Implementation Science and Comparative Effectiveness Research

Abstract

The resurgence of interest in comparative effectiveness research (CER) in the last decade has trained a bright spotlight on ensuring that clinical findings obtained from CER are implemented and disseminated to routine practice so that all patients and populations benefit. The focus on implementation science as part of CER reflects the collective realization that findings from clinical studies have not uniformly resulted in changes in the practices of health care providers or patients, nor have they always yielded improvements in health outcomes. Implementation science, as defined by the journal that bears its name is, “the scientific study of methods to promote the systematic uptake of proven clinical treatments, practices, organizational and management interventions into routine practice, and hence to improve health” “Implementation Science About Implementation Science.” The field has evolved as a multidisciplinary science, drawing principles from the behavioral and social sciences, process engineering, economics, and traditional health services research. Parallel to this evolution, new methodologies and evaluation approaches have emerged to track the processes, organizational contexts, and other elements which contribute to the successful implementation of CER findings. Embedding implementation research into CER starts with strong multidisciplinary teams – from institutional leadership to frontline care providers – to bridge the gap between research and operations; and then depends on organizational receptivity, appropriate infrastructure, and project-specific researcher-clinician partnerships. Governmental agencies around the world are already using forms of implementation science to inform health care; in the United States, the 2010 passage of health care reform legislation offers an unprecedented opportunity to make implementation science part and parcel of clinical practice.

This chapter brings together a brief history of implementation science and CER with a discussion of the current political and economic context, an overview of the major funders in this space, and the myriad evaluation frameworks and other conceptual models for the successful uptake of evidence into practice. Readers will also find a treatment of the ethics associated with research in this field, and a consideration of the state of the research workforce, followed by recommendations for the future.