The Implementation Science and Engineering Lab
Our research group strives to speed the use of evidence-based practices in primary care. Of course, primary care clinicians already use evidence-based practices to treat patients every day. Yet a great number of research-proven ideas go unused. We focus primarily on implementation of evidence-based practices for the prevention and treatment of substance use disorders. Our approach to implementation uses principles and tools from systems engineering.
We conduct research related to three goals—describing a model of implementation, improving the uptake of clinical guidelines, and using mHealth to improve outcomes for chronic conditions.
A conceptual model of implementation: To close the wide gap between evidence-based practices (EBPs) and actual clinical practices—estimated to average 17 years—we are developing and testing a model of implementation that describes the process as a multi-player, sequential coordination game (modeled after tenets of game theory) that requires serial cooperation from three stakeholder groups: management, staff, and patients. This work is rooted in practical value models from decision analysis and borrows ideas from several other fields, including systems engineering, behavioral economics, and marketing. In this model, those wishing to implement a new practice assess stakeholder perspectives of the value of adopting it. Then implementation strategies are used to assure that stakeholder values are addressed as the EBP is rolled out. The focal EBP in this work is A-CHESS, a mobile-phone-based system for addiction treatment. The goal is a flexible, pragmatic model that can be used for assessing and improving the adoption potential of many EBPs in diverse healthcare settings.
Systems consultation – a blended implementation strategy to improve the uptake of clinical guidelines: Systems consultation is a blended implementation strategy derived from the NIATx model, an evidence-based approach for promoting organizational change that has been widely used in addiction treatment organizations. The strategy adapts the NIATx model to primary care. The focal problem addressed in this work is improving guideline-concordant opioid prescribing. Like NIATx, systems consultation uses tools and processes from systems engineering, starting with a systematic process of translating clinical guidelines into an actionable list. A team consisting of a physician peer coach with expertise in opioid prescribing and a facilitator who guides organizational change works with clinic staff members to make workflow changes that improve opioid prescribing. A pilot study of the strategy produced an 11% decline in morphine milligram equivalents among patients on long-term opioid therapy for chronic non-cancer pain. The approach has been modified based on the pilot study to make it ready for wider dissemination in primary care.
Mobile health (mHealth): Smartphones make it possible to offer patients resources for managing and monitoring their chronic conditions 24/7. A-CHESS, a smartphone-based recovery support system for patients recovering from alcohol use disorder (AUD), has proven effective in a randomized clinical trial of recovering AUD patients. We work to extend the use of A-CHESS and other apps into the primary care setting to test their efficacy and cost effectiveness for substance use disorders and other chronic conditions.