The field would have a set of tools and cost-effective strategies that could be used to promote implementation and measure the degree of implementation success for a given intervention. The development of effective implementation strategies can rapidly reduce the time between the discovery of effective interventions and the routine delivery of the interventions in healthcare settings. |
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