Implementation Science

Implementation science can be defined 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.” [1]

It takes 17-20 years for research innovations to be used in routine clinical practice [2]. This gap, called the research-practice gap, spurred along an effort to develop methods that put evidence-based practices into the hands of the people who most need them. Though its roots can be traced back to the early 1900s, Implementation Science has existed by name since the early 2000s [3]. Over the last 25 years, there has been an explosion of resources for doing implementation science, including over 150 theories, models, and frameworks and dozens of implementation methods [4,5]. These methods are derived from myriad disciplines, including human-computer interaction, improvement science, public health, clinical psychology, and anthropology. Implementation science methods are being applied across the globe in hospitals, clinics, schools, and beyond.

A recent article (Curran, 2020) provides some helpful terminology for understanding the complementary nature of implementation research to clinical research [6] .

The thing is the innovation that one is trying to implement. The innovation can be anything: a pill, a procedure, a policy, a “nudge,” an algorithm.

Traditional efficacy and effectiveness research seeks to understand whether that thing achieves its intended clinical outcome. Did patients’ health or mental health outcomes improve resulting from use of this thing?

Implementation research seeks to understand how to help places and people do the thing in the best way possible. For example, did clinicians use the thing? Did patients like the thing? Can a healthcare system sustain the thing?

To put it practically, if cognitive behavioral therapy (CBT) delivered as a telephone app is our thing, efficacy and effectiveness research seeks to understand whether the delivery of CBT via the app decreases anxiety symptoms and diagnoses. Implementation research focuses on exploring the best way to help clinicians, clinics, and patients adopt and sustain their use of the CBT app.

Implementation scientists strive to improve health equity and close the research-practice gap by partnering with communities to explore and prepare the implementation context (e.g., a clinic or hospital), systematically develop implementation strategies to overcome barriers to evidence-based practice implementation, and evaluate implementation efforts. Implementation science methods can be used across several stages of treatment development and testing: designing innovations for sustainable implementation, adapting and implementing established evidence-based practices, and optimizing evidence-based practices that are already in use.

References

  1. Bauer MS, Damschroder L, Hagedorn H, Smith J, Kilbourne AM. An introduction to implementation science for the non-specialist. BMC Psychol. 2015 Sep 16;3(1):32. doi: 10.1186/s40359-015-0089-9. PMID: 26376626; PMCID: PMC4573926.

  2. Balas EA, Boren SA. Managing Clinical Knowledge for Health Care Improvement. Yearb Med Inform. 2000;(1):65-70. PMID: 27699347.

  3. Eccles MP, Mittman BS. Welcome to Implementation Science. Implementation Sci. 2006;1(1). https://doi.org/10.1186/1748-5908-1-1

  4. Nilsen P. Making sense of implementation theories, models and frameworks. Implement Sci. 2015 Apr 21;10:53. doi: 10.1186/s13012-015-0242-0. PMID: 25895742; PMCID: PMC4406164.

  5. Beidas RS, Dorsey S, Lewis CC, Lyon AR, Powell BJ, Purtle J, Saldana L, Shelton RC, Stirman SW, Lane-Fall MB. Promises and pitfalls in implementation science from the perspective of US-based researchers: learning from a pre-mortem. Implement Sci. 2022 Aug 13;17(1):55. doi: 10.1186/s13012-022-01226-3. PMID: 35964095; PMCID: PMC9375077.

  6. Curran GM. Implementation science made too simple: a teaching tool. Implement Sci Commun. 2020 Feb 25;1:27. doi: 10.1186/s43058-020-00001-z. PMID: 32885186; PMCID: PMC7427844.

Resources

Articles

  • Tabak RG, Khoong EC, Chambers DA, Brownson RC. Bridging research and practice: models for dissemination and implementation research. Am J Prev Med. 2012 Sep;43(3):337-50. doi: 10.1016/j.amepre.2012.05.024. PMID: 22898128; PMCID: PMC3592983.

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