As health and community settings grapple with resource-constrained conditions, the use of evidence-based strategies in routine practice will be critical to maximizing the value of care and improving health outcomes. Implementation science research plays a critical role in promoting uptake of these strategies. Penn is home to a rich network of implementation science expertise and activities across many fields in health care. Activities include grant-funded projects, an education program, an annual Implementation Science Institute, and an ongoing working group.
ADVANCING THE QUALITY OF CANCER CARE THROUGH BEHAVIORAL ECONOMICS AND IMPLEMENTATION SCIENCE
Rinad Beidas, PhD, Justin Bekelman, MD, and Robert Schnoll, PhD, received funding from the National Cancer Institute to use implementation science and behavioral economics to increase use of evidence-based practices in cancer care, with health equity as a focus across all projects. Penn becomes the 7th Implementation Science Center in Cancer Control (ISC3) funded by the NCI as part of the Cancer Moonshot.
HANDOFFS AND TRANSITIONS IN CRITICAL CARE – UNDERSTANDING SCALABILITY
Meghan Lane-Fall, MD, was awarded a R01 grant to study the implementation of a standardized handoff protocol in adult and pediatric ICUs. While standardized post-surgical handoffs are an intervention deemed high priority by the American Heart Association, there is inconsistent adoption of this by hospitals. This pragmatic Hybrid Type 2 effectiveness-implementation study will have a dual focus on demonstrating improvements in both short-term patient outcomes and implementation outcomes.
CP3 STUDY: CARDIOVASCULAR PREVENTION FOR PSORIASIS AND PSORIATIC ARTHRITIS
Joel Gelfand, MD, MSCE, received a grant from the National Psoriasis Foundation to improve implementation of preventive cardiovascular care with a focus on the use of statins per guidelines for patients with psoriasis and psoriatic arthritis. This research will aim to leverage implementation science to shift screening for, and management of, dyslipidemia from primary care physicians to the specialists who mostly care for patients with psoriatic disease, dermatologists and rheumatologists.
REDUCING CHALLENGING BEHAVIORS IN CHILDREN WITH AUTISM THROUGH DIGITAL HEALTH
Heather Nuske, PhD, was awarded a K23 grant to develop and pilot test a personalized mobile-health emotion regulation app that will pair heart rate tracking with digital tools to support teachers’ use of evidence-based practices with children with autism spectrum disorder. As part of this grant, Dr. Nuske will evaluate the acceptability, feasibility, and appropriateness of the app by conducting interviews and observations, use rapid-cycle prototyping to refine the app, and then conduct a randomized waitlist field trial to test the app.
THE ROLE OF PEDIATRIC INTERCONCEPTION CARE IN PREVENTING ADVERSE BIRTH OUTCOMES
Emily Gregory, MD, MHS, was awarded a K23 grant to leverage existing contact between pediatric health systems and mothers by utilizing a pediatric-based nurse intervention to reduce preterm births. Many interconception women with a history of preterm birth do not receive preventive health care but do have frequent contact with pediatric health systems in their roles as mothers. Dr. Gregory will conduct a pilot pragmatic randomized trial to evaluate if nurse care coordination, in addition to embedded motivational interviewing, can increase the receipt of preventive care.
A HYBRID TYPE 1 EFFECTIVENESS-IMPLEMENTATION STUDY OF SOCIAL INCENTIVE STRATEGIES TO INCREASE PHYSICAL ACTIVITY
Karen Glanz, PhD, MPH, and Mitesh Patel, MD, MBA, were awarded a R01 grant to adapt and test the effectiveness of two successful social incentive-based interventions to increase physical activity. The two interventions are a gamification strategy and financial incentives donated to charity participant's behalf. Following an initial phase of community-participatory adaptation of the two proven social-incentive intervention strategies, a three-arm, cluster-randomized trial of 225 families will be conducted to evaluate the two social incentive interventions in the community. This study focuses on scalable approaches to address health disparities in physical activity by partnering with community organizations in low-income and minority neighborhoods, using behavioral economics to deploy low-cost social incentive interventions, and applying implementation science frameworks from the Consolidated Framework for Intervention Research (CFIR) to improve adoption and dissemination.
A COMPARATIVE EFFECTIVENESS TRIAL OF STRATEGIES TO IMPLEMENT FIREARM SAFETY PROMOTION AS A UNIVERSAL SUICIDE PREVENTION STRATEGY IN PEDIATRIC PRIMARY CARE
Rinad Beidas, PhD, received funding from the NIMH to study two different approaches for implementing the SAFE Firearm program, an evidence-based program that involves brief counseling and providing a free cable lock to parents if they would like one, in pediatric primary care. This grant will build on previous research conducted in partnership with the Mental Health Research Network.
PREPARING FOR USE OF A COMPUTERIZED BATTERY TO IDENTIFY NEUROCOGNITIVE IMPAIRMENTS AMONG HIV-AFFECTED YOUTH IN BOTSWANA
Amy Van Pelt, MPH, was awarded a F31 training award that will help to lay the foundation for implementing the Penn Computerized Neurocognitive Battery (CNB) in Botswana. This research will aim to evaluate whether the CNB can distinguish between children living with HIV with and without functionally-significant neurodevelopmental deficits, assess the acceptability of the CNB among youth, and identify essential elements for the effective use of the CNB in clinical settings.
