AcademyHealth and the National Institutes of Health co-hosted the 8th Annual Conference on the Science of Dissemination and Implementation in Health on December 14-15 in Washington, DC. Plenary and breakout sessions highlighted the need for an integration of evidence-based practice and service delivery to improve both healthcare delivery and population health in the US and globally. Below are brief summaries of selected sessions. If you missed the conference, presentation slides are available, or review the Twitter conversation via #discience15.
America Bracho: Implementation Science Toward Community Health
America Bracho kicked off the 8th Annual Conference on the Science of Dissemination and Implementation in Health with an inspiring presentation on the vital importance of community inclusion in implementation science. She cited numerous examples of the need for community involvement including her own extensive work in California, Melinda Gates’ work with women and girls, and the Grandmothers of Nepal.
“Communities are key in improving the health of communities and families,” she said, “because they live the data, have the knowledge, and are the researchers. They advocate for what works, and are the most interested in improving their health.” She encouraged attendees to look closely at the environment around them in order to understand the difficulty of translating research into practice.
Bracho’s presentation set the tone for an energized, action-oriented conference.
Crossing Boundaries, Changing Roles: Dissemination and Implementation Opportunities to Achieve Population Health
The second plenary session of day 1, Crossing Boundaries, Changing Roles: Dissemination and Implementation Opportunities to Achieve Population Health, featured Steven Woolf, Virginia Commonwealth University; Nirav Shah, Kaiser Permanente of Southern California; Leana Wen, Baltimore City Health Department; and LaMar Hasbrouck, National Association of County and City Health Officials. Moderator Lisa Simpson led a rich discussion, and took questions from the audience and via Twitter, following the opening remarks.
Steven Woolf emphasized the need for researchers to make a serious effort to understand the world view on the ground in the community that they are studying, and to then shape the research agenda around that view. He presented an innovative research paradigm with collaboration in the center and research, policy outreach, strategic communication, and stakeholder engagement surrounding it. “It is not about engaging communities in our research,” he stated, “it is about how we get engaged in what communities are doing.”
Nirav Shah discussed the opportunities and challenges in a health system drawing on his work with Kaiser Permanente Southern California and the need for researchers to design programs that “go beyond the traditional.” At Kaiser, when researchers ask patients about all environmental factors that contribute to their health, they can connect social determinants of health to improve population health in communities. “We define innovation as elegant integration,” he stated, “not just invention.”
Leana Wen spoke on engaging communities and breaking down silos. She illustrated statistics with actual stories, and encouraged the audience to do the same. Stories, she argued, speak as much (if not more) about success as numbers do. Additionally, she encouraged the audience to focus on tangible goals to make a large impact, and to provide measures of progress to the community. Engaging the community is not just a one-time check-box, but rather, a continued relationship. Her work in Baltimore City highlights the opportunity for public health to level the playing field of inequality. “What can we do to make a difference for not only the one patient,” she asked, “but also the population?”
LaMar Hasbrouck focused on the theme that researchers should develop models to best leverage what local governmental public health departments are working on. He called for attendees to make real investments in sustaining these local health departments, and highlighted the disconnect between the needs of local health departments and well-resourced organizations and partners.
Global D&I Research: Building a Worldwide Evidence Base
Tuesday’s panelists on the global health plenary emphasized the challenges ofusing the right data in the right places. The panel agreed that while science is rapidly globalizing, there is a serious disconnect between where evidence is coming from and where it is needed.
Lisa Hirschhorn began the panel using lessons learned from the BetterBirth program and Safe Childbirth Checklist. To address the tension between what we know works and what we actually do, she suggested finding a middle ground to implement and improve global community health with science as opposed to versus science. Given that policymakers want results quickly, she encouraged attendees to consider how much rigor and evidence are actually needed in trial design. Her solution was to draw on multiple disciplines to use a mix of data and an adaptive trial design that includes feasibility and flexibility.
