Applying an Implementation Science Approach to Genomic Medicine Workshop Summary (2016) / Chapter Skim
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2 Implementation Science: Methods and Approaches
2 Implementation Science: Methods and Approaches
Pages 7-18
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From page 7... ...
• Researchers often consider delaying implementation because they are working with an incomplete evidence base; however, by designing hybrid approaches that combine effectiveness and implementation re search, it could be possible to move ahead with implementation as the evidence base is still expanding. (Mittman)
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Mittman defined implementation science as "the scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice and, hence, to improve the quality and effectiveness of health services. The field of implementation FIGURE 2-1 A depiction of the translational research continuum showing how basic science can potentially result in improved health processes and outcomes.
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Quality improvement commonly targets specific local quality problems via rapid-cycle iterative improvement. Implementation science generally seeks to develop and rigorously evaluate fixed implementation strategies to address implementation gaps across multiple sites.
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"For most of these implementation problems," Mittman said, "there's a relatively constant list of functions that need to be fulfilled. But the exact form that those implementation strategies or components would take -- the way we provide for patient education support or clinician education, or the way that we achieve conducive professional norms -- those strategies are likely to differ across sites." INSIGHTS ON THE ADOPTION OF NEW CLINICAL PRACTICES Implementation science has generated several key insights concerning the adoption of new clinical practices, Mittman said.
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There were several distinct components within the toolkit, including a continuing medical education–approved lecture series, patient and clinician information sheets, a reminder embedded in the electronic health record system, patient questionnaires, and a practice feedback report. According to the authors, this multilevel approach resulted in increased clinician knowledge regarding cancer genetics, an increase in cancer family history documentation, and higher rates of patient referrals to genetic counselors.
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For example, the Evaluation of Genomic Applications in Practice and Prevention (EGAPP) working group, overseen by the Centers for Disease Control and Prevention, has developed a systematic process for assessing evidence regarding the validity and utility of rapidly emerging genetic tests for clinical practice.
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From page 13... ...
The journal Implementation Science is an open-access, peer-reviewed online journal which publishes research that is relevant to the scientific study of methods to promote the uptake of research findings into routine health care in clinical, organizational, or policy contexts. Chambers said that those interested in implementing genomics into clinical practice can learn a great deal from other disciplines that face similar issues.
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What May Be Learned from Implementation Research In an effort to identify which health interventions can fit within realworld public health and clinical service systems, the National Institutes of Health (NIH) is conducting dissemination and implementation research.2 Chambers noted that the NIH defines dissemination as "the targeted distribution of information and intervention materials to a specific public health or clinical practice audience" and implementation as "the use of strategies to adopt and integrate evidence-based health interventions and change practice patterns within specific settings" (Lomas, 1993)
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From page 15... ...
Today, however, the body of required knowledge has grown so large that clinicians cannot keep it in their minds, and a much larger spectrum of factors influence clinical practice, Mittman said. "It's no longer a matter of changing physician practices through continuing medical education; it's now a matter of trying to influence all of these different factors, levers, or constraints." As a result of this added complexity, quality improvement strategies that focus on just a few causes of conservative practice and instability typically are not sufficient, Mittman remarked.
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"What do we do about a clinical practice for which the evidence base is not quite as strong as we
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" One potential answer to this dilemma is hybrid approaches that combine effectiveness and implementation research. Blended effectiveness– implementation studies may provide benefits such as accelerated translation, more effective implementation strategies, and higher quality information for researchers and decision makers (Curran et al., 2012)
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From page 18... ...
18 IMPLEMENTATION SCIENCE AND GENOMIC MEDICINE and how they fit into the workflow as well as the needs of the population that we're trying to serve."
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