Strengthening Dissemination, Implementation and Improvement (DII) Science at UCLA:

Launching a New CTSI Initiative

Strategy presented by:

Brian Mittman, Moira Inkelas, Stefanie Vassar, Ibrahima Sankare, Arturo Martinez, Arleen Brown

October 25, 2013

• “Translational roadblocks”: IoM Clinical Research Roundtable, NIH Roadmap, NIH CTSA Program

• “Quality chasm”: IoM Reports, add’l US and non-US reports documenting significant gaps in the quality, outcomes, equity, safety, value and patient-centeredness of health care and public health

• Affordable Care Act, de-implementation and “affordability”: Significant growth in pressure and interest in improving value and efficiency

Background and motivation, national

• UCLA CTSI Mission: Accelerating Discoveries Toward Better Health

• Changes in funding agency priorities and opportunities: NIH, AHRQ, PCORI, foundations, etc.

• UCLA Health System, Los Angeles County Department of Health Services, other CTSI stakeholder priorities, needs

Background and motivation, local

UCLA CTSI External Advisory Board Report, June 4, 2012:

“Explore the role of Community Engagement and Research Program (CERP) in the dissemination and implementation of evidence-based interventions; transferring knowledge from all forms of CTSA research to benefit community stakeholders and population health in a sustainable manner.”

Background and motivation, local

Dissemination science is the study of communication strategies to increase awareness and understanding of innovative, effective policies and practices to facilitate their widespread adoption.

Implementation science is the study of contextual influences, organizational and professional characteristics, and specific interventions that impede or facilitate the adoption of effective practices.

Improvement science is the study of factors and strategies for improving the quality, performance and outcomes of healthcare and public health systems and services.

Research responses to these challenges

Goals: Expand UCLA capacity and activity in dissemination, implementation, and improvement (DII) research to:

1. Enhance UCLA competitiveness for DII funding and publication opportunities;

2. Position the CTSI for future renewal, based on expected NCATS review criteria (local impact, unique contributions to CTSA consortium);

3. Enhance societal impact and benefits of UCLA research and improve health care quality, health behaviors and health outcomes in Los Angeles County and beyond.

UCLA CTSI Dissemination, Implementation and Improvement Science Initiative

• Results of clinical studies are put into practice in Southern California, and benefit diverse populations

• Local providers take part in studies of how to implement, spread and scale findings and innovations

• Research, implementation and dissemination occur seamlessly, by design

• Delivery systems can find researchers to help them develop system solutions

• Researchers can find delivery systems and/or provider networks to partner on implementation-oriented funding proposals and studies

The vision

• Establish DII as a focus area within the CTSI, to promote use of

existing CTSI infrastructure that supports increased DII research, and

identify potential synergies across CTSI programs

• House the organizing efforts for the DII focus area within CERP, while

identifying DII opportunities and needs involving other CTSI programs

(such as Education, and Regulatory)

• Priorities are to:

– Increase awareness by investigators of DII supports available through CERP

– Support training and learning opportunities in DII, including methods and

undertaking DII research with community partners (shared strategy of CERP

and the CTSI Education program)

– Identify value added opportunities for increasing DII research within CTSI

partner organizations

The strategy

• Education, Training & Capacity Building

–Enhance DII skills within the UCLA academic research workforce

–Build CTSI institution and community partner capacity to conduct and use

DII research

• Consultation

–Provide expertise in DII study design, conduct and publication

–Facilitate successful responses to DII FOAs (NIH, PCORI, CMS, foundations)

• Tools and Resources

–Create and provide links to DII tools and resources

–Create templates for DII funding applications, IRB applications

• Interface with CTSI and other CTSI programs

–Support dissemination of UCLA research, targeting health care delivery

–Develop measures and track activities and impact with Evaluation program

–Collaborate with RRT’s environmental scanning of DII funding opportunities

DI&I Science Initiative goals and components

• Establish new Master of Science in Improvement and

Implementation Science

–New courses in the School of Public Health, in advanced

improvement science methods and in implementation science

research methods

–Offered in Winter and Spring 2013

• Offer DII content/modules within array of content offered for

clinician researchers in training

• Identify additional curriculum expansion needs and

opportunities, including the possibility of new training

programs/tracks

Education, training & capacity building

• Develop DII research components/supplements in

ongoing/planned clinical research

• Identify DII opportunities linked with quality improvement

departments and efforts within CSTI institutions

– UCLA Health, Harbor, CSMC Medical Delivery Network

• Identify DII opportunities involving community partners

– e.g., Los Angeles Department of Health Services

Education, training & capacity building

Integrating Patient Voice into Quality and Process Improvement

A prototype of consumer involvement in quality improvement in the Los Angeles County Department of

Health Services, Harbor-UCLA Medical Center

Daniel Castro, MD, Moira Inkelas, PhD, Joslyn Levy, BSN, MPH, Jane Taylor, Ed D

Goals Patient=Consumer

• Partner with the Los Angeles County Department of Health Services (DHS) to identify and respond to patient priorities for improving care processes

• Bring consumer perspective into quality and process improvement activities

• Standardize a methodology to integrate consumer perspective into quality and process improvement

• Implement consumer input into LA County DHS quality and process improvement activities, through a future spread strategy (practice based research network, PBRN)

Context for This Research

• Large evidence base for understanding the patient experience

– Multiple methods of modeling the patient experience, such as clinic walk-throughs

– Extensive use of surveying

• Increasing appreciation of the value of explicit involvement of patients/consumers in how care is designed and delivered

– Examples include the NIH-funded Collaborative Chronic Care (C3N) Transformative grant

• This perspective is now reflected in:

– federal research funding (e.g., PCORI)

– models of care (e.g., Medical Home Index supported by HRSA/Maternal and Child Health Bureau)

• The current research is a novel application of the “N=1” clinical method, for care innovation and improvement

• Future strategies

– Improve data capture and reporting capacity within CTSI institutions

and community partners to facilitate more efficient research

– Identify practice-level incentives for participating in expanded DII

activity

– Identify opportunities for continuing education programs for local

practicing health care professionals in improvement science

– Identify collaboration opportunities with professional organizations

(e.g., CAFP, AAP, CCALA, CPCA)

Education, training & capacity building

• Facilitate successful DII funding applications, projects and

publications, through expert consultation in DII study design,

conduct and publication

– Increase awareness of CERP consulting service

Consultation

• Make available opportunities in DII training, and methods

– Posting on UCLA CTSI website

• Offer templates for components of proposals and projects

– Dissemination plans, and/or other components

Tools and resources

• Future strategies:

– Strengthening dissemination infrastructure within the UCLA CTSI

Other institutional support and dissemination