Implementation Science and Comparative Effectiveness Research

Living reference work entry
Part of the Health Services Research book series (HEALTHSR)


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.


Knowledge Translation Implementation Research Comparative Effectiveness Research Implementation Science Comparative Effectiveness Research Study 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Aarons GA, Hurlburt M, Horwitz SM. Advancing a conceptual model of evidence-based practice implementation in public service sectors. Adm Policy Ment Health. 2010;38(1):4–23.CrossRefPubMedCentralGoogle Scholar
  2. Bonham AC, Solomon MZ. Moving comparative effectiveness research into practice: implementation science and the role of academic medicine. Health Aff. 2010;29(10):1901–5.CrossRefGoogle Scholar
  3. Caldwell DF, Chatman J, O’Reilly 3rd CA, Ormiston M, Lapiz M. Implementing strategic change in a health care system: the importance of leadership and change readiness. Health Care Manage Rev. 2008;33(2):124–33.CrossRefPubMedGoogle Scholar
  4. Chambers D. Foreword. In: Brownson RC, Colditz GA, Proctor EK, editors. Dissemination and implementation research in health. New York: Oxford University Press; 2012. p. vii.Google Scholar
  5. CIHR. About knowledge translation. Last modified 2014. Accessed 26 July 2013.
  6. CIHR. Knowledge to action: a knowledge translation casebook. 2008. Accessed 26 July 2013.
  7. CMS. Center for medicare and medicaid innovation – health care innovation awards. Care-Innovation-Awards/. Accessed 26 July 2013.
  8. CMS. National healthcare expenditures fact sheet. Last modified in 2014. Accessed 26 July 2013.
  9. Colditz GA, Wolin KY, Gehlert S. Applying what we know to accelerate cancer prevention. Sci Transl Med. 2012;4(127):127rv4.CrossRefPubMedCentralPubMedGoogle Scholar
  10. Damschroder L, Aron D, Keith R, Kirsh S, Alexander J, Lowery J. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:50.CrossRefPubMedCentralPubMedGoogle Scholar
  11. Dixon-Woods M, Bosk C, Aveling E, Goeschel C, Pronovost P. Explaining Michigan: Developing an Ex Post Theory of a Quality Improvement Program. Milbank Q. 2011;89(2):167–205.Google Scholar
  12. Emanuel E, Wendler D, Grady C. What makes clinical research ethical? JAMA. 2000;283:2701–11.CrossRefPubMedGoogle Scholar
  13. Faden R, Beauchamp TL, Kass NE. Learning health care systems and justice. Hastings Center Report, 2011; July–August: 3.Google Scholar
  14. Feldstein AC, Glasgow RE. A practical, robust implementation and sustainability model (PRISM) for integrating research findings into practice. Jt Comm J Qual Patient Saf. 2008;34(4):228–43.PubMedGoogle Scholar
  15. Gagnon MP, Sanchez E, Pons JM. From recommendation to action: psychosocial factors influencing physician intention to use Health Technology Assessment (HTA) recommendations. Implement Sci. 2006;1:8.CrossRefPubMedCentralPubMedGoogle Scholar
  16. Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999;89(9):1322–7.CrossRefPubMedCentralPubMedGoogle Scholar
  17. Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004;82(4):581–629.CrossRefPubMedCentralPubMedGoogle Scholar
  18. Implementation Science About Implementation Science. Implementation science “About this Journal”. Accessed 26 July 2013.
  19. Institute of Medicine (IOM). Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academy Press; 2001.Google Scholar
  20. Kalfoglou AL, Boenning DA, Korn D, Institute of Medicine. Exploring the map of clinical research for the coming decade: symposium summary, Clinical Research Roundtable, December 2000. Washington, DC: Board on Health Sciences Policy, Institute of Medicine; 2001.Google Scholar
  21. Kass N, Faden R, Tunis S. Addressing low-risk comparative effectiveness research in proposed changes to U.S. federal regulations governing research. JAMA. 2012;307(15):1589–90.CrossRefPubMedGoogle Scholar