Dr. Narayan drew on his extensive experience in studying non-communicable diseases (NCD) to make three recommendations on how to best improve work in global dissemination and implementation science in low and middle income countries:
- Lower the cost of innovations and interventions to apply what works to low and middle income countries.
- Remember that the role of technology is extremely important. We should use technology to make connections, obtain data, and create platforms and networks that can create good data.
- Task-shifting to non-physician health staff must occur. The role of ancillary staff is important in prevention.
He concluded with the need to do the research in the environment that it will be implemented: science is globalizing extremely rapidly but 90 percent of the burden of NCDs is on low and middle income countries, yet only 2 percent of research comes from there.
Ambassador Birx spoke on the fact that the disease burden is expanding and that an expanding epidemic is unsustainable, so how do we use the concept of implementation science to focus on the right things, in the right places, at the right time? There is a need to use big data sets and mine the programmatic data to find the best performers in a way that is systematic and highlights successes. "Most of the successes we need have already been done, we just need to find them and take them to scale," she said. Ambassador Birx also called for attendees to build programs that consider outcomes and produce the data that countries can utilize and present the data more effectively and thusly result in a policy change.
“Sometimes,” she noted, “a policy change can have a bigger impact than new dollars.” If we prioritize and fast-track treatments, countries will adopt key policy changes and service delivery models, and we can achieve high-quality implementation on a large scale.
Dr. Ghaffar noted that there are several proven interventions that are not being implemented - to make progress, he highlighted the need to get the evidence to policymakers and consider context and the environment in which the evidence will be used.
“Health policy and systems research,” he said, “does provide the knowledge to stimulate thinking and inform choices, but it does not provide single solutions for answers to complex challenges. Research does not equal decision-making.”
Impact of Social Determinants of Health and Prevention in Reducing Health Disparities and Sustaining Healthy Communities
In a concurrent session moderated by Pamela Thorton, Betsy Shenkman presented on how the state of Florida, through the One Florida Clinical Research Consortium, is using big data to examine social determinants of health. Discussing the grassroots level of building partnerships between academic institutions, community-based organizations, and delivery systems, Deanna Kepka highlighted the need to understand the community and build trust between participants and researchers. Jenerius Aminawung spoke on his work in improving outcomes and reducing health disparities for justice-involved individuals. James Teufel presented an innovative approach to transforming systems using medical-legal partnerships to address unmet legal needs, which adversely influence health.
Discussant Tiffany Powell-Wiley put the abstracts into context and drew connections between each abstract and the need to link health and social determinants data to reduce health disparities. Each presentation addressed the need for researchers to connect with the community as well as interdisciplinary partners to improve health.
New Approaches to Measure and Improve Health Systems in the Era of Big Data
In this session, Eric Hughes discussed the National Patient Safety Partnership, a unique collaboration between three national children’s hospitals and The MITRE Corporation, which came together based on plateaued areas of patient safety. Key features of the partnership include the use of multidisciplinary teams and descriptive statistics rather than traditional hypotheses. The partnership has shown that collaborationplus analytics equals major insights.
Speaking on her team’s experience in using electronic health record systems to inform registries, Danielle Loeb used technology to identify primary barriers and sources of error. While EHR systems are built to support billing optimization, she found that they are not built to support clinical documentation.
Aaron Lyon presented on measurement-based care (MBC), the use of systemic data collection to monitor client/patient progress and directly inform care decisions. A growing evidence base exists that MBC benefits patients, providers, and organizations, but fewer than 20 percent of behavioral health providers assess patient outcomes. He pointed to great potential in client engagement and improved outcomes with the use of MBC through existing measurement feedback systems.
Moderator Erin Holve identified data quality as a theme that ran throughout each presentation. Speakers responded to audience questions and shared their thoughts on how to combat data “messiness,” how to move the concept of data quality upstream, and the need to do more usability research on data systems.