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Evidence Integration Triangle. Implementation Science Team Division of Cancer Control and Population Sciences National Cancer Institute. August 2011. Rationale – Square Peg, Round Hole. Majority of research tested programs do not translate into real world settings

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evidence integration triangle

Evidence Integration Triangle

Implementation Science Team

Division of Cancer Control and Population Sciences National Cancer Institute

August 2011

rationale square peg round hole
Rationale – Square Peg, Round Hole
  • Majority of research tested programs do not translate into real world settings
  • Those that do, often take an inordinately long period of time to so so

2

Glasgow 2011

research to practice pipeline
Research to Practice Pipeline

Green, LW et al. 2009. Annual Rev. Public Health. 30: 151-174

Balas EA, Boren SA. 2000. Managing clinical knowledge for health care improvement. In: Yearbook of Medical Informatics.

slide4

Evidence Integration Triangle

Intervention Program/Policy(Prevention or Treatment)

(e.g. design; key components; principles; external validity)

Evidence

Stakeholders

4

Glasgow 2011

slide5

Evidence Integration Triangle

Intervention Program/Policy(Prevention or Treatment)

(e.g. design; key components; principles; external validity)

Evidence

Stakeholders

Practical Progress Measures

(e.g. actionable & longitudinal measures)

5

Glasgow 2011

slide6

Evidence Integration Triangle

Intervention Program/Policy(Prevention or Treatment)

(e.g., design; key components; principles; external validity)

Evidence

Stakeholders

Practical Progress Measures

(e.g., practical, actionable & longitudinal measures)

Implementation Process

(e.g., stakeholder engagement team-based science; CBPR; patient centered care)

6

Glasgow 2011

intervention program policy the what

Evidence Integration Triangle

Intervention Program/Policy – The “What”

“If we want more evidence-based practice,

we need more practice-based evidence.”

Identify key components or theoretical principles

Need for detailed implementation guides, lessons learned manuals

Need to focus and report on both internal and external validity (need to add relevance to rigor)

Current focus mostly on treatment, more is needed on prevention, and even more on policy

Green LW & Glasgow R. Eval Health Profess. 2006, 29: 126-53.

Rothwell, PM. Lancet. 2006, 365:82-93.

7

Glasgow 2011

practical measures of progress the so what

Evidence Integration Triangle

Practical Measures of Progress – the “So What”

Measures need to be:

Brief and practical

Collected longitudinally to assess progress

Reliable and valid

Sensitive to change

Have national norms, easily understood and ACTIONABLE

Culturally appropriate across groups

Reflect multiple stakeholder perspectives

Society of Behavioral Medicine Health Policy Statement on Public Health Need for Patient Reported Measures. http://www.sbm.org/policy/patient-reported_measures.pdf

8

Glasgow 2011

implementation process the how

Evidence Integration Triangle

Implementation Process – The “How”

Partnership and Community Based Participatory Research (CBPR) approaches1

Patient-centered Care Approach

Team science in action2,3

Iterative, self-correcting

1 Guidelines and Categories for Classifying Participatory Research Projects in Health: http://lgreen.net/guidelines.html

2Gray, D. O. (2008). In C. L. S. Coryn& M. Scriven (Eds.), Reforming the evaluation of research. New Directions for Evaluation, 118, 73–87.

3Mâsse, LC, et al. Am J Prev Med. 2008; 35 (2S): S151-S160.

9

Glasgow 2011

slide10

Evidence Integration Triangle

CURRENT

IDEAL

Intervention Program/Policy(Prevention or Treatment)

(e.g., design; key components; principles; external validity)

Evidence

Stakeholders

Practical Progress Measures

(e.g., actionable & longitudinal measures)

Implementation Process

(e.g., stakeholder engagement; team-based science; CBPR; patient centered care)

10

Glasgow 2011

slide11

Evidence Integration Triangle

Intervention Program/Policy(Prevention or Treatment)

(e.g., design; key components; principles; external validity)

Feedback

Feedback

Evidence

Stakeholders

Practical Progress Measures

(e.g., actionable & longitudinal measures)

Implementation Process

(e.g., stakeholder engagement; team-based science; CBPR; patient centered care)

Feedback

11

Glasgow 2011

conclusions
Conclusions
  • The evidence-based movement was a good start, but only gets us so far
  • To make greater progress, two other elements also need attention:
      • Practical MEASURES to track PROGRESS, and
      • Implementation PROCESSES that use partnership principles
      • The 3 legs of the ‘EIT” are each necessary but not sufficient by themselves

12