Implementation Science: the first 10 years and future directions Michel Wensing, Paul Wilson and Anne Sales https://implementationscience.biomedcentral.com/
Eccles and Mittman. Implement Sci 2006; 1:1. https://implementationscience.biomedcentral.com/
Journal mission Implementation Science is an open access, peer-reviewed online journal that aims to publish research relevant to promoting the uptake of research findings into healthcare practice and health policy. Foy et al. Implement Sci 2015;10:51. https://implementationscience.biomedcentral.com/
Key facts • Founded in 2006 by Martin Eccles and Brian Mittmann • Published by Biomedcentral, now part of Springer Nature, as open access journal • Not formally linked to any particular organisation (material support from VA until 2014) • Current editors-in-chief: Anne Sales, Michel Wensing, Paul Wilson • Group of Editors and international Editorial Board • Currently > 700 submissions per year, < 25% acceptance rate https://implementationscience.biomedcentral.com/
Manuscripts submitted / published 764 800 700 644 600 529 500 441 400 254 252 300 175 200 100 87 59 100 11 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Submitted Published https://implementationscience.biomedcentral.com/
Publications and citations (23nov2016) • Total publications: 1213 • Total citations: 16480 • Average citations per Publications per year article: 13.59 https://implementationscience.biomedcentral.com/ Citations per year
Impact factor • 2016 IF = 3.201 (5 year IF = 4.325) • Ranked 15/87 in Health Care Sciences & Services (SCI) • Ranked 5/74 Health Policy & Services (SSCI) https://implementationscience.biomedcentral.com/
Editorials • De-implementation (Prasad & Ionnanidis) • Economics of implementation (Severens ) https://implementationscience.biomedcentral.com/
Program (14.30-15.45) • Paul Wilson: Evolving scope and methods • Anne Sales: Theories and frameworks • General discussion https://implementationscience.biomedcentral.com/
10 years of evolving scope and methods Paul Wilson Deputy Editor in Chief, Implementation Science Alliance Manchester Business School paul.wilson@manchester.ac.uk https://implementationscience.biomedcentral.com/
Sustained growth over last ten years 800 700 600 500 400 300 200 100 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Submitted Published https://implementationscience.biomedcentral.com/
Our current scope • Research examining the implementation of evidence-based practices or policies or the de-implementation of those demonstrated to be relatively ineffective or even harmful • Study of processes, fidelity and context • Study of influences on provider, patient and organisational behaviour • Includes population health interventions Foy et al. Implement Sci 2015;10:51. https://implementationscience.biomedcentral.com/
So not…. • Research establishing the effectiveness of novel clinical, organisational, public health or policy interventions • Quality improvement or service evaluation • Weak designs • Doing implementation or lessons learned https://implementationscience.biomedcentral.com/
General guiding principles • Address a clear question using an appropriate design • Build on existing knowledge • Increasingly priority given to substantial, rather than marginal, contributions to the field https://implementationscience.biomedcentral.com/
Implementation effectiveness • Randomised controlled trials – Cluster RCTs • Non-randomised controlled trials (NRCTs) • Controlled before-after studies • Interrupted time series (difference in difference, repeated measures) https://implementationscience.biomedcentral.com/
Cluster RCTs in Implementation Science 30 25 20 15 10 5 0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Findings Protocols https://implementationscience.biomedcentral.com/
Hybrid design types I. Effects of a clinical intervention on relevant outcomes while observing and gathering information on implementation II. Dual testing of clinical interventions and implementation strategies III. Testing an implementation strategy while observing and gathering information on the clinical intervention's impact on relevant outcomes Curran et al. Med Care 2012;50:217-26. https://implementationscience.biomedcentral.com/
Prospective trials registration • Now only normally consider for publication trials that have been registered prior to enrolment of the first participant/ cluster • Continue consider retrospectively registered trials on a case by case basis • Should we encourage prospective registration of other study designs? https://implementationscience.biomedcentral.com/
But not just about trials You damned positivists https://implementationscience.biomedcentral.com/
Study of processes, fidelity and context Moore et al. BMJ 2015; 350:h1258. https://implementationscience.biomedcentral.com/
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Enhancing reporting • Variation in the standards of reporting of the research that we publish – CONSORT – PRISMA • Quality of intervention description remains an issue – TIDier – WIDER – StaRI https://implementationscience.biomedcentral.com/
Protocol publication • Fit our journal scope and inclusion criteria for rigorous study designs AND • Have received funding from a nationally or internationally recognised research agency AND • Have received appropriate ethics review board approval AND • Submitted within three possible time points: – 1) WITHIN 3 months of ethics approval – 2) PRIOR to enrolment of the first participant/ cluster – 3) BEFORE the end of participant/ cluster recruitment https://implementationscience.biomedcentral.com/
In summary • 10 years of sustained growth • Field and scope has evolved and as submissions have risen, we have become more selective in what we publish. • Scientific quality and transparency key drivers in selection • Priority given to research that offers significant contributions to knowledge, methodology or thinking https://implementationscience.biomedcentral.com/
10 years of theories and frameworks in Implementation Science Anne Sales Editor in Chief, Implementation Science https://implementationscience.biomedcentral.com/
Theory vs. framework • Theories contain constructs • Frameworks contain constructs – Sub-particles invoking specific phenomena • Constructs are categorized • Posit relationships among • No formal relationships constructs among constructs are – X affects Y in some specific proposed way • Graphic representation (if • Graphic representation any) is mostly heuristic generally includes arrows • Checklists which describe relationship https://implementationscience.biomedcentral.com/
Searching on “framework” in IS • 963 results – Most are papers or conference proceedings that explicitly explore a specific framework – Some are new frameworks proposed for use in research • Many of these are very purpose-built and focus on specific topical areas – Most use frameworks but few contribute new insights – Some are original new frameworks • Some of these are consolidations of existing frameworks and/or theories • Notable examples – Damschroder et al. Implementation Science 2009 4 :50 » Consolidated Framework for Implementation Research framework – Flottorp et al. Implementation Science 2013 8 :35 » Tailored Implementation for Chronic Disease checklist https://implementationscience.biomedcentral.com/
Searching on “theory” in IS • 785 results – Many are papers or conference proceedings that describe using or testing theory rather than building or creating theory • Many invoke the term theory as a building block for designing interventions or instruments • Many of these use frameworks rather than theories for this kind of design • Primary approach is to use a framework or theory to assess barriers and/or facilitators (primarily barriers) then design or tailor an intervention to address these • Often described as “theory - based intervention design” – Some are articulations of new or extended theories • May Implementation Science 2013 8 :18 • May et al. Implementation Science 2009 4 :29 https://implementationscience.biomedcentral.com/
Lots of results • Suggest that use of a framework or theory is seen as important in implementation research – Not a uniform perception – Two of the first papers published in IS debate the utility of theory in implementation research • The ICEBeRG group Implementation Science 2006 1 :4 • Bhattacharyya et al. Implementation Science 2006 1 :5 – Evidence for this position is not strong • Frameworks are not well distinguished from theory – Suggests some degree of confusion – Unclear whether there is any way to “test” a framework – Testing theory is not trivial but theoretically possible – The essential “checklist” nature of frameworks is not recognized https://implementationscience.biomedcentral.com/
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