  22. Kitson A, Rycroft-Malone J, Harvey G, McCormack B, Seers K, Titchen A. Evaluating the successful implementation of evidence into practice using the PARiHS framework: theoretical and practical challenges. Implement Sci. 2008;3:1. doi: 10.1186/1748-5908-3-1Google Scholar
  23. Kitson A, Strauss SE. The knowledge-to-action cycle: identifying the gaps. Can Med Assoc J. 2010;182(2):E73–7.CrossRefGoogle Scholar
  24. Kohn LT, Corrigan JM, Donaldson MS, Institute of Medicine. To err is human: building a safer health system. Washington, DC: National Academy Press; 2000.Google Scholar
  25. Kroenke K, Kapoor W, Helfand M, Meltzer DO, McDonald MA, Selker H. Training and career development for comparative effectiveness research workforce development: CTSA Consortium Strategic Goal Committee on comparative effectiveness research workgroup on workforce development. Clin Transl Sci. 2010;3(5):258–62.CrossRefPubMedCentralPubMedGoogle Scholar
  26. Largent E, Joffe S, Miller F. Can research and caer be ethically integrated? Hastings Center Rep. 2011;41(4):37–46.Google Scholar
  27. Lee DH, Vielemeyer O. Analysis of overall level of evidence behind Infectious Diseases Society of America practice guidelines. Arch Intern Med. 2011;171(1):18–22.CrossRefPubMedGoogle Scholar
  28. Lenfant C. Shattuck lecture–clinical research to clinical practice–lost in translation? N Engl J Med. 2003;349(9):868–74.CrossRefPubMedGoogle Scholar
  29. McGlynn EA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the United States. N Engl J Med. 2003;348:2635–45.CrossRefPubMedGoogle Scholar
  30. Meissner HI, Glasgow RE, Vinson CA, Chambers D, Brownson RC, Green LW, Ammerman AS, Weiner BJ, Mittman B. The U.S. training institute for dissemination and implementation research in health. Implement Sci. 2013;8:12. doi:10.1186/1748-5908-8-12.CrossRefPubMedCentralPubMedGoogle Scholar
  31. Mittman BS. Implementation science in health care. In: Brownson RC, Colditz GA, Proctor EK, editors. Dissemination and implementation research in health. New York: Oxford University Press; 2012. p. 400–18.Google Scholar
  32. National Research Council. The CTSA program at NIH: opportunities for advancing clinical and translational research. Washington, DC: The National Academies Press; 2013.Google Scholar
  33. NHLBI. Facts about ALLHAT: new findings about drugs to lower high blood pressure and cholesterol. Accessed 24 July 2013.
  34. NICE. How to put NICE guidance into practice. London: National Institute for Health and Care Excellence; 2005, Interim.Google Scholar
  35. NIH. Center for scientific review. Dissemination and implementation research in health study section. Accessed 24 July 2013.
  36. NIH. Dissemination and implementation science. The National Library of Medicine. Last modified 2015. Accessed 26 July 2013.
  37. Patient Protection and Affordable Care Act. 111–148. 2010 42 U.S.C. Secs. 1185–9511.Google Scholar
  38. PCORI. National priorities for research and research Agenda. Washington, DC: Patient Centered Outcomes Research Institute; 2012. Accessed 24 July 2013.
  39. Proctor EK, Knudsen KJ, Fedoravicius N, Hovmand P, Rosen A, Perron B. Implementation of evidence-based practice in community behavioral health: agency director perspectives. Adm Policy Ment Health. 2007;34(5):479–88.CrossRefPubMedGoogle Scholar
  40. Pronovost P, Needham D, Berenholtz S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med. 2006;355(26):2725–32.CrossRefPubMedGoogle Scholar
  41. Riley WT, Glasgow RE, Etheredge L, Abernethy AP. Rapid, responsive, relevant (R3) research: a call for a rapid learning health research enterprise. Clin Transl Med. 2013;2(1):10.CrossRefPubMedCentralPubMedGoogle Scholar
  42. Rycroft-Malone J, Kitson A, Harvey G, et al. Ingredients for change: revisiting a conceptual framework. Qual Saf Health Care. 2002;11(2):174–80.CrossRefPubMedCentralPubMedGoogle Scholar
