Effective Strategies for Dissemination, Diffusion, and Adoption

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Dr. Steve WoolfKeynote Session II: Effective Strategies for Dissemination, Diffusion, And Adoption . Disclosures. The Following Faculty have No Relevant Financial Relationshipswith Commercial Interests. Accelerating the Dissemination and Translation of Clinical Research into Practice. Visibility of Translational Research.

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Effective Strategies for Dissemination, Diffusion, and Adoption

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1. Effective Strategies for Dissemination, Diffusion, and Adoption Steven H. Woolf, MD, MPH Department of Family Medicine Virginia Commonwealth University

2. I have received no financial support for consultation, research or evaluation or have a financial interest relevant to this presentation. I will not reference unlabeled/unapproved uses of drugs or products. I have received no financial support for consultation, research or evaluation or have a financial interest relevant to this presentation. I will not reference unlabeled/unapproved uses of drugs or products.

3. Visibility of Translational Research CTSA program By 2012, 60 programs at a cost of $500 million per year Foundations Industry Disease-related organizations Hospitals and health systems Journals

4. What is “translational research”?

6. “Bench to Bedside”

7. Translational Research, Classically Defined “…effective translation of the new knowledge, mechanisms, and techniques generated by advances in basic science research into new approaches for prevention, diagnosis, and treatment of disease is essential for improving health” Source: Fontanarosa PB, DeAngelis CD. Basic science and translational research in JAMA. JAMA 2002;287:1728.

9. Translating Research into Practice (TRIP) Improving access Reorganizing and coordinating systems of care Helping clinicians and patients to change behaviors and make more informed choices Reminders, point-of-care decision support tools Strengthening the clinician-patient relationship

11. IOM Clinical Research Roundtable

12. T1 and T2 T1: “The transfer of new understandings of disease mechanisms gained in the laboratory into the development of new methods for diagnosis, therapy, and prevention and their first testing in humans.” T2: “The translation of results from clinical studies into everyday clinical practice and health decision making.”

14. T1 and T2: Translational Research Alike in Name Only Goals Settings Study designs Investigators

15. The Laboratory of T1

17. The “Laboratory” of T2

18. Resources Needed for T1 Mastery of molecular biology, genetics, and other basic sciences Appropriately trained clinical scientists Strong laboratories Cutting-edge technology Supportive infrastructure within the institution

22. Medicare Spending per Capita in the United States, by Hospital Referral Region, 2003

24. The “Ecology” of Medical Care

26. Resources Needed for T2 “Implementation science”: evaluating interventions in real-world settings Clinical epidemiology and evidence synthesis Communication theory Behavioral science Public policy Financing Organizational theory System redesign Informatics Mixed methods/qualitative research

27. The Dominant Challenges Biological and technological mysteries Trial recruitment Regulatory concerns Human behavior Organizational inertia Infrastructure and resource constraints Messiness of “moving targets” and conditions that investigators cannot fully control

28. NIH Budget, 2001

29. The Conventional “Afferent” Model

30. Bidirectional Collaborative Research

32. Societal Preference

33. T2 Community Is Still Defining Itself Translational research Translating research into practice (TRIP) Dissemination science Health services research Knowledge translation Knowledge transfer Implementation science Quality improvement research

35. Where T2 Occurs

36. “Practitioners” Who Apply Evidence Health care professionals and hospitals Patients and the public Public health administrators Employers School officials Regulating bodies and policymakers Product designers Food industry

37. Larger Dimensions of Basic Science

38. Why Disproportion Matters

40. What T2 Needs A new name: “translational research” is too vague Not using the same label for T1 and T2 would reduce confusion New recognition and emphasis Policymakers need to understand distinction between inventing treatments and getting them used T2 salvages investment in T1 research

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