Our expert answers 3 Questions
To improve the health of the nation, we must understand the science of translation for populations to receive interventions informed by research findings. Most of my research, which is focused on implementation of effectiveness science, has centered on improving outcomes of older adults in areas such as pain management, cancer care, heart failure and fall prevention. These studies have tested the effectiveness of implementation interventions and explicated the contributions of health care interventions to outcomes of older adults. I am particularly passionate about understanding why some implementation interventions are effective in translating research into practice in some contexts of care delivery and not others. We have tested implementation interventions in academic and community hospitals as well as home hospice settings. We are currently working on proposals to further test the effectiveness of an implementation intervention that promotes use of a fall prevention “bundle” that targets patient-specific, fall risk factors of older hospitalized adults. We are also collaborating with a large multi-hospital system to explicate the effectiveness of fall prevention interventions delivered in acute care settings using a large clinical database extracted from the system’s data warehouse. Implementation and effectiveness science are essential to discover mechanisms for promoting use of research findings in real world settings.
When we encounter individuals or populations, we have the potential to deliver evidence-informed interventions to improve health care outcomes. The chasm between availability of effective health care interventions, demonstrated through clinical trials, and use of those findings in practice must be filled. As noted by both federal agencies and professional organizations, continuing to invest in research without application in practice is no longer tolerable. We must deliver evidence-informed interventions in systems of health care delivery that promote knowledge uptake and use at the point of care delivery. The implications for practice are both an individual and system responsibility.
This area of science can improve health care of individuals and populations as well as provide insights into transformation of health care delivery systems. I have focused on care of older adults, as there are many areas in which there is a scientific basis for care that is not being used in practice. For example, there is an evidence-base for acute pain management in older adults, but our studies demonstrated that these research findings were not being used in practice. Our TRIP (translating research into practice) intervention, tested through a cluster-randomized trial, improved both processes of care for acute pain management as well as decreased pain intensity of older adults hospitalized with a hip fracture. This study provided the basis for subsequent research in other areas of translation.