Implementation Science

Implementation Science research guides the implementation of evidence-based interventions across a range of healthcare settings.

Public Insurance Expansions And Mental Health Care Availability

Aug. 1, 2020

Elson Oshman Blunt, Johanna Catherine Maclean, Ioana Popovici, Steven C. Marcus

Abstract [from journal]

Objective: To provide new evidence on the effects of large-scale public health insurance expansions, associated with the Affordable Care Act (ACA), on the availability of specialty mental health care treatment in the United States. We measure availability with the probability that a provider accepts Medicaid.

Data source/study setting: The National Mental Health Services Survey (N-MHSS) 2010-2018.

Study design: A quasi-experimental differences-in-differences design

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Institutional Review Board Quality, Private Equity, And Promoting Ethical Human Subjects Research

Holly Fernandez Lynch 160
Jul. 21, 2020

Holly Fernandez Lynch, Stephen Rosenfeld

Abstract [from journal]

Evaluating the quality and effectiveness of the institutional review boards (IRBs) responsible for overseeing research involving human participants is critically important but perpetually challenging. Seemingly common-sense measures, such as the number of proposals approved with and without major modifications and the number of unexpected adverse events occurring in approved protocols, can be misleading indicators of participant protection, and regulatory compliance may not correspond to achieving ethical goals. These measurement

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Variation In Tonsillectomy Cost And Revisit Rates: Analysis Of Administrative And Billing Data From US Children's Hospitals

Ron Keren, MD, MPH
Jun. 30, 2020

Sanjay Mahant, Troy Richardson, Ron Keren, Rajendu Srivastava, Jeremy Meier, Pediatric Research in Inpatient Setting (PRIS) Network

Abstract [from journal]

Background: Tonsillectomy is one of the most common and cumulatively expensive surgical procedures in children. We determined if substantial variation in resource use, as measured by standardised costs, exists across hospitals for performing tonsillectomy and if higher resource use is associated with better quality of care, as measured by revisits to hospital.

Methods: We conducted a retrospective analysis of children undergoing routine outpatient tonsillectomy between 2011 to 2017 across US

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Ethical And Regulatory Issues For Embedded Pragmatic Trials Involving People Living With Dementia

Jun. 26, 2020

Emily A. Largent, Spencer Phillips Hey, Kristin Harkins, Allison K. HoffmanSteven Joffe, Julie C. Lima, Alex John London, Jason Karlawish

Abstract [from journal]

Embedded pragmatic clinical trials (ePCTs) present an opportunity to improve care for people living with dementia (PLWD) and their care partners, but they also generate a complex constellation of ethical and regulatory challenges. These challenges begin with participant identification. Interventions may be delivered in ways that make it difficult to identify who is a human subject and therefore who needs ethical and regulatory protections. The need for informed consent, a core human subjects protection, must be considered but can be

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Transforming Mental Health Care Through Implementation of Evidence-Based Practices

Issue Brief
May. 21, 2020

Changing clinical practice is hard, and changing practices within larger organizations is even harder. Increasingly, policymakers are looking to implementation science—the study of why some changes prove more durable than others—to understand the dynamics of successful transformation. In this brief, we summarize the results of an ongoing community-academic partnership to increase the uptake of evidence-based practices in Philadelphia’s public behavioral health care system. Over five years, researchers found that widescale initiatives did successfully change the way care was delivered, albeit modestly and slowly. The evidence suggests that organizational factors, such as a proficient work culture, are more important than individual therapist factors, like openness in change, in influencing successful practice change. While practice transformation is possible, it requires focusing on underlying problems within organizations as well as championing new policies. 

Does Implementing A New Intervention Disrupt Use Of Existing Evidence-Based Autism Interventions?

Rinad Beidas, PhD, U of Penn
May. 20, 2020

Melanie Pellecchia, Rinad S Beidas, Gwendolyn Lawson, Nathaniel J Williams, Max Seidman, John R Kimberly, Carolyn C Cannuscio, David S Mandell

Abstract [from journal]

Interventions for children with autism spectrum disorder are complex and often are not implemented successfully within schools. When new practices are introduced in schools, they often are layered on top of existing practices, with little attention paid to how introducing new practices affects the use of existing practices. This study evaluated how introducing a computer-assisted intervention, called TeachTown:Basics, affected the use of other evidence-based practices in autism support classrooms. We compared how

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Dual-Method Contraception Use Among Young Women Pre- And Post-ACA Implementation

May. 12, 2020

Tiffany M. Montgomery, Alisa J. Stephens-Shields, Marilyn M. Schapira, Aletha Y. Akers

Abstract [from journal]

The 2012 implementation of the Patient Protection and Affordable Care Act (ACA) contraceptive coverage mandate removed financial barriers to contraception access for many insured women. Since that time, increases in sexually transmitted disease (STD) rates have been noted, particularly among Black adolescent and young adult women aged 15 to 24 years. It is unclear whether changes in dual-method contraception use (simultaneous use of nonbarrier contraceptive methods and condoms) are associated with the increase in STD rates. A repeated cross...

Nudging Clinicians Toward Higher-Value Cancer Care

May. 5, 2020

In a new study published in JAMA Oncology, my colleagues and I find that behavioral nudges can promote high-value, evidence-based prescribing of specialty drugs in cancer care. For patients with breast, lung, and prostate cancer with bone metastases, clinicians face a decision between two therapies of comparable effectiveness but dramatically different cost.

Life-Sustaining Treatment Decisions Initiative: Early Implementation Results of a National Veterans Affairs Program to Honor Veterans’ Care Preferences

Feb. 24, 2020

Cari Levy, Mary Ersek, Winifred Scott, Joan G. Carpenter, Jennifer Kononowech, Ciaran Phibbs, Jill Lowry, Jennifer Cohen, Marybeth Foglia

Abstract [from journal]

Background: On July 1, 2018, the Veterans Health Administration (VA) National Center for Ethics in Health Care implemented the Life-Sustaining Treatment Decisions Initiative (LSTDI). Its goal is to identify, document, and honor LST decisions of seriously ill veterans. Providers document veterans’ goals and decisions using a standardized LST template and order set.

Objective: Evaluate the first 7 months of LSTDI

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