WE'LL GET STARTED.
WELCOME, GOOD AFTERNOON.
THANK YOU FOR BEING HERE.
I'M DEB TUCCI, DIRECTOR OF THE
NATIONAL INSTITUTE ON DEAFNESSS
AND OTHER COMMUNICATION
DISORDERS.
AND I WANT TO WELCOME YOU TO THE
NIDCD DIRECTOR'S SEMINAR SERIES,
TITLED ADVANCING THE SCIENCE OF
COMMUNICATION TO IMPROVE LIVES.
FOR THOSE OF YOU WHO ARE VIEWING
ON THE NIH VIDEOCAST, PLEASE, IF
YOU NEED CAPTIONS, FOR TODAY'S
PRESENTATION, CLICK ON THE C.C.
BUTTON AT THE BOTTOM OF THE
SCREEN.
THIS ANNUAL SEMINAR SERIES IS
DESIGNED TO ALIGN WITH THE
THEMES AND PRIORITIES OF THE
2023 TO 2027 NIDCD STRATEGIC
PLAN.
OUR GOAL IS TO ADVANCE THE
SCIENCE OF HEARING, BALANCE,
TASTE, SMELL, VOICE,
LANGUAGE, OUR SEVEN MISSION
AREAS.
I'M DELIGHTED TO INTRODUCE TODAY
DR. MEGHAN LANE-FALL, THE
EXECUTIVE DIRECTOR OF THE PENN
IMPLEMENTATION SCIENCE CENTER AT
THE UNIVERSITY OF PENNSYLVANIA,
DR. LANE-FALL IS A B
CERTIFIED ANESTHESIOLOGIST,
SURGICAL IST, MAIN
RESEARCH INTEREST IS IMPROVINGTR
COMMUNICATION AT TIMES OF
TRANSITION OR HANDOFF ACROSS
SITES OF CARE.
AS A SURGEON, FOR MUCH OF MY
CAREER, I UNDERSTAND HOW
IMPORTANT THAT IS.
AND HOW POTENTIALLY FRAUGHT
SITUATIONS CAN BE.
SO THAT'S REALLY, REALLY
IMPORTANT WORK.
SHE EMPLOYS QUALITATIVE AND
MIXED METHODS TO DEVELOP
EFFECTIVE COMMUNICATION
STRATEGIES THAT INCORPORATE
HUMAN FACTORS PRINCIPLES WHILE
COMPLEMENTING CLINICIAN
WORKFLOW.
HER WORK IS BEST CHARACTERIZED
AS HEALTH CARE DELIVERY SCIENCE,
PULLING AT INTERSECTION OF
IMPLEMENTATION SCIENCE AND
IMPROVEMENT SCIENCE.
DR. LANE-FALL IS ALSO INTERESTED
IN BUILDING RESEARCH CAPACITY IN
HEALTH SERVICES RESEARCH AND SHE
MENTORSMERCH FELLOWS,
CLINICAL TRAINEES, AND IS
CO-DIRECTOR OF PENN GRADUATE
LEVEL IMPLEMENTATION SCIENCE
COURSE.
DR. LANE-FALL'S PRESENTATION
WILL PROVIDE AN OVERVIEW OF
IMPLEMENTATION SCIENCE INCLUDING
CURRENT CHALLENGES AND
OPPORTUNITIES.
AFTER HER REMARKS WE'LL HAVE A
PANEL OF THREE NIH SCIENTISTS
WHO WILL PARTICIPATE IN A BRIEF
DISCUSSION AND I'LL INTRODUCE
THEM AT THAT TIME.
NOW I'LL TURN IT OVER TO YOU,
DR. LANE-FALL.
THANK YOU.
>> THANK YOU, DR. TUCCI.
JOINING IN PERSON AND THOSE OF
YOU JOINING ON THE VIDEOCAST.
IT'S MY GREAT PLEASURE TO BE
HERE WITH YOU THIS AFTERNOON AND
TO TALK ABOUT SOMETHING NEAR AND
DEAR TO MY HEART AND HOPEFULLY
SOMETHING I'LL MAKE NEAR AND
DEAR TO YOUR HEARTS IF IT'S NOT
ALREADY, THINKING HOW TO GET
EVIDENCE INTO PRACTICE AND
CHANGE BEHAVIOR IN SERVICE OF
HEALTH.NG OUTCOMES IN POPULATION
ALL RIGHT.
HERE WE GO.
SO, THIS IS MY S PUN FORE NIDCDF
DISSEMINATION AND IMPLEMENTATION
RESEARCH.
I'LL TRY TO GET BETTER WITH THE
PUNS.
SO, IN TERMS OF DISCLOSURES, I
HAVE GRANT FUNDING TO THE
UNIVERSITY OF PENNSYLVANIA FROM
AGENCIES ON THE SCREEN, INDUSTRY
RELATIONSHIPS I WON'T TALK
ABOUT, AND I HAVE THE HONOR OF
SERVING AS CHAIR OF THE STUDY
SECTION, SCIENCE OF
IMPLEMENTATION IN HEALTH AND
HEALTH CARE.
OBJECTIVES FOR THE TIME TODAY
ARE FOR ME TO PROVIDE YOU A
REFRESHER ON IMPLEMENTATION
SCIENCE, I KNOW THAT NIDCD AND
OTHER NIH INSTITUTES HAVE BEEN
INTERESTED IN IMPLEMENTATION
SCIENCE AND ARE INCREASINGLY
HEARING ABOUT IT.
SO I WON'T GO INTO DETAIL.
BUT IT IS USEFUL TO LEVEL-SET SO
I'LL GIVE A LITTLE BIT OF A
REFRESHER FOR FOLKS.
I WANT TO HIGHLIGHT IMPORTANCE
OF EQUITY INFORMED APPROACHES TO
THE WORK I'M GOING TO DISCUSS
ESPECIALLY IN NIDCD-RELEVANT
RESEARCH.
I WANT TO TALK ABOUT SOME
CHALLENGES AND POSSIBLE
SOLUTIONS TO CONDUCTINGEMENESEAT
TO NIDCD MISSION AREAS TO
HOPEFULLY SET US UP FOR THE
PANEL DISCUSSION.
I THANK THE TEAM, DR. TUCCI AND
COLLEAGUES, FOR INVITING ME,
PRIMING ME, HELPING ME
UNDERSTAND ABOUT THE LANDSCAPE
OF IMPLEMENTATION RESEARCH IN
DISORDERS AND OTHER CONDITIONS
RELEVANT TO THE NIDCD, AND MY
PANELISTS THAT I'LL GET TO TALK
WITH AFTER THIS, AFTER THESE
REMARKS.
I'M A QUALITATIVE SCIENTIST,
REOFFER REFLEXIVITY STATEMENTS
TO TALK ABOUT OURSELVES, ONLY A
LITTLE BIT, SO YOU KNOW WHO IS
TALKING TO YOU AND WHAT
PEES THEY ARE B
TO THE WORK.
