Goal 4: Develop Workforce and Resources

Implementation Research Workforce Addressing Health Inequities

What are the best strategies to develop a highly competent diverse Implementation Science research workforce to address health inequities?

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

• Enhance fundamental knowledge about new and trans-disciplinary D&I field.

• Improve understanding on ways to scale-up and deliver proven interventions to address health inequities.

• New knowledge generation regarding important adaptations of interventions implemented in the local context.

• Improve health outcomes, particularly in underserved populations in both the U.S. and abroad.

• Successful D&I research training programs will help ensure a competent diverse D&I research workforce.

• Identification of the most effective career timing and combination (balance) of discipline-specific and trans-disciplinary courses essential to develop a cadre of trans-disciplinary implementation science researchers.

Feasibility and challenges of addressing this CQ or CC :

Feasibility:

• Dedicated NHLBI Center to promote, develop, implement, and disseminate research findings to address heart, lung, blood, sleep-related conditions and diseases.

• Identified new approaches to creating partnerships with trans-disciplinary research teams that expand beyond academia and increased understanding of the unique nature of mentorship needed for this discipline.

• Experience from several other ICs can be leveraged to improve or ability to be successful and decrease our launch time.

• Field is gaining momentum because of the realization of the unsustainable economic burden of health inequities (expected to increase in the future) in the U.S.

 

Challenges:

 

 

• Dedicated training mechanisms are needed to develop and meet our current/future T4 research workforce needs to address health inequities.

 

• Resources needed that provide unique training approaches (e.g., a trans-disciplinary scientific training environment, knowledge and experience with health disparity populations, unique training faculty (mentor) composition and opportunities to train mentees as future D&I mentors, innovative research tools and research experiences, and broad and diverse partnerships.

 

• Unique linkages with practice settings across disciplines needed.

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

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11 net votes
20 up votes
9 down votes
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Goal 4: Develop Workforce and Resources

Medical student research training in LMIC settings

What are the strategies for heart, lung, blood, sleep workforce to gain first-hand international experience in clinical research/implementation research training in low- and middle-income country (LMIC) settings?

Submitted by (@nhlbiforumadministrator1)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

• Among the students who earn medical degrees in the United States, very few of them have been sufficiently trained to address the health needs of the most vulnerable populations.

• An international exposure in an LMIC setting would have enormous impact on clinical practice and research

• Any medical student interested in broadening their training may have opportunities for clinical and non-clinical hands-on experience and in turn this would increase number of physicians and researchers in global health.

Feasibility and challenges of addressing this CQ or CC :

Feasibility: • The NHLBI has a wealth of experience in training and career development programs in general and has supported and worked with global centers of excellence in this area.

• This experience can be used to leverage international experience in clinical practice and research outcomes in LMIC settings.

 

Challenges: • NHLBI would have to develop additional training mechanism(s) to foster clinical practice and research in an LMIC area.

 

• Resources for this unique training may be a challenge.

 

• Helping patients from vulnerable populations would involve confronting cultural differences and language barriers.

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

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-30 net votes
5 up votes
35 down votes
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Goal 3: Advance Translational Research

Impactful GH Research to reduce heart, lung, blood, sleep diseases worldwide

We have characterized the risk factors associated with heart, lung, blood, sleep diseases from various papers and reports; what is needed for this information and translation research to be used to reduce morbidity and mortality globally?

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Global reduction of heart, lung, blood, sleep diseases

Feasibility and challenges of addressing this CQ or CC :

Identify and form partnerships with nongovernmental organizations, Ministries of Health and other partners and develop an implementation strategy collaboratively to reduce risk for heart, lung, blood, sleep diseases globally within 10 years. This could use the framework of the previously announced ARRA “Grand Challenges”.

