Research Translation: General Introduction

1. Research Translation: General Introduction Marcia Ory March 20, 2008

2. Topics/Activities for Today • Translational research concepts and examples • Revisiting RE-AIM model • Class questions • Class exercise

3. What is Translational Research?

4. What is the Popular Usage • Google Translational Research Images • Almost 3000 entries • Confirms wide-spread use of term • Shows different perceptions and uses

10. Translational Research • Translational research is the application of discoveries from basic biomedical and behavioral research toward the diagnosis, treatment or prevention of human disease, with the ultimate goal of improving public health (NIH) • Translational research focuses on the testing the application of evidence-based research to real world settings (RWJF).

11. Translational Research • From bench to bedside • From bedside to community

12. Translational Research • The transition from research to practice • Applies basic science (laboratory or social science) in the development and implementation of an intervention or treatment. Prohaska, UIC School of Public Health

13. Re-engineering the Clinical Research EnterpriseTranslational Research* • Scientific discoveries must be translated into practical applications. • Such discoveries typically begin at "the bench" with basic research—in which scientists study disease at a molecular or cellular level—then progress to the clinical level, or the patient's "bedside.“ • Scientists are increasingly aware that this bench-to-bedside approach to translational research is really a two-way street. • A stronger research infrastructure could strengthen and accelerate this critical part of the clinical research enterprise. The NIH Roadmap attempts to catalyze translational research in various ways. *NIH Roadmap

14. Why isn’t Research Being Translated into Practice?

15. Considerations for Diabetes Translational Research “A complex array of social, financial, behavioral, and organizational barriers impede the application of high quality diabetes care.” Garfield et al 2002

16. Lessons Learned from Diabetes Prevention Trials • Behavior is influenced by a combination of multilevel forces • No single best practice is appropriate for all patients and practitioners. • Tailoring to patients and customizing to settings is necessary. • Real-world translation requires flexibility to deal with pragmatic issues • Rigorous nonrandomized study designs including quasi-experimental, time-series, and observational studies are frequently most appropriate. Garfield et al 2002

17. Why Don’t Clinicians Follow Clinical Practice Guidelines? • Barriers to Adherence? • Possible Solutions? Cabana 1999

18. Gap in Recommended Services • Americans only receive 50% of the recommended preventive, acute, and long-term health care. • There are wide variation in health use McGlynn et al 2003)

19. Pathway for Translation and Dissemination Brownson 2005

20. Discovery • To investigate determinants of health, disease, behavior • To evaluate intervention efficacy • To test scientific methods

21. Translation • Synthesize research findings • Apply findings to target population • Understand intervention context • Explore needed adaptations • Examine relative advantage (fit within existing systems)

22. Dissemination • Spread of research findings • Institution and delivery of discovery

23. Change • Long term behavior change • Program adoption • Organizational change • Policy adoption • Environmental change

24. Future of Health Behavior Change Research Understanding implications of different research emphasizes and approaches • Efficacy vs Effectiveness • Internal vs External validity Glasgow 2003; 2004

25. Translation of Evidence-Based Prevention Programs • Old question: Does what we are doing work? • New question: Can we do what is known to work?

26. What is Evidence-Based Health Promotion? A process of planning, implementing, and evaluating programs adapted from tested models or interventions in order to address health issues at an individual level and at a community level Source: Altpeter, M., Schneider, E., Bryant, L. Beattie, B., & Whitelaw, N. (2004).Using the evidence base to promote healthy aging. National Council on the Aging Evidence-based Health Promotion Series, Vol. 1. Washington, DC: National Council on the Aging.

27. Public Policy Community Organizational Interpersonal Individual Target of Evidence-based Health Promotion Programs: Individuals to communities Source: McLeroy et al., 1988, Health Educ Q; Sallis et al., 1998, Am J Prev Med

28. 5 Crosscutting Themes of Evidence-based Health Promotion Programs • Individual level • Use of effective self-management • Assessment, goal setting, action planning, problem solving, follow-up • Social and familial context • Use of peer support, peer health mentors, professional support, role modeling, sharing and feedback, reinforcement • Cultural context • Saliency, appeal and adaptation to community norms, language, customs, beliefs Adapted from Nancy Whitelaw presentation, AHRQ Conference, 2006

29. 5 Crosscutting Themes of Evidence-based Health Promotion Programs (continued) • Connections to health care • Partnerships with public health, health care providers, hospitals, health care systems • Outcomes focus • Track social, mental, physical and functional changes • Objective and self-reported subjective measures Adapted from Nancy Whitelaw presentation, AHRQ Conference, 2006

30. Anatomy of an Evidence-based Program • Has a specific target population • Has specific, measurable goal(s) • Has a stated reasoning behind it and proven benefits • Describes a well-defined program structure and timeframe so others understand how the program works • Specifies staffing needs/skills • Specifies facility and equipment needs • Builds in program evaluation to measure program quality and health outcomes