  43. Schillinger D. An introduction to effectiveness, dissemination and implementation research. In: Fleisher P, Goldstein E, editors. From the series: UCSF Clinical and Translational Science Institute (CTSI) resource manuals and guides to community-engaged research. Published by Clinical Translational Science Institute Community Engagement Program, University of California San Francisco. 2010. Accessed 26 July 2013.
  44. Scott IA, Glasziou PP. Improving the effectiveness of clinical medicine: the need for better science. Med J Aust. 2012;196(5):304–8.CrossRefPubMedGoogle Scholar
  45. Selker H, Grossman C, Adams A, Goldmann D, Dezii C, Meyer G, Roger V, Savitz L, Platt R. The common rule and continuous improvement in health care: a learning health system perspective. Unpublished discussion paper posted on Institute of Medicine website. 2011. Accessed 31 July 2013.
  46. Selker H, Leslie L, Wasser J, Plaut A, Wilson I, Griffith J. Tufts CTSI: Comparative Effectiveness Research as a Conceptual Framework for a Focus on Impact. Clin Transl Sci. 2011;3(2):56–58.Google Scholar
  47. Shrank W. The center for medicare and medicaid innovation’s blueprint for rapid-cycle evaluation of new care and payment models. Health Aff. 2013;32(4):807–12.CrossRefGoogle Scholar
  48. Stafford RS, Bartholomew LK, Cushman WC, Cutler JA, Davis BR, Dawson G, Einhorn PT, Furberg CD, Piller LB, Pressel SL, Whelton PK, ALLHAT Collaborative Research Group. Impact of the ALLHAT/JNC7 Dissemination Project on thiazide-type diuretic use. Arch Intern Med. 2010;170(10):851–8.CrossRefPubMedCentralPubMedGoogle Scholar
  49. Stetler C, Damschroder L, Helfrich C, Hagedorn H. A Guide for applying a revised version of the PARIHS framework for implementation. Implement Sci. 2011;6:99.Google Scholar
  50. Stone EG, Morton SC, Hulscher ME, et al. Interventions that increase use of adult immunization and cancer screening services: a meta-analysis. Ann Intern Med. 2002;136(9):641–51.CrossRefPubMedGoogle Scholar
  51. Sung NS, Crowley Jr WF, Genel M, et al. Central challenges facing the national clinical research enterprise. JAMA. 2003;289(10):1278–87.CrossRefPubMedGoogle Scholar
  52. Tricoci P, Allen JM, Kramer JM, Califf RM, Smith Jr SC. Scientific evidence underlying the ACC/AHA clinical practice guidelines. JAMA. 2009;301(8):831–41.CrossRefPubMedGoogle Scholar
  53. VHA. QUERI implementation guide, vol 2012. U.S. Department of Veterans Affairs; 2009.Google Scholar
  54. Washington AE, Lipstein SH. The Patient-Centered Outcomes Research Institute–promoting better information, decisions, and health. N Engl J Med. 2011;365(15):e31.CrossRefPubMedGoogle Scholar
  55. Weiss AP. Measuring the impact of medical research: moving from outputs to outcomes. Am J Psychiatry. 2007;164(2):206–14.CrossRefPubMedGoogle Scholar
  56. Woolf SH. The meaning of translational research and why it matters. JAMA. 2008;299:211–3.PubMedGoogle Scholar
  57. Woolf SH, Johnson RE. The break-even point: when medical advances are less important than improving the fidelity with which they are delivered. Ann Fam Med. 2005;3(6):545–52.CrossRefPubMedCentralPubMedGoogle Scholar
  58. Zerhouni EA. Translational and clinical science–time for a new vision. N Engl J Med. 2005;353(15):1621–3.CrossRefPubMedGoogle Scholar

Authors and Affiliations

  1. 1.Association of American Medical CollegesWashingtonUSA
  2. 2.The Hastings CenterGarrisonUSA
  3. 3.Department of Veterans Affairs Greater Los Angeles Healthcare SystemVA Center for Implementation Practice and Research SupportLos AngelesUSA
  4. 4.Clinical Effectiveness and Implementation ResearchAssociation of American Medical CollegesWashingtonUSA
  5. 5.Scientific AffairsAssociation of American Medical CollegesWashingtonUSA

Personalised recommendations