 

Common goals and deliverables between NHLBI and partners will need to be identified

 

Common milestones should be delineated at the outset

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

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-11 net votes
10 up votes
21 down votes
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Goal 3: Advance Translational Research

Promoting Research on Translation of Evidence into Practice within Academic Medical Health Care Systems

Academic Medical Centers (AMCs) must become translational research leaders by conducting implementation research (IR) within their own health care systems. Doing so will require new paradigms, breaking down silos between research and operations, new incentives, and new funding streams. Steps include CTSA renewal requirements for significant IR and building on the QUERI (Quality Enhancement Research Initiatives) from ...more »

Submitted by (@kevinfiscella)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

AMCs are the engines of scientific research in the US. They possess the brain power, resources and reputation necessary to alter the trajectory of the translational continuum of research. Currently 62 AMCs are funded through CTSA in 31 states. Through their own health systems and their affiliates, AMCs provide health care to a sizable portion of the US population. Most AMCs now use the same EHR (EPIC). Nearly all are embarking on system change including establishing accountable care organizations, bundled payments, and medical centered homes. These assets provide fertile ground for research on how to best implement scientific evidence into health care to achieve the triple aim: improved care to patients, improved health to populations, and reduced costs. If AMCs take IR to heart, this could be a game changer. Success could establish a virtuous cycle whereby improved health and reduced costs convinces a skeptical Congress to authorize greater funding for NIH tagged to IR. This change requires moving AMC rhetoric into action and becoming leaders in IR in their own back yards.

Feasibility and challenges of addressing this CQ or CC :

The major challenges are new paradigms, incentives, infrastructure, and funding. Most AMCs regard health care systems operations and research as separate. Despite the mantra to become "learning health care systems" few AMCs conduct IR within their own health systems. Changing this paradigm will require incentive to change, new infrastructure including new types of teams, and funding streams. The CTSA renewal mechanism represents a starting place but this will need to be coupled with program announcements and center awards that establish a QUERI like infrastructure including teams of IR researchers, health care administrators and PBRNs. The challenge is great but a new paradigm is critical if scientific research is to guide the seismic changes that are occurring in within US health care.

Name of idea submitter and other team members who worked on this idea : Kevin Fiscella, MD, MPH

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15 net votes
19 up votes
4 down votes
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Goal 3: Advance Translational Research

Leveraging Networks of Federally Qualified Healthcare Centers

How best do we leverage the existing Federally Qualified Healthcare Center’s (FQHC) infrastructure to study T4 Implementation Research for heart, lung, blood, sleep diseases and conditions among high risk and vulnerable populations?

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

• Develop strategies to reduced Health Inequities

• Potentially be scaled up across an entire health system with huge population impact

• Studies would be done in the environment and context where the findings with be implemented leading to better uptake and sustainability.

Feasibility and challenges of addressing this CQ or CC :

• Formative FQHC groups are already being organized but do not have strong leadership and support

• FQHCs have ready access to the high risk and vulnerable populations that would benefit most from the research

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

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-14 net votes
7 up votes
21 down votes
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Goal 3: Advance Translational Research

Best Implementation Strategies

What are the best implementation strategies to improve adherence to clinical practice guidelines, protocols, and other evidence-based practices that actually lead to the elimination of inequities in preventable disability and death from heart, lung, blood, and sleep diseases?

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

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12 net votes
20 up votes
8 down votes
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Goal 3: Advance Translational Research

T4 Implementation Research Platform in Low Income Countries

What are the best strategies to stimulate development of a T4 Implementation Research network within low income countries (LICs)?

Submitted by (@nhlbiforumadministrator1)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

• Currently there are huge implementation challenges within LIC contexts and only limited progress is being made to address the gaps

• Conducting research in the context where its finding will be scaled up will vastly increase its appropriateness, adoption and uptake, fidelity, and sustainability

• Small improvements in the challenging context of LICs should provide opportunities to make a large burden reduction

Feasibility and challenges of addressing this CQ or CC :

• Currently there are formative efforts to engage biomedical research in LICs with H3Africa, Global Alliance for Chronic Diseases, and others

• NHLBI Think Tanks and Workshops have found much interest and demand to T4 Implementation research engagement

• Key non-traditional partners (World Bank, USAID) are working on implementation strategies in LICs currently and will be strong partners

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

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-22 net votes
7 up votes
29 down votes
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Goal 3: Advance Translational Research

NHLBI Cohort Populations for T4 Implementation Research

How best can NHLBI observational cohorts be utilized to study observational T4 Implementation Research among both general and vulnerable US populations?

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

• Would help identify key factor associated with successful implementation that could be studied in interventional T4 implementation research

• Result would refine implementation strategies and health and social policy aimed to reduce heart, lung, blood, sleep diseases and conditions

• Builds on excellent established platform of research with high quality outcomes in well characterized study populations over long term follow-up.