31. Perceived Advantages of Evidence-based Health Promotion

32. Perceived Advantages of Evidence-based Health Promotion • Facilitates the use of common performance measures • Supports continuous quality improvement • Increases the likelihood of positive outcomes • Leads to efficient use of resources • Makes it easier to justify funding • Helps to establish partnerships –esp. with health care • Facilitates the spread of programs Adapted from: Nancy Whitelaw, Director, NCOA Center on Healthy Aging

33. Perceived Disadvantages of an Evidence-Based Approach

34. Perceived Disadvantages of an Evidence-Based Approach • Feels like standardization of programs rather than site-specific tailoring • Difficult to build community support – many prefer “home grown” to “off the shelf” • Tools and processes are unfamiliar • Requires knowing where to find and how to understand/judge the “evidence” Adapted from: Nancy Whitelaw, Director, NCOA Center on Healthy Aging

35. Fundamental Question • Do evidence-based successes translate to community-settings? • Are they of same magnitude? • What does it take to achieve similar results?

36. Pilot Study Accomplishments: Outcomes* • Significant results for increases in physical activity levels • Results of similar magnitude as research studies • Anecdotally clinically significant improvements in health and health care costs • Recommendations for next generation of studies *Data Presented at ACSM, 2005

37. Implementing Guidelines in Community or Clinical Settings* • There are many research-based guidelines that can improve health • Guidelines are difficult to implement especially in rural areas • Test out strategies for improving implementation and dissemination

38. Prevention Research CenterDiabetes Prevention and Management • Assessing Current Practice • Identifying Priority Guidelines • Collaborative Strategies for Implementation

39. RE-AIM FRAMEWORK • Used in planning and evaluating clinical and community based programs • Provides a tool for talking about elements critical to both research and practice

40. Components of RE-AIM How do I measure the results of my program (improvements or adverse effects)? How do I attract my intended audience? Reach – targeted population Effectiveness – program outcomes Adoption – participation rate among settings Implementation – delivered as intended and consistently Maintenance – long term effects at individual and setting levels How do I address barriers and develop organizational support for my program? How do I ensure the program is delivered properly and consistently? Setting level: What is the extent to which my program can be sustained (modified or discontinued) over time? Individual level: What are the long term effects of my program on targeted outcomes?

41. Partners and Planning – (P)RE-AIM • Find your partners • Identify and review evidence of health conditions and risk factors for older adults in the community • Review scientific evidence on proven, effective interventions or models • Identify core components of effective programs • Which specific program components contributed to the positive results?

42. Partners and Planning – (P)RE-AIM • Select interventions/models • Appropriate for targeted conditions or risk factors • Suitable for targeted populations and locations • Feasible to implement – can preserve core components • Suitable for adoption by a variety of agencies, staff with different skills • Communicate – to community leaders, other stakeholders

43. Reach and Retention - People • The number, proportion, and representativeness of individuals in a given program. • Key questions: • Do participants truly reflect the targeted population? • How do I reach and retain these high risk, diverse older adults? • Are those who become “enrolled” the ones who have the most to gain?

44. How to Improve Reach

45. How to Improve Reach • Build relationships with your community and target population. • Get your target population to help with recruitment. • Track the success of your various recruitment materials. • Offer programs where the target population is.

46. Adoption - Organizations • The number, proportion, and representativeness of settings and staff who are willing to offer the program. • Key questions: • How many organizations could implement this program? “Readiness” • How many of these organizations will actually operate the program? • What will motivate these organizations to participate?

47. Adoption – Organizational Readiness • Is the agency/partnership willing to do evidence-based health programs and stay true to the model being implemented? • Can distinguish between evidence-based health programs and other programs • Can gain and keep the support of health care organizations • Can preserve fidelity to key interventions and provide quality control while making necessary modifications

48. Adoption – Organizational Readiness • Is there funding for the program? • Can secure sustainable funding for evidence-based health promotion and self-management programs • Can reallocate current funds to support new evidence-based health programs

49. Adoption – Organizational Readiness • Is there access both to personnel with the expertise to do these programs, and to the population that needs these programs? • Can recruit and retain knowledgeable staff or contractors • Can recruit and retain lay leaders, peer supporters and other “volunteers” • Can offer programming at times and places that are convenient for the target population

50. Adoption – Organizational Readiness • Is there buy-in from senior leadership and key partners as reflected in both programmatic and financial support? • Can ensure that programs receive necessary time and attention by knowledgeable staff and agency leaders • Board is aware of move to evidence-based health programming and is supportive • Partners can commit existing funds or have identified new funding to build and sustain the program