MANAGED PROBLEM SOLVING FOR ART ADHERENCE AND HIV CARE RETENTION DELIVERED BY COMMUNITY HEALTH WORKERS: A STEPPED WEDGE HYBRID TYPE II EFFECTIVENESS IMPLEMENTATION
Florence Momplaisir, MD, MSHP, FACP, Robert Gross, MD, MSCE, and Rinad Beidas, PhD, were awarded a R01 grant to test if an adapted evidence-based practice, Managed Problem Solving (MAPS+), delivered by community health workers (CHWs) can improve viral suppression, retention, and reach of HIV care in the City of Philadelphia. CHWs will be located in clinics to implement MAPS+ to improve viral suppression and care retention in people living with HIV. They will conduct a hybrid type II effectiveness-implementation trial with a stepped-wedge cluster randomized design in 12 clinics to test MAPS+ compared to usual care using a set of implementation strategies that they believe will best support implementation.
A STANDARDIZED LABOR INDUCTION PROTOCOL TO REDUCE PRIMARY CESAREAN AND RACIAL DISPARITIES IN LABOR OUTCOMES: A PROSPECTIVE COHORT STUDY
Rebecca Feldman Hamm, MD, MSCE, was awarded a K23 grant to study the effectiveness of a standardized labor protocol. Using protocols to standardize care has been shown to decrease adverse outcomes and reduce racial disparities in health care by reducing care variation across medicine. As part of this grant, Dr. Feldman Hamm will compare obstetric outcomes pre-and post-implementation of the labor induction protocol into routine care at two diverse sites, determine if the induction protocol reduces racial disparities in obstetric outcomes, and utilize mixed methods to understand acceptability, penetration, and fidelity of the induction protocol.
- The Implementation Science Workgroup was founded in 2011 to create a community around implementation science at Penn. The working group situates Penn as a leader in advancing the science of implementation and provides training opportunities for the next generation of implementation science researchers.
- In 2018, PISCE@LDI was launched. PISCE@LDI supports development of research to guide the implementation of evidence-based interventions across a range of healthcare settings. Past activities include a conference and speaker series. Bimonthly work in progress meetings focus on research proposals, ongoing projects, manuscripts, and pilot grant funding.
- Postdoctoral Fellowships in Implementation Research in Mental Health and Substance Abuse Treatment
- Course: HPR 611: Implementation Science in Health and Health Care
- Taught by Meghan Lane-Fall, MD, MSHP, Associate Professor, Perelman School of Medicine.
- Offered as part of Penn’s Masters of Science in Health Policy Research, this course is a survey of implementation science theory, design, and measurement, and its applications in health.
- Course: HPR 612: Advanced Topics in Implementation Science
- Taught by Meghan Lane-Fall, MD, MSHP, Associate Professor, Perelman School of Medicine and Rinad Beidas, PhD, Associate Professor, Perelman School of Medicine.
- Offered as part of Penn’s Masters of Science in Health Policy Research, this course offers an opportunity for students to advance their understanding of the thorniest methodological challenges in implementation science.
- Implementation Science Institute (ISI)
- This annual meeting on Penn’s campus offers a unique opportunity to learn the tools to design and execute rigorous implementation science research. At ISI, implementation science experts also provide tips for writing specific aims for Implementation Science grants.
- Next ISI will be June 7-10, 2021
The effects of a prolonged exposure workshop with and without consultation on provider and patient outcomes: A randomized implementation trial. Implementation Science. Jul 2020. Foa EB, McLean CP, Brown LA, Zang Y, Rosenfield D, Zandberg LJ, Ealey W, Hanson BS, Hunter LR, Lillard IJ, Patterson TJ, Rosado J, Scott V, Weber C, Wise JE, Zamora CD, Mintz J, Young-McCaughan S, Peterson AL, STRONG STAR Consortium.
Identifying the organizational innovation-specific capacity needed for exposure therapy. Depression and Anxiety. May 2020. Becker-Haimes EM, Byeon YV, Frank HE, Williams NJ, Kratz HE, Beidas RS.
A pragmatic method for costing implementation strategies using time-driven activity-based costing. Implementation Science. May 2020. Cidav Z, Mandell D, Pyne J, Beidas R, Curran G, Marcus S.
Where is the implementation science? An opportunity to apply principles during the COVID19 pandemic. Clinical Infectious Diseases. May 2020. Taylor SP, Kowalkowski MA, Beidas RS.
A systematic review of empirical studies examining mechanisms of implementation in health. Implementation Science. Apr 2020. Lewis CC, Boyd MR, Walsh-Bailey C, Lyon AR, Beidas R, Mittman B, Aarons GA, Weiner BJ, Chambers DA.
Testing a theory of strategic implementation leadership, implementation climate, and clinicians’ use of evidence-based practice: A 5-year panel analysis. Implementation Science. Feb 2020. Williams NJ, Wolk CB, Becker-Haimes EM, Beidas RS.
Designing clinical practice feedback reports: Three steps illustrated in Veterans Health Affairs long-term care facilities and programs. Implementation Science. Jan 2020. Landis-Lewis Z, Kononowech J, Scott WJ, Hogikyan RV, Carpenter JG, Periyakoil VS, Miller SC, Levy C, Ersek M, Sales A.
Implementation strategies for infection prevention and control promotion for nurses in Sub-Saharan Africa: A systematic review. Implementation Science. Dec 2019. Barrera-Cancedda AE, Riman KA, Shinnick JE, Buttenheim AM.