Feasibility and challenges of addressing this CQ or CC :

• Big data is developing methods to link large data sets from national, state, and community level surveys – surveys that can define exposures to various policies and interventions in place, time, and population.

• A family of high quality cohorts are available for ancillary observation studies

• Collection of community level and more broad policy level exposures is feasible through data already collected and through potentially new data collection.

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

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-4 net votes
11 up votes
15 down votes
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Goal 3: Advance Translational Research

Implementation of Evidence-based Guidelines in LMICs

How can implementation strategies be tested in low and middle income countries for contextually and culturally adapted evidence-based clinical care guidelines with a focus on prevalent non-communicable diseases with large burdens such as sickle cell disease, hypertension, heart disease, stroke, asthma, and COPD?

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Evidence-based guidelines for heart, lung, and blood diseases, developed within high income countries are challenging to implement within low and middle income countries because delivery capacity and health care infrastructure is often limited. Contextually, culturally and language adapted guidelines implementable within low and middle income countries can impart substantial benefit while distributing more evenly global knowledge of proven effective interventions while improving health equity. Proven effective interventions would get delivered in an effective manner across low and middle income countries which will improve heart, lung, and blood health outcomes.

Feasibility and challenges of addressing this CQ or CC :

The NHLBI Global Health Think Tank recommended research on implementation of contextually, culturally and language-adapted clinical care guidelines in low and middle income countries and encouraged addressing this issue in the near future.

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

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-10 net votes
8 up votes
18 down votes
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Goal 3: Advance Translational Research

Translation Research Dissemination & Implementation Frameworks

We need to identify and test the proven effective dissemination and implementation frameworks that are relevant to heart, lung, and blood disorders in order to scale up evidence-based interventions in real world settings, ultimately improving health equity among minority populations, including low income minority residents living in public housing.

Submitted by (@nhlbiforumadministrator1)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Critical Challenge (CC)

Details on the impact of addressing this CQ or CC :

• Ability to determine how much of an evidence based intervention can be sustained in real world settings.

• Add utilization of D&I frameworks to researcher’s core competency training skills.

• Promote long term sustainability of evidence based interventions.

Feasibility and challenges of addressing this CQ or CC :

• Researchers from the 2014 NIH’s Annual Conference on the Science of Dissemination and Implementation: Transforming Health Systems to Optimize Individual and Population Health presented compelling evidence that dissemination and implementation frameworks are an effective means to scaling up evidence based interventions.

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

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4 net votes
13 up votes
9 down votes
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Goal 3: Advance Translational Research

Leveraging big data for T4 translation research

What approaches can help leverage the emerging big data in health and health care for observational and interventional implementation research in heart, lung, blood, sleep diseases?

Submitted by (@nhlbiforumadministrator)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

• Integration of big data analytics into T4 research study design and interventions development

• Innovative linkages across multiple health and non-health sector data

• Innovative methods to analyze big data linked across sectors

• Various communities are using big data analytics to understand population health data (e.g. electronic medical records s) and opportunities exist for consolidation of these efforts and standardization of methodologies

Feasibility and challenges of addressing this CQ or CC :

• NIH now has focus on big data in its formative stages

• Significant amount of NIH’s budget is/will be dedicated to big data research

• NHLBI can leverage NIH’s investment by foster research in D&I big data analytics and systems science

• Future investment in big data should yield opportunities and focus efforts

Name of idea submitter and other team members who worked on this idea : NHLBI Staff

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0 net votes
16 up votes
16 down votes
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Goal 3: Advance Translational Research

Increasing the adoption of low tidal volume ventilation in ARDS patients

How can we use implementation science to increase the adoption of low-tidal volume ventilation in patients with acute respiratory distress syndrome (ARDS)?

Submitted by (@lar000)

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? : Compelling Question (CQ)

Details on the impact of addressing this CQ or CC :

Low tidal volume ventilation has been shown to significantly reduce mortality in ARDS patients (from 40% to 31% in the ARMA trial published in NEJM in 2000), but it is inconsistently adopted (frequently with rates <50% in both community and academic settings). Improving adherence has the potential to significantly improve mortality in patients with ARDS.

Feasibility and challenges of addressing this CQ or CC :

Given the rapid growth and interest in the field of implementation science over the past several years, addressing this question is now feasible.

Voting

-10 net votes
2 up votes
12 down votes
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