PLANNING FOR REAL WORLD IMPACT
COPRH 2020 NATIONAL VIRTUAL CONFERENCE | August 11-12, 2020
“Let’s Get Real: Planning Rigorous Pragmatic Health Services Research for Equitable, Real-World Care”
There is increased demand from consumers, providers, health systems, communities, and policymakers for effective health care innovations that make a substantial public health impact and can be readily adopted in real-world settings. However even in the 21st Century it can still take decades for a fraction of effective clinical innovations to be successfully adopted in routine health care settings. Moreover, many of these innovations are tested in small, select populations using clinical trial methods that have not adapted to the changing needs of patients and the providers and communities who care for them. The National Academy of Medicine, in their groundbreaking report on the Future of Health Services Research strongly suggests the need for more timely and pragmatic research that addresses the practical issues facing health systems and communities. This presentation provides a novel strategy for applying pragmatic research methods in health services research in order to enhance the real-world impact of health care innovations and health equity, incorporating lessons learned from the Learning Health System and QUERI implementation frameworks. We also outline the use of pragmatic research methods across the different research lifecycle stages (e.g., prioritization, discovery, validation, scale-up) that can be used to accelerate the substantial real-world impact of research at multiple levels (e.g., consumer, provider, practice, system, policy) and provide examples of how implementation science employs pragmatic research methods to accelerate adoption of effective innovations ad reduce health disparities in real-world settings.
"Using multiphase optimization strategy (MOST) for developing, optimizing, and evaluating multicomponent interventions"
Describe the ways in which the MOST framework differs from the traditional intervention development and evaluation process
Explain why MOST is a good approach for pragmatic research (ensuring fit to context)
Describe the three phases of MOST
Understand how to identify and select experimental designs to be used in the Optimization phase of MOST (e.g., factorial designs, SMART)
Identify relevant examples for application of MOST across the health research spectru
The majority of behavioral and biobehavioral interventions in use today have been evaluated as a treatment package using a two-arm randomized controlled trial (RCT). This approach is an excellent way to determine whether an intervention is effective; however, it is less helpful in providing empirical information that can be used to optimize the intervention to achieve improved effectiveness and efficiency while maintaining a desired level of economy, and/or scalability. In this presentation, an innovative framework for optimizing behavioral interventions, the multiphase optimization strategy (MOST), will be introduced. MOST is based on ideas inspired by engineering methods, which stress careful management of research resources and ongoing improvement of intervention products. MOST is a comprehensive strategy that includes three phases: preparation, optimization, and evaluation. MOST can be used to build a new intervention or to improve an existing intervention. Using MOST it is possible to engineer an intervention that meets an a priori specified optimization criterion such as a particular effect size, level of cost-effectiveness, or any other implementation-related constraint.
VA Quality Enhancement Research Institute (QUERI)
“Planning Pragmatic Research and the Value of Frameworks: using PRECIS-2 as a case example”
Associate Professor, Clinician-Investigator,
Division of General Internal Medicine
Assistant Research Professor
Methodology Center, Pennsylvania State University
"Pragmatic Challenges of Engaging Stakeholders in Pragmatic Trials"
"Desigining for Dissemination: Beginning with the End in Mind"
Describe core principles of designing for dissemination (D4D).
Learn about progress in conducting D4D.
Describe D4D methods.
Learn how to incorporate D4D principles in your work to make it more pragmatic.
Designing for dissemination (D4) is an active process that helps to ensure that public health and clinical interventions, often developed by researchers, are implemented in ways that match well with adopters’ needs, assets, and time frames. Data from the United States and Canada has shown considerable room for improvement in D4D. The lack of effective D4D is due in part to differing priorities and incentives between researchers, practitioners, and policy makers. A range of methods (e.g., user panels, advisory committees) may improve D4D yet vary widely in their use. This presentation will frame key issues related to D4D and describe a set of actions designed to speed up the process of D4D and enhance the impact of research. Actions include processes (e.g., stakeholder engagement), outcomes (e.g., data segmentation), and products (e.g., user-friendly summaries). Many of these themes fit closely and are complemented by pragmatic research methods and frameworks.
Director, Center for Bioethics and Humanities
Lipstein Distinguished Professor,
Washington University, St. Louis
"Moving effectiveness research into practices: Lessons from a faith based physical activity intervention"
Physical inactivity is prevalent and chronic diseases impact racial/ethnic minorities at a disproportionate rate. Evidence-based approaches for increasing physical activity (PA) and reducing obesity such as Faith in Action exist, but few PA interventions go to scale. Implementation strategies that enhance the capacity of faith-based organizations (FBO) leaders to implement EBIs can facilitate their uptake.
Research that addresses health disparities may need to consider dissemination plans in the early developmental phases of the study. Several lessons to successfully scale up PA interventions in FBOs will be discussed including: 1) adapting the program to different contexts/denominations, 2) tailoring the messages to fit the context, 3) engaging key stakeholders in the implementation and scale up process while considering costs, 4) shifting focus to organizational level outcomes, and 5) collecting data relevant to stakeholders (e.g., health outcomes).
San Diego State University