AS WAS MENTIONED, I'M AN
ANESTHESIOLOGIST, I SPEND TIME
IN THE OPERATING ROOM TRYING TO
KEEP PATIENTS ALIVE WHILE
SURGEONS TRY TO DO THE OPPOSITE.
I ALSO SPEND A LOT OF TIME IN
THE SURGICAL INTENSIVE CARE UNIT
CARING FOR PEOPLE WHO HAVE HAD
SURGERY OR SURGERY-RELATED
CONDITIONS.
I AM A RESEARCHER AND
IMPLEMENTATION SCIENTIST WHO
THINKS ABOUT ICU HANDOFFS AND
OTHER TYPES OF COMMUNICATION,
BUT I THINK A LOT ABOUT
WORKFLOW.
AND ONE OF THE THINGS THAT I'LL
MENTION, HOPEFULLY THAT WILL
COME UP IN THE PANEL, IS AS
WE'RE THINKING ABOUT
IMPLEMENTATION, AS WE'RE
THINKING ABOUT BEHAVIOR CHANGE,
IT'S ALSO REALLY IMPORTANT TO
THINK ABOUT THE WORKFLOW OF THE
PEOPLE WHOSE BEHAVIOR WE'RE
TRYING TO CHANGE.
IT'S VERY DIFFICULT TO GET
PEOPLE TO CHANGE THEIR BEHAVIOR
IF YOU MAKE THEIR JOBS HARDER.
SO THAT'S SOMETHING I THINK
ABOUT A LOT IN MY WORK.
I ALSO AS WAS MENTIONED, THE
EXECUTIVE DIRECTOR OF THE PENN
IMPLEMENTATION SCIENCE CENTER, A
PLACE FOR BUILDING COMMUNITY,
FOR FOLKS INTERESTED IN
IMPLEMENTATION RESEARCH WE HAVE
HUNDREDS OF PEOPLE ON OUR
LISTSERV AT PENN, AROUND THE
COUNTRY, WHO PARTICIPATE INTIUR
EDUCATIONAL OFFERINGS AND
CAPACITY BUILDING EFFORTS.
SO LET'S TALK ABOUT
IMPLEMENTATION SCIENCE.
HOW WE GET PEOPLE AND SYSTEMS TO
CHANGE BEHAVIOR, SPECIFICALLY
RELEVANT TO AREAS OF INTEREST
FOR THE NIDCD.
SO, YOU ALREADY HEARD SOMETHING
ABOUT IMPLEMENTATION SCIENCE.
THERE WAS A D&I SCIENCE AND
COMMUNICATION DISORDERS WORKSHOP
HELD LAST YEAR IN OCTOBER.
I HAD THE OPPORTUNITY TO REVIEW
SOME OF THOSE VIDEOS ONLINE
WHICH ARE PHENOMENAL.
IF YOU HAVEN'T SEEN THEM
ALREADY, I ENCOURAGE YOU TO TAKE
A LOOK AT SOME OF THOSE
PRESENTATIONS.
WE ARE IN THE SEMINAR SERIES
RIGHT NOW TO ADVANCE THE SCIENCE
OF COMMUNICATION TO IMPROVE
LIVES, AND MY UNDERSTANDING IS
THAT IMPLEMENTATION RESEARCH HAS
BEEN AN AREA OF INTEREST FOR
THAT.
AS WAS MENTIONED, IMPLEMENTATION
IS PART OF THE STRATEGIC PLAN
FOR THE NIDCD.
WHICH ALSO IS A LOVELY DOCUMENT,
IF YOU HAVEN'T HAD A CHANCE TO
TAKE A LOOK, IT'S WORTH TAKING A
LOOK AT.
WHEN I REVIEWED THE STRATEGIC
PLAN FOR THE NIDCD I SAW THESE
THEME AREAS, WHICH COVER THE
GEUM
GAMUT.
WHAT DOES IMPLEMENTATION SCIENCE
FIT?
I THINK THERE, RIGHT?
BECAUSE IF YOU WANT TO TRANSLATE
AND IMPLEMENT SCIENTIFIC
ADVANCES, TRYING TO CHANGE
BEHAVIOR OF PEOPLE GIVING
SERVICES, IN A THEORY-DRIVEN WAY
AND RELIABLE WAY.
BUT THEN MAYBE IF WE'RE TRYING
TO PROMOTE PRECISION MEDICINE
WE'RE TRYING TO GET PROVIDERS OF
CARE TO CHANGE THEIR BEHAVIOR.
ACTUALLY IMPLEMENTATION SCIENCE
IS RELEVANT TO THAT.
IF WE'RE TRYING TO GET PEOPLE TO
USE BEST PRACTICES IN BIOMEDICAL
DATA SCIENCE, IT'S ALSO BEHAVIOR
CHANGE.
SO I THINK IMPLEMENT SCIENCE
RELEVANT TO THAT.
IT'S ALL OF THEM ACTUALLY
BECAUSE WE'RE TRYING TO GET
PEOPLE TO CHANGE THEIR BEHAVIOR.
I TEND TO THINK ABOUT
IMPLEMENTATION SCIENCE 1.0 AND
2.0, IMPLEMENTATION 1.0 TO GET
EVIDENCE INTO PRACTICE.
2.0 IS TRYING TO GET ANY PERSON
OR SYSTEM TO CHANGE THEIRNG
BEHAVIOR.
NOW, IF THE BEHAVIOR THAT YOU'RE
INTERESTED IN ISN'T
EVIDENCE-BASED, I THINK IT
BEHOOVES TO YOU MAKE SURE IT
WORKS AND CHECK FOR
EFFECTIVENESS, BUT INCREASINGLY
WE'RE USING TOOLS OF
IMPLEMENTATION SCIENCE FOR
BEHAVIOR CHANGE AT MANY LEVELS
IN CLINICAL SETTINGS, ALSO IN
THE BIOMEDICAL RESEARCH.
CLASSICALLY CONCEIVED
IMPLEMENTATION SCIENCE IS ABOUT
BRIDGING EVIDENCE TO PRACTICE
GAPS.
THERE ARE SOME ESTIMATES THAT IT
MAKES MORE THAN A DECADE
SOMETIMES TWO TO GET EVIDENCE
INTO PRACTICE, AND THAT'S NOT
ALL THE EVIDENCE, JUST SOME.
SO IMPLEMENTATION SCIENCE IS
INSPIRED BY TRYING TO NARROW
THAT GAP TO IMPROVE THE
POTENTIAL OF THOSE INNOVATIONS
THAT THE NIDCD FUNDED AND MANY
OTHER INSTITUTES FUNDED TO
IMPROVE HEALTH.
SO THE OFFICIAL DEFINITION OF
IMPLEMENTATION SCIENCE COMES
FROM THE FIRST EDITION OF THE
FLAGSHIP JOURNAL, IMPLEMENTATION
SCIENCE IN 2006.
THEY CALL IMPLEMENTATION SCIENCE
THE SCIENTIFIC STUDY OF METHODS
TO PROMOTE SYSTEMATIC UPTAKE OF
RESEARCH FINDINGS AND OTHER
EVIDENCE-BASED PRACTICES INTO
ROUTINE PRACTICE AND HENCE TO
IMPROVE QUALITY
EFFECTIVENESS OF HEALTH SERVICES
AND CARE.
IT'S OKAY, I FIND IT A LITTLE
BIT CLUNKY, BUT IT'S OKAY.
MY FAVORITE DEFINITION COMES
FROM ANN SALES, ONE OF THE
THOUGHT LEADERS IN
IMPLEMENTATION SCIENCE.
SHE'S AT THE UNIVERSITY OF
MISSOURI.
SHE CALLS IMPLEMENTATION SCIENCE
THE STUDY OF PLANNED HUMAN
BEHAVIOR CHANGE UNDER
ORGANIZATIONAL CONSTRAINTS.
ONE OF THE REASONS I LOVE THAT
DEFINITION IS IT'S CONCISE.
IT TELLS YOU THAT ANY DISCIPLINE
THAT'S INTERESTED IN HUMAN
BEHAVIOR CHANGE WILL BE RELEVANT
TO IMPLEMENTATION SCIENCE.
AND ANY DISCIPLINE THAT'S
INTERESTED IN ORGANIZATIONAL
BEHAVIOR WILL BE RELEVANT TO
IMPLEMENTATION SCIENCE.
AND SO WHAT WE DO IS COMBINE THE
TRADITIONS FROM THOSE FIELDS, TO
TRY TO DEVICE WAYS TO CHANGE
BEHAVIOR IN SERVICE OF IMPROVING
HEALTH.
SO, AS I'VE SIGN POSTED FOR YOU
IMPLEMENTATION SCIENCE IS A
DISCIPLINE, A BIT OF A MUTT.
IT INCLUDES ALL OF THESE
DISCIPLINES AND MORE.
SOME PEOPLE WILL CALL
IMPLEMENTATION SCIENCE OLD WINE
IN NEW BOTTLES.
I DON'T THINK THAT'S EXACTLY
RIGHT BECAUSE WE'RE COMBINING IN
WAYS THEY HAVE NOT BEEN COMBINED
BEFORE.
BUT WE DO STAND ON THE SHOULDERS
AND TRADITIONS AND FOUNDATIONS
OF THESE FIELDS.
SO MANY OF THE THEORIES WE DRAW
ON IN IMPLEMENTATION SCIENCE
COME FROM THE FIELDS YOU SEE UP
HERE, INCLUDING PUBLIC HEALTH
AND PSYCHOLOGY, AND MANAGEMENT
SCIENCE.
INCREASINGLY PEOPLE ARE BRINGING
SYSTEMS AND HUMAN FACTORS
ENGINEERING INTO IMPLEMENTATION
SCIENCE.
I HAVE TO GIVE A NOD TO
COMMUNICATION AND DISSEMINATION.
ONE OF THE CONCEPTS THAT CAME UP
IN THE OCTOBER 23 WORKSHOP WAS
THAT THERE'S A LITTLE BIT OF A D
AND BIG I WHEN WE TALK ABOUT
DISSEMINATION AND IMPLEMENTATION
RESEARCH.
PART IS THE DIFFUSION OF
INFORMATION IS OFTEN NOT ENOUGH
TO CHANGE BEHAVIOR, SO THERE'S
BEEN AN UNDERSTANDABLE FOCUS ON
TRYING TO ACTIVELY CHANGE
BEHAVIOR BUT WE HAVE TO
ACKNOWLEDGE THAT IN ORDER TO
CHANGE THAT BEHAVIOR, PEOPLE
HAVE TO KNOW WHAT IT IS.
WE HAVE TO THINK ABOUT
DISSEMINATION AND EFFECTIVE
COMMUNICATION AS PART OF THE
WORK WE DO.
THERE ARE FIVE KEY FEATURES OF
IMPLEMENTATION SCIENCE THAT I
THINK ARE USEFUL TO HIGHLIGHT.
THIS COMES FROM A PAPER THAT WAS
COHORT BY ONE OF MY FORMER
PARTNERS IN CRIME, NOW AT
NORTHWESTERN UNIVERSITY.
THE FIRST KEY FEATURE OF
IMPLEMENTATION SCIENCE IS
THERE'S A THING WE'RE INTERESTED
IN, EVIDENCE-BASED PRACTICE.
CLASSICALLY, WE TALK ABOUT A
THING OR CONCEPT OR PRACTICE
THAT DOES HAVE EVIDENCE BEHIND
IT.
SECOND KEY FEATURE IS THAT WE DO
THIS WORK IN PARTNERSHIP WITH
PEOPLE WHOSE BEHAVIOR WE'RE
TRYING TO CHANGE AND PEOPLE
WHOSE HEALTH MIGHT BE INFLUENCED
BY THE BEHAVIOR WE'RE TRYING TO
FACILITATE.
THAT MEANS WE WORK WITH
PARTNERS, PATIENTS, COMMUNITIES,
FAMILIES, PAYERS, PROVIDERS,
ANYONE WHO IS A PART OF THE MIX
IN TERMS OF CHANGING BEHAVIOR
ARE THE FOLKS WE WORK WITH.
SO, THIS IS A SAMPLING OF SOME
OF THE PEOPLE THAT CAN BE PART
OF AN IMPLEMENTATION TEAM.
BUT ONE OF THE KEY TAKEAWAYS IS
THIS TEAM SCIENCE.
I'VE NEVER SEEN AN
IMPLEMENTATION RESEARCH STUDY
WITH ONE INVESTIGATOR.
IT'S NOT A THING.
WE HAVE TO DO THIS IN
PARTNERSHIP.
IN PART BECAUSE OF THE
METHODOLOGIC COMPLEXITY OF THE
DISCIPLINE, BUT ALSO THE NEED
FOR CONSTANT EXPERTISE AND BRING
LIVED EXPERIENCE TO THE TEAM.
THIRD KEY FEATURE IS OUR
OUTCOMES IN IMPLEMENTATION
SCIENCE ARE DIFFERENT THAN
TRADITIONAL EFFECTIVENESS
OUTCOMES.
SO TRADITIONAL EFFECTIVENESS
OUTCOMES ARE QUALITY OF LIFE,
MORTALITY, HEALTHCARE
UTILIZATION, THESE ARE SORT OF
END OUTCOMES THAT TELL US
WHETHER OUR INTERVENTIONS
ACTUALLY ACHIEVED THE GOALS
WE'RE TRYING TO ACHIEVE.
OUR IMPLEMENTATION OUTCOMES ON
TOP HAVE MORE TO DO WITH HOW
WELL WE DID THE THING THAT
AFFECTS THE OUTCOME.
OUR OUTCOMES TEND TO BE CONCEPTS
LIKE ACCEPTABILITY,
APPROPRIATENESS, COST,
FEASIBILITY, FIDELITY WHICH IS
HOW WELL PEOPLE DO THE THING.
THE WAY I EXPLAIN IT IS THAT THE
IMPLEMENTATION OUTCOMES ARE MORE
PROXIMAL IN CAUSAL MODEL BETWEEN
THE PRACTICE OF INTEREST AND
OUTCOME OF INTEREST.
THE IDEA YOU DON'T GET THE
OUTCOME OF INTEREST UNLESS
PEOPLE DO THE THING.
AND IMPLEMENTATION SCIENCE IS
HOW TO GET PEOPLE DO THE THING,
OUTCOMES ARE HOW WELL THEY DO
THE THING.
FOURTH KEY FEATURE IS CONTEXTUAL
INFORMATIVE AND NOT PROBLEMATIC,
EVERYTHING THAT CREATES
STATISTICAL NOISE IN RCT,
RANDOMIZED CONTROLLED TRIAL, IS
DATA FOR US.
WE WANT TO KNOW WHY SITE 1 DID
WELL AND SITE 3 DIDN'T.
OH, SITE 5 WAS OKAY BUT ONLY
WHEN THEY HIRED A NEW NURSE.
THOSE ARE THE THINGS WE WANT TO
KNOW THAT HELP US UNDERSTAND HOW
TO RELIABLY CHANGE BEHAVIOR IN
THE REAL WORLD.
AND THE FIFTH KEY FEATURE WE USE
SPECIFIC LANGUAGE, METHODS,
THEORIES, FRAMEWORKS,
STRATEGIES, AND THIS IS
IMPORTANT IN CREATING A COMMON
LANGUAGE ACROSS THE FIELD BUT IT
IS ALSO ONE OF THE REASONS THAT
THE BARRIERS TO ENTRY TO
IMPLEMENTATION SCIENCE TEND TO
BE PRETTY HIGH BECAUSE THERE'S A
LOT OF JARGON.
SO PART OF WHAT THE FIELD IS
TRYING TO DO IS MAKE IT EASIER
FOR PEOPLE TO COME IN, TO USE
THE TOOLS, TO USE THE LANGUAGE
SO THEY CAN BE A PART OF THE
GROUP.
I'LL GIVE AN EXAMPLE.
THIS IS A FIGURE FROM NELSON'S
PAPER IN IMPLEMENTATION SCIENCE
APTLY NAMED, THERE ARE WELL OVER
100 THEORIES, MODELS, AND
FRAMEWORKS USED IN
IMPLEMENTATION SCIENCE WHICH IS
A REALLY UNWIELDY NUMBER OF
THINGS TO DEAL WITH WAYS OF
CHANGING BEHAVIOR.
SO ONE OF NELSON'S KEY
CONTRIBUTIONS WAS TO CREATE
TAXONOMY OF THESE THEORIES,
MODELS, FRAMEWORKS.
BUT THIS IS SOME JARGON WE TALK
ABOUT MAKING THE FIELD SEEM LESS
ACCESSIBLE.
I'M GOING TO TALK ABOUT, AT THE
END, HOW WE CAN MAKE THE FIELD
MORE ACCESSIBLE TO FOLKS.
THESE ARE KEY FEATURES.
THERE ARE EMERGING FOCAL AREAS
WITHIN IMPLEMENTATION SCIENCE.
FOR THOSE IN OR AROUND THE D.C.
AREA, NEXT WEEK THERE WILL BE
ANNUAL ACADEMY HEALTH
NIH CONFERENCE ON SCIENCE OF
DISSEMINATION AND IMPLEMENTATION
IN HEALTH.
COME BY, HANG OUT.
IT'S A FRIENDLY CROWD.
YOU'LL SEE PEOPLE THAT HAVE
INTEREST IN THESE VARIOUS FOCAL
AREAS, WHETHER HEALTH EQUITY,
WHETHER IT'S MOBILE HEALTH,
GLOBAL HEALTH, DISSEMINATION,
THERE ARE A LOT OF SORT OF
DIFFERENTIATING BUCKETS WITHIN
IMPLEMENTATION SCIENCE.
SO AS WE THINK ABOUT APPLYING
IMPLEMENTATION SCIENCE TO NIDCD
RELEVANT FOCAL AREAS, THERE'S
CHALLENGES THAT I SEE THAT
HOPEFULLY WE'LL TALK ABOUT MORE
IN THE PANEL DISCUSSION.
THE FIRST IS THINKING ABOUT
STANDARDS OF EVIDENCE, AND
WHETHER PRACTICES OF INTEREST
ARE ACTUALLY READY FOR
IMPLEMENTATION.
SO, I THINK ABOUT AS A
COUNTERPOINT SOME OF THE
EVIDENCE-BASED PRACTICES IN
MENTAL HEALTH.
I THINK ABOUT COGNITIVE
BEHAVIORAL THERAPY.
I'M NOT A PSYCHOLOGIST OR
BEHAVIORAL SCIENTIST BUT I'M
TOLD THERE'S REALLY SOLID
EVIDENCE FOR COGNITIVE
BEHAVIORAL THERAPY TO CHANGE
BEHAVIOR, THERE ARE MULTIPLE
LARGE SCALE RANDOMIZED
CONTROLLED TRIALS, NO QUESTION
ABOUT WHETHER CBT WORKS.
SO MUCH SO THAT WHEN PEOPLE DO
IMPLEMENTATION RESEARCH ON
COGNITIVE BEHAVIORAL THERAPY,
THEY WILL SOMETIMES NOT MEASURE
PATIENT OUTCOMES, THEY WILL JUST
MEASURE IMPLEMENTATION OUTCOMES
BECAUSE EVERYONE KNOWS IT WORKS.
I WOULD ARGUE THAT IN SOME OF
THE NIDCD FOCAL AREAS SOME AREAS
IN MY WORLD, IN THE PERIOP
WORLD, EVIDENCE ISN'T THAT
STRONG.
WE HAVE AN INKLING, THERE MIGHT
BE AN INDICATION THAT IT MIGHT
SHOW EFFICACY IN A PILOT STUDY,
BUT SOMETIMES IT'S HARD TO KNOW
WHETHER THE EVIDENCE IS ACTUALLY
READY.
SO WE HAVE TO MAKE DECISIONS
ABOUT IS IT TIME TO ACTUALLY
STUDY IMPLEMENTATION, HAD YOU WE
BE DOING THE MECHANISTIC WORK OR
IS IT TIME TO TRANSLATE AND LOOK
AT IMPLEMENTATION?
INCREASINGLY WE'RE SEEING PEOPLE
DO WHAT ARE CALLED HYBRID
EFFECTIVENESS IMPLEMENTATION
STUDIES, WHERE THEY ARE DOING
TWO THINGS AT ONCE.
SO YOU'RE ASKING QUESTIONS ABOUT
IS THE INTERVENTION EFFECTIVE AT
IMPROVING PATIENT OUTCOME, ALSO
HOW YOU GOT PEOPLE TO DO IT.
BUT UNDERSTANDING SORT OF WHAT
THE APPROPRIATE STANDARDS OF
EVIDENCE ARE SHOULD BE AN
ON AN
ONGOING DISCUSSION.
IMPLEMENTATION SCIENCE AND
EQUITY IS AN ISSUE FOR ALL OF US
BUT MAY PLAY OUT DIFFERENTLY.
ONE ISSUE I TALKED ABOUT WITH
HOLLY AND PROBABLY WITH DEB AND
ELKE WAS MEETING NEEDS OF
PARENTS AND CHILDREN WITH
DISABILITIES, YOU MAY BE FOCUSED
ON ON CHILDREN WITH DISABILITIES
BUT IF PARENTS OFFERING CONSENT
ALSO HAVE COMMUNICATION
DISORDERS OR OTHER DISABILITIES
HOW DO YOU ENGAGE THEM AND MAKE
SURE YOU'RE DOING THE WORK IN AN
ETHICAL WAY, IN A WAY FULLY
PARTICIPATORY, AND THEN WE HAVE
TO THINK HOW TO ELIMINATE
EVIDENCE TO PRACTICE GAPS,
RATHER THAN RECREATING THEM
WHICH SOMETIMES WE DO WHEN WE DO
RESEARCH AND REALLY WELL
RESOURCED SETTINGS.
I'VE SEEN GREAT EXAMPLES OF
RESEARCH PLAYING OUT IN THE
COMMUNITY AND I'LL GIVE SOME
EXAMPLES OF THOSE.
BUT WE DO HAVE TO THINK WHERE WE
DO THE WORK TO MAKE SURE 245 ALL
OF THE INSIGHTS ARE REACHING
POPULATIONS EQUITABLY.
THE THIRD CHALLENGE IS MULTIPLE
SETTINGS OF INTEREST RELATIVE TO
THE NIDCD SCHOOLS AND OTHER
TYPES OF SETTINGS WHERE CHANGING
BEHAVIOR INVOLVES DIFFERENT
MECHANISMS, STRATEGIES, YOU MAY
HAVE TO INVOLVE POLICYMAKERS IN
A WAY -- A DIFFERENT WAY,
CLINICAL SETTING COMPARED TO
SCHOOL SETTING.
SO LET'S TALK SPECIFICALLY ABOUT
IMPLEMENTATION SCIENCE AND SOME
NIDCD INTEREST AREAS.
THESE ARE AREAS TO KEEP IN MIND.
I THINK I GOT THIS RIGHT.
I WANT YOU TO KEEP THESE IN MIND
AS WE TALK THROUGH.
I'LL GIVE A COUPLE EXAMPLES OF
NIDCD-FUNDED RESEARCHERS DOING
IMPLEMENTATION SCIENCE.
I WANT YOU TO KEEP THESE MISSION
AREAS IN MIND.
I ALSO WANT YOU TO KEEP
EQUITABLE IMPLEMENTATION IN
MIND.
IN THE LAST FIVE YEARS THERE'S
BEEN MORE OF AN EXPLICIT
DISCUSSION ABOUT HOW TO
INCORPORATE EQUITY INTO ALL OF
THE WORK WE DO FROM THE
CONCEPTION OF THE QUESTION TO
FORMATION OF THE TEAM, TO
MEASUREMENT AND DISSEMINATION SO
THAT SHOULD BE SOMETHING WE KEEP
TOP OF MIND.
SO I'M GOING TO WALK YOU THROUGH
TWO EXAMPLES OF APPLYING
IMPLEMENTATION SCIENCE TO
MISSION AREAS.
FIRST IS KEVIN KIRBER'S WORK,
SECOND IS EARLY HEARING
DETECTION AND INTERVENTION FOR
INFANT HEARING LOSS BY MATTHEW
BUSH, TWO OF THE THREE
RESEARCHERS THAT WERE
HIGHLIGHTED IN THE OCTOBER 2023
SEMINAR ON IMPLEMENTATION
SCIENCE BUT ONLY HAD A LITTLE
BIT OF TIME TO TALK ABOUT THEIR
WORK SO I'LL TALK MORE AND IF
THEY ARE LISTENING HOPEFULLY I
GET IT RIGHT.
SO THIS IS KEVIN KERBER FROM THE
OHIO STATE UNIVERSITY, THE "THE"
IS VERY IMPORTANT, STUDYING
PRACTICE OF DIAGNOSIS AND
TREATMENT OF BPPV IN THE
EMERGENCY DEPARTMENT, BENIGN
PAROXYSMAL VERTIGO, THEY ARE
SCARED AND PRESENT TO THE
EMERGENCY DEPARTMENT, TRYING TO
FIGURE OUT WHAT'S HAPPENING AND
HOW TO MAKE IT GO AWAY.
EMERGENCY PHYSICIANS WILL OFTEN
DO IR-- WILL IRRADIATE, CT
SCANS, NON-INDICATED TESTS WHEN
THERE LESS INVASIVE AND MORE
APPROPRIATE TESTS TO DIAGNOSE
AND TREAT.
THE FOCUS OF THIS STUDY, THE
FIRST STUDY WAS DISTINCT ONE,
FIRST IS DISTINCT TWO.
I'LL FOCUSED ON THE ONE
PUBLISHED IN 2020.
THEY FOCUSED ON BPPV,
EVIDENCE-BASED PRACTICE, TWO OF
THEM, TESTING FOR THIS VERTIGO
USING DIX-HALLPIKE TEST AND
CANALITH POSITIONING MANEUVER, A
TWO-PART EVIDENCE-BASED
PRACTICE, DIAGNOSIS AND
TREATMENT.
THE SETTING IS AN EMERGENCY
DEPARTMENT.
THIS WAS A STEPPED WEDGE TRIAL,
PLAPS IN -- PERHAPS WE COULD TK
MORE IN THE PANEL.
THEY LOOK GREAT ON PAPER, HARD
TO DO.
I APPLAUD THEM FOR GETTING
THROUGH THE STEPPED WEDGE IN SIX
EMERGENCY DEPARTMENTS, EMPLOYED
COMBINATION IMPLEMENTATION
STRATEGY TO GET EMERGENCY
PHYSICIANS TO USE APPROPRIATE
TEST FOR VERTIGO AND THEN IF IT
WAS POSITIVE TO TREAT IT USING
THE CANALITH REPOSITIONS
MANEUVERS.
IMPLEMENTATION STRATEGIES, THEY
CREATED AND PROVIDING HANDS-ON
EDUCATIONAL SESSIONS, CREATED
DECISION AID FOR THE CLINICIANS
THAT HAD A WEB-BASED COMPONENT
BUT ALSO PRINT MATERIALS THAT
THEY COULD ACCESS A LITTLE BIT
EASIER SORT OF AT THE POINT OF
CARE TO ACCESS.
THEY DESIGNATED LOCAL CHAMPIONS,
CREATED REFERRAL RESOURCE FOR
PATIENTS THAT TESTED POSITIVE,
PARTNER DEVELOPMENT OF THE
STRATEGY.
THIS WAS A PRETTY LARGE TRIAL,
ENROLLED MORE THAN 7 600
PATIENTS ACROSS SIX E.D.s OVER
18 MONTHS.
THIS IS ALL-COMERS OF PEOPLE WHO
PRESENTED TO EMERGENCY
DEPARTMENTS WITH DIZZINESS.
CARED FOR BY 287 PROVIDERS, THAT
INCLUDED PHYSICIANS, ATTENDING
PHYSICIANS, RESIDENTS, ADVANCED
PRACTICE PROVIDERS.
204 ARE THE DIX-HALL PIKE TEST
OR CANALITH MANEUVER.
3.5% OF THE INTERVENTION VISITS
HAD THIS, ODDS RATIO OF THE USE
OF THESE EVIDENCE-BASED
PRACTICES POST-INTERVENTION WAS
2.44, WHICH FAVORABLE 95%
CONFIDENCE INTERVAL SO TAKEAWAY
HERE IS THAT THIS SUITE OF
IMPLEMENTATION STRATEGIES WAS
VERY EFFECTIVE AT CHANGING
BEHAVIOR OF THE CLINICIANS TO
APPROPRIATELY USE THIS
DIAGNOSTIC TREATMENT, DIAGNOSTIC
APPROACH AND TREATMENT FOR
VERTIGO.
THEY LOOKED AT BALANCING
MEASURES OF STROKE BECAUSE THE
CONCERN WOULD BE IF YOU USE
THESE NON-INVASIVE APPROACHES TO
DIAGNOSTIC VERTIGO AND SOMEONE
HAD A STROKE THEY MAY HAVE
UNTOWARD OUTCOMES, THEY DID NOT
SEE INCREASED INCIDENCE OF
MISSED STROKE.
THE SECOND EXAMPLE I WANT TO
TALK ABOUT IS WORK BY MATTHEW
BUSH AND COLLEAGUES FROM
UNIVERSITY OF KENTUCKY.
THIS IS COMMUNITIES HELPING THE
HEARING OF INFANTS BY REACHING
PARENTS THROUGH PATIENT
NAVIGATION.
THIS ONE IS INTERESTING BECAUSE
IT HAS A COUPLE EVIDENCE-BASED
PRACTICES.
SO, THIS CHHIRP JUST WRAPPED,
STILL IN DEVELOPMENT, HAVEN'T
PUBLISHED FINDINGS.
FIRST EVIDENCE-BASED PRACTICE
WAS ALL INFANTS SHOULD HAVE
SCREENING FOR HEARING BY AGE
THREE MONTHS.
WHERE THE PRACTICE FALLS OFF IS
NEWBORNS THAT TEST POSITIVE,
HAVE A POSITIVE SCREEN, AREN'T
NECESSARILY FOLLOWED UP THE WAY
THEY NEED TO BE.
PART OF THE GOAL IS TO MAKE SURE
FOLLOW-UP HAPPENS.
SECONDS IS PATIENT NAVIGATION TO
MAKE SURE IF SOMEONE TESTS
POSITIVE THEY GO THROUGH THE
REST OF THE DIAGNOSTIC PROCESS.
SO THE SETTING IS STATE-FUNDED
EARLY HEARING DETECTION AND
INTERVENTION CLINICS, AND THE
PATIENTS ARE INFANTS WHO
FOLLOWED THIS POSITIVE, THIS
FAILED SCREENING.
SO, WE'LL SEE WHAT HAPPENS BUT I
WANTED TO SHOW AN EXAMPLE OF
APPLYING IMPLEMENTATION SCIENCE
TO AN NIDCD MISSION AREA.
I WAS ASKED TO SORT OF DISTILL
THIS DOWN AND TALK IF YOU DON'T
REMEMBER ANYTHING ELSE, BECAUSE
IMPLEMENTATION SCIENCE DOES HAVE
A LOT OF JARGON, THERE ARE A LOT
OF WORDS, SOCIAL SCIENCE,
SOMETIMES PEOPLE FEEL LIKE IT'S
SQUISHY, WHAT SHOULD YOU TAKE
AWAY?
SO, ONE OF THE KEY TAKEAWAYS IS
THINKING ABOUT DESIGN.
AND I'VE BECOME INCREASINGLY
MINDFUL THAT AS WE DESIGN
INTERVENTIONS, AS WE DESIGN
IMPLEMENTATION STRATEGIES, TO
TRY TO GET PEOPLE TO CHANGE
THEIR BEHAVIOR.
WE NEED TO APPLY DESIGN
PRINCIPLES TO DO THAT.
AND SO I'M SHOWING SOMETHING
CALLED THE DIGITAL ETHICS E
COMPASS FROM THE DANISH DESIGN
CENTER.
FOR THOSE SO INCLINED I'D
ENCOURAGE YOU TO GOOGLE THE
DANISH DESIGN CENTER AS YOU
MIGHT IMAGINE, THE WEBSITE IS
PRETTIER THAN WHAT I CAN SHOW
YOU, BUT THIS COMPASS WHICH I'M
ONLY SHOWING PART OF ACTUALLY
TURNS, IF YOU LOOK ON THE
WEBSITE.
AND THIS IS MEANT TO HELP US
THINK THROUGH LOTS OF PRINCIPLES
THAT MAKE INTERVENTIONS EASY TO
DEPLOY.
SO THERE ARE A FEW KEY
PRINCIPLES TO GIVE YOU HERE.
WE SHOULD BE THINKING ABOUT
PEOPLE AS WE DESIGN OUR
INTERVENTIONS.
AND PART OF THAT WILL HELP US
DEPLOY INTERVENTIONS IN A WAY
THAT'S SUSTAINABLE, RELIABLE,
BUT IT WILL HELP US SUPPORT
EQUITY.
SO, THE ONE TAKEAWAY FROM THE
SLIDE YOU SHOULD PUT PEOPLE THEY
CENTER.
SOUNDS EASY TO SAY BUT WHEN YOU
THINK ABOUT SOME INTERVENTION
TH DO, LET'S THINK ABOUT
THE DIX-HALL TEST AND CANALITH
MANEUVER.
E.D.ES ARE NOT JUST CARING FOR
PEOPLE WITH VERTIGO BUT HEART
ATTACK, PEOPLE WHO MIGHT HAVE
STUBBED A TOE OR BE IN LABOR.
AN IMPLEMENTATION STRATEGY NEEDS
TO WORK FOR THE BEHAVIOR YOU'RE
TRYING TO CHANGE, NOT THE
RESEARCHER, IF YOU'RE WORKING
WITH PARENTS OF INFANTS WHO
FAILED THEIR NEWBORN SCREENING
TEST WHAT IS A STRATEGY THAT
ACTUALLY WORKS FOR THOSE
PARENTS?
SO WE HAVE TO PUT PEOPLE AT THE
CENTER OF WHAT WE DO, IF WE
EXPECT INTERVENTIONS TO WORK,
THAT'S ONE KEY PIECE TO TAKE
AWAY AS YOU THINK ABOUT
IMPLEMENTATION AND WHAT WE CAN
DO TO FOSTER IMPLEMENTATION.
THERE'S SOME OTHER PRINCIPLES
WITH POWER SHARING BUT THE KEY
TAKEAWAY FROM THIS IS PUTTING
PEOPLE AT THE CENTER WHICH WE
DON'T ALWAYS DO IN OUR RESEARCH.
SECOND TAKEAWAY I WOULD OFFER
YOU IS WE NEED TO THINK ABOUT
HOW WE GET THE MESSAGES OUT TO
PEOPLE.
TO THINK ABOUT DISSEMINATION
METHODS AND CHANNELINGS.
THERE'S ACTUALLY A LOT TO LEARN
FROM ADVERTISING.
WHICH SOUNDS FUNNY ADVERTISERS
HAVE BEEN FIGURING OUT HOW TO
REACH GROUPS, SEGMENTING
POPULATIONS.
IF YOU'RE FAMILIAR WITH AUDIENCE
SEGMENTATION TO DELIVER A
MESSAGE TO A BABY BOOMER IT'S
DIFFERENT THAN A GEN XER.
TO AN URBAN POPULATION MIGHT BE
DIFFERENT THAN RURAL.
I WOULD ARGUE IN RESEARCH WE
DON'T ALWAYS THINK HOW TO GET
MESSAGES OUT THERE EFFECTIVELY.
THERE ARE PRINCIPLES OF SOCIAL
MARKETING THAT WE CAN USE TO
CREATE MORE EFFECTIVE MESSAGES.
I'M SHOWING TWO HERE RELEVANT TO
COVID-19 VACCINES, ONE FROM AN
INDIGENOUS PERSPECTIVE, ANOTHER
ONE IS SOMETHING WE CREATED AT
PENN MEDICINE WHERE WE NOTICED
DURING THE COVID-19 PANDEMIC
WHEN WE OFFERED VACCINE TO ALL
OF OUR 40,000 EMPLOYEES, MAYBE
45,000 AT THIS POINT, BLACK
EMPLOYEES WERE
DISPROPORTIONATELY LESS LIKELY
TO GET THE VACCINE.
AND SO A GROUP OF BLACK
PHYSICIANS SAID IF WE PUT OUR
FACES ON THIS AND SAY WE GOT
VACCINATED HERE IS WHY, LET'S
TALK TO PEOPLE AND SHOW THEM
IT'S ACTUALLY OKAY, MAYBE THEY
WILL DO IT.
AND THEY DID.
WE HAD TO THINK ABOUT WHAT WAS
THE MESSAGING TO GET TO SPECIFIC
GROUPS OF PEOPLE THAT WAS
COMPELLING, SALIENT, RELEVANT TO
THEM.
IT'S PART OF WHAT WE NEED TO
THINK ABOUT IN IMPLEMENTATION.
AND THE THIRD THING TO SHARE
IT'S USEFUL TO TAP INTO
IMPLEMENTATION SCIENCE KNOWLEDGE
ACROSS NETWORKS, ACROSS
COMMUNITIES.
AN EXAMPLE OF AN INITIATIVE, NIH
INITIATIVE DOING THAT, THIS IS
THE "IMPROVE" INITIATIVE, AN
NIH-WIDE INITIATIVE ON MATERNAL
HEALTH AND HEALTH EQUITY.
IT'S LED BY NICHD BUT I THINK
JUST EVERY NIH INSTITUTE IS A
PART OF THIS INITIATIVE.
WHAT IMPROVE HAS DONE IS STAND
UP A NUMBER OF PROGRAMS ON
MATERNAL HEALTH EQUITY BUT THE
MOST RECENT IS STANDING UP
CENTERS OF EXCELLENCE DOING
RESEARCH IN PRIORITY
POPULATIONS.
THAT NETWORK OF CENTERS LOOKS
LIKE THIS.
12 OF THEM AROUND THE COUNTRY,
BUT WHAT I WANT TO POINT TO IS
IN THE MIDDLE, TWO HUBSES THAT
SUPPORT THIS RESEARCH NETWORK,
ONE IS DATA INNOVATION AND
COORDINATION HUB, ONE WE LEAD AT
THE UNIVERSITY OF PENNSYLVANIA
IS AN IMPLEMENTATION SCIENCE
HUB.
THE REASON THIS WAS CREATED WAS
THAT THERE IS NOT ENOUGH
IMPLEMENTATION SCIENCE EXPERTISE
IN MATERNAL HEALTH AROUND THE
COUNTRY.
AND THE IMPROVE GROUP
APPROPRIATELY NOTED THEY WANTED
IMPLEMENTATION SCIENCE
INTEGRATED INTO THIS WORK.
HOW DO WE DO THIS?
LET'S CREATE A CENTRAL RESOURCE
FOR THESE FOLKS.
WHAT MY TEAM AND I DO, WE
PROVIDE EXPERTISE TOSE THE NETWK
OF INVESTIGATORS.
THIS IS A POTENTIALLY VERY
EFFECTIVE MODEL THAT COULD BE
USED BY OTHER CENTERS AND
INSTITUTES IF YOU THINK
IMPLEMENTATION SCIENCE IS
SOMETHING THAT WOULD BE USEFUL,
BUT THERE'S NOT ENOUGH FOLKS IN
THE FIELD THAT HAVE THAT
EXPERTISE.
SO THIS IS ONE WAY WE'VE SORT OF
DEMOCRATIZED AND INCREASED
ACCESS TO IMPLEMENTATION
SCIENCE.
WE HAVE A CAPACITY BUILDING
MISSION WHICH MAKES SENSE TOO SO
WE'RE TRYING TO GROW THE C
OF PEOPLEOF T HAVE THIS
EXPERTISE IN MATERNAL HEALTH.
SO, WHAT SHOULD NEWCOMERS NEW
ABOUT IMPLEMENTATION SCIENCE?
WE'RE REALLY NICE.
LIKE REALLY, REALLY NICE.
IF YOU GO TO THE MEETING, YOU'LL
SEE MANY OF THE LUMINARIES IN
THE FIELD GOING TO THE MIC,
PRESENTING POSTESSERS, YOU CAN
WALK UP TO ANYBODY AND THEY WILL
TALK TO YOU.
WE WANT PEOPLE TO USE THIS WORK.
THE FIELD MAY FEEL INACCESSIBLE
BECAUSE OF THE JARGON BUT THAT'S
NOT THE INTENT.
IF YOU TALK TO ANY OF THESE
PEOPLE FOR THE MOST PART IF YOU
E-MAIL ANY OF THESE PEOPLE THEY
WILL RESPOND TO YOU.
WE WANT PEOPLE TO USE EVIDENCE
TO GET IT INTO PRACTICE SO THE
FIELD IS VERY WELCOMING.
WE ALSO LIKE ALTERNATIVE
VIEWPOINTS, AND SO THERE IS A
GROUP OF PEOPLE WHO ARE THOUGHT
LEADERS IN THE FIELD, BUT IT
DOESN'T MEAN THEY HAVE IT RIGHT.
THERE ARE A LOT OF THEORIES AND
MODELS AND FRAMEWORKS BUT
DOESN'T MEAN THEY ARE PERFECT.
WE WELCOME DISCUSSION.
WE WELCOME PEOPLE TO CHALLENGE
THE FIELD.
THE RECENT FOCUS ON EQUITY CAME
ABOUT IN PART BECAUSE PEOPLE WHO
WERE EQUITY SCHOLARS SAID, HEY,
THIS ISN'T WORKING WELL.
A LOT OF THIS KNOWLEDGE IS
COMING OUT OF THE GLOBAL NORTH,
OUT OF THE U.S. AND CANADA IN
PARTICULAR, AND THERE ARE PLACES
THIS MAKES NO SENSE IN THE
WORLD.
HOW DO WE BRING ANOTHER
PERSPECTIVE AND MAKE SURE THESE
FINDINGS, THESE APPROACHES AND
CONCEPTS, WORK FOR EVERYONE?
SO, COME IN.
IF YOU HAVE ALTERNATIVE
VIEWPOINTS WE WANT TO HEAR THEM.
WE WANT TO MAKE THE SCIENCE
STRONGER.
THE THIRD POINT IS THAT
METHODOLOGISTS ARE USED TO
WORKING WITH CONTENT EXPERTS SO
YOU DON'T HAVE TO BE AN EXPERT
IN BOTH.
THERE ARE LOTS OF CONTENT
EXPERTS WHO FIND CONTENT
AGNOSTIC IMPLEMENTATION TO APPLY
THE MODEL OR FRAMEWORK OR
STEPPED WEDGE DESIGN.
FINAL POINT, IT'S HARD TO GET IN
THE FIELD.
IN ADDITION TO US BEING NICE
WE'VE TRIED TO CREATE ACCESS TO
INFORMATION ABOUT IMPLEMENTATION
SCIENCE.
YOU'LL SEE LOTS OF COURSES IN
IMPLEMENTATION SCIENCE.
SOME ARE PAID, MANY ARE NOT.
THERE ARE A LOT OF FREE
RESOURCES ONLINE TO CHECK, TO
SELECT THEORIES MODELS AND
FRAMEWORKS.
ALMOST ALL JOURNALS ARE OPEN
ACCESS.
WE KNOW IT'S DIFFICULT BUT WE'RE
TRYING TO MAKE THAT INFORMATION
AS AVAILABLE AS POSSIBLE.
SO AS I WRAP UP, I KNOW I'M
EARLY BUT USUALLY IT'S BETTER TO
TALK A LITTLE LESS, MAYBE WE CAN
HAVE MORE DISCUSSION.
EVIDENCE-BASED INTERVENTIONS IN
NIDCD RELEVANT TOPIC AREAS NEED
TO BE EFFECTIVELY IMPLEMENTED TO
HAVE IMPACT.
LATE STAGE RESEARCH, T3, T4,
WE'RE ALL ON THE SAME TEAM EVEN
DOING BASIC T-0 RESEARCH, THE
FINDINGS IN YOUR LAB,
INNOVATIONS YOU CREATE, WILL
NEVER CHANGE LET UNLESS THERE
ARE PEOPLE DOING IMPLEMENTATION,
RIGHT?
SO, IF YOU'RE A BASIC SCIENTIST
IT'S NOT THAT YOU HAVE TO BE A
SOCIAL SCIENTIST ABOUT TO HAVE
SOME SENSE THAT THIS INNOVATION
THAT YOU'RE CREATING NEEDS TO BE
IMPLEMENTED AT SOME LEVEL AND
HAVE A PARTNERSHIP AT SOME LEVEL
WITH IMPLEMENTATION SCIENTISTS
IS USEFUL.
WE SHOULD BE THINKING ABOUT
IMPLEMENTATION AT ALL STEPS OF
THE RESEARCH PROCESS.
AND THERE'S INCREASING NUMBER OF
FOLKS LOOKING AT INTEGRATING
IMPLEMENTATION SCIENCE INTO
INNOVATION DESIGN.
THERE'S ONE APPROACH DEVELOPED
BY COLLINS AT NYU, MULTI-PHASE
OPTIMIZATION STRATEGY, WHICH IS
A REALLY INTERESTING WAY OF
DOING RAPID CYCLE TESTING OF
INTERVENTION COMPONENTS TO
CREATE OPTIMALLY IMPLEMENTABLE
INTERVENTIONS THAT CAN THEN BE
IMPLEMENTED BUT WE NEED TO START
THINKING ABOUT IMPLEMENTATION AT
THE VERY BEGINNING, NOT AT THE
END.
SO THAT WE GIVE OURSELVES THE
BEST CHANCE OF GETTING THESE
INNOVATIONS INTO PRACTICE.
AND THEN FOR MAXIMAL IMPACT,
EQUITY IS NOT JUST RACE AND
ETHNICITY, IT'S ABILITY,
DISABILITY, NEURODIVERSITY,
LOCALITY, ANY DIMENSION OF
DIFFERENCE YOU CAN THINK ABOUT
WE HAVE TO THINK ABOUT IT AS WE
DO IMPLEMENTATION, OTHERWISE WE
RISK CREATING MORE
EVIDENCE-TO-PRACTICE GAPS.
I'LL STOP THERE.
AND I THINK WE'RE GOING TO MOVE
TO THE PANEL.
>> THANK YOU SO MUCH.
THAT WAS A REALLY WONDERFUL
TALK.
I APPRECIATE VERY MUCH HOW MUCH
YOU INTEGRATED IMPLEMENTATION
SCIENCE INTO OUR PORTFOLIO.
SO IT WAS VERY INTERESTING.
SO, WE'LL HAVE A PANEL
DISCUSSION NOW.
OUR PANELISTS INCLUDE IN
ADDITION TO DR. LANE-FALL, DR.
MONICA WEBB HOOPER, WHO IS
DEPUTY DIRECTOR OF THE NATIONAL
INSTITUTE ON MINORITY HEALTH AND
HEALTH DISPARITIES.
DR. SHANNON ZENK, DIRECTