Dissemination and Implementation Science in Primary Care Research and Practice: Contributions and Opportunities

Holtrop, Jodi Summers; Rabin, Borsika; Glasgow, Russell E.

doi:10.3122/jabfm.2018.03.170259

Cited by 48 publications

(55 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Team‐based care is arguably the future of primary care and a cornerstone of preventive care for patients. As a complex system, it deserves an evaluation approach that is flexible and nuanced and targets the right outcomes at the right time (eg, acceptability and adoption as outcomes in early implementation phase) . Embedded rapid ethnography addresses growing awareness and movement towards including patient‐centered perspective in evaluation (eg, Patient‐Centered Outcomes Research Initiative).…”

Section: Discussionmentioning

confidence: 99%

“…As a complex system, it deserves an evaluation approach that is flexible and nuanced and targets the right outcomes at the right time (eg, acceptability and adoption as outcomes in early implementation phase). 7 Primary care redesign has been increasingly evaluated 19 but has yet to be thoroughly explored from an implementation science perspective. This study takes a novel implementation science perspective and in so doing highlights a key lesson: Practice redesign can redistribute responsibility and patient connection throughout a team, but success of a team-based model might depend on clear role definition.…”

Section: Md/app Pairings For Team-based Carementioning

confidence: 99%

“…In this vacuum, scholars have called for hybrid implementation studies that incorporate implementation science outcomes such as feasibility, adoption, and sustainability into traditional evaluation outcomes. Implementation science studies are needed to bridge the gap between initial implementation and long‐term sustainability, including definition of best practices for PCMH implementation and the ultimate spread of new care models into clinical practice …”

Section: Introductionmentioning

confidence: 99%

“…Implementation science studies are needed to bridge the gap between initial implementation and long-term sustainability, including definition of best practices for PCMH implementation and the ultimate spread of new care models into clinical practice. 7 One implementation study found that changes in individual and team roles, and the accompanying changes in workflow, were among the biggest PCMH implementation challenges. 3 Based on this insight, we hypothesized that the degree of clarity in new/modified roles would impact adoption and acceptability in successful implementation of new team-based care models.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Role definition is key—Rapid qualitative ethnography findings from a team‐based primary care transformation

Brown‐Johnson

Shaw

Safaeinili

et al. 2019

Learning Health Systems

View full text Add to dashboard Cite

Purpose Implementing team‐based care into existing primary care is challenging; understanding facilitators and barriers to implementation is critical. We assessed adoption and acceptability of new roles in the first 6 months of launching a team‐based care model focused on preventive care, population health, and psychosocial support. Methods We conducted qualitative rapid ethnography at a community‐based test clinic, including 74 hours of observations and 28 semi‐structured interviews. We identified implementation themes related to team‐based care and specifically the integration of three roles purposively designed to enhance coordination for better patient outcomes, including preventive screening and mental health: (1) medical assistants as care coordinators; (2) extended care team specialists, including clinical pharmacist and behavioral health professional; and (3) advanced practice providers (APPs)—ie, nurse practitioners and physician assistants. Results All stakeholders (ie, patients, providers, and staff) reported positive perceptions of care coordinators and extended care specialists; these roles were well defined and quickly implemented. Care coordinators effectively managed care between visits and established strong patient relationships. Specialist colocation facilitated patient access and well‐supported diabetes services and mental health care. We also observed unanticipated value: Care coordinators relayed encounter‐relevant chart information to providers while scribing; extended care specialists supported informal continuing medical education. In contrast, we observed uncertain definition and expectations of the APP role across stakeholders; accordingly, adoption and acceptability of the role varied. Conclusions Practice redesign can redistribute responsibility and patient connection throughout a team but should emphasize well‐defined roles. Ethnography, conducted early in implementation with multistakeholder perspectives, can provide rapid and actionable insights about where roles may need refinement or redefinition to support ultimate physical and mental health outcomes for patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Md/app Pairings For Team-based Carementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Role definition is key—Rapid qualitative ethnography findings from a team‐based primary care transformation

Brown‐Johnson

Shaw

Safaeinili

et al. 2019

Learning Health Systems

View full text Add to dashboard Cite

show abstract

“…Summers Holtrop et al 5 lead off the theme issue with an overview of dissemination and implementation science by defining this nascent field of research in context for both the researcher and primary care provider. The authors go on to provide 2 case studies that "uncover the factors important to making the adoption, implementation, and maintained use of evidence-based approaches successful," important insights as we attempt to shorten the time between evidence creation and routine practice.…”

Section: Recommendations From Thought Leaders On Advancing Implementamentioning

confidence: 99%

Advancing the Science of Implementation in Primary Health Care

Bazemore¹,

Neale²,

Lupo³

et al. 2018

J Am Board Fam Med

View full text Add to dashboard Cite

Implementation Science is commonly described as the study of methods and approaches that promote the uptake and use of evidence-based interventions into routine practice and policymaking. In this issue of JABFM, investigators share a wealth of new insights from the frontlines of Implementation Science in primary care: what it is, how we are doing it, and how it is advancing the evidence base of primary care. The breadth of implementation science in primary care is affirmed by the range of topics covered, from thought leader recommendations on future directions for the field, to reports on how best practices in policy and practice are shaping primary care implementation in the United States and Canada. There are also important updates on agents of primary care implementation themselves, such as practice facilitators, geriatric care teams, and family physicians interested in providing obstetric care. Other articles report on novel practice transformation efforts that advance health promotion and disease prevention, and innovative approaches to identifying and addressing social determinants of health in primary care practices and the communities they serve. The articles seem to generate as many new questions as they answer, and highlight the need for continued emphasis on advancing the science of implementation in primary health care. (J Am Board Fam Med 2018;31:307-311.)It is commonly estimated that evidence-based interventions require an average of 17 years to be incorporated into routine practice.1,2 Increasing payer and delivery system interest in narrowing that time gap has rapidly elevated the field of Implementation Science; the study of how evidence-based practice and policy can be effectively communicated, deployed, and brought to scale. Effective and efficient implementation is of particular importance in primary care, which is both the largest delivery platform and niche in the US health care ecology and an area largely neglected in the landscape of health care spending and biomedical research. 3,4 This theme issue of JABFM highlights lessons from, and efforts to advance implementation science in primary care.

show abstract

Research and scholarly methods: Implementation science studies

Kuo

Trinkley

Rabin

2022

J Am Coll Clin Pharm

View full text Add to dashboard Cite

Traditional research focuses on efficacy or effectiveness of interventions but lacks evaluation of strategies needed for equitable uptake, scalable implementation, and sustainable evidence‐based practice transformation. The purpose of this introductory review is to describe key implementation science (IS) concepts as they apply to medication management and pharmacy practice, and to provide guidance on literature review with an IS lens. There are five key ingredients of IS, including: (a) evidence‐based intervention; (b) implementation strategies; (c) IS theory, model, or framework; (d) IS outcomes and measures; and (e) stakeholder engagement, which is key to a successful implementation. These key ingredients apply across the three stages of IS research: (a) pre‐implementation; (b) implementation; and (c) sustainment. A case example using a combination of IS models, PRISM (Practical, Robust Implementation and Sustainability model) and RE‐AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance), is included to describe how an IS study is designed and conducted. This case is a cluster‐randomized trial comparing two clinical decision support tools to improve guideline‐concordant prescribing for patients with heart failure and reduced ejection fraction. The review also includes information on the Standards for Reporting Implementation Studies (StaRI), which is used for literature review and reporting of IS studies, as well as IS‐related learning resources.

show abstract

Dissemination and Implementation Science in Primary Care Research and Practice: Contributions and Opportunities

Cited by 48 publications

References 51 publications

Role definition is key—Rapid qualitative ethnography findings from a team‐based primary care transformation

Role definition is key—Rapid qualitative ethnography findings from a team‐based primary care transformation

Advancing the Science of Implementation in Primary Health Care

Research and scholarly methods: Implementation science studies

Contact Info

Product

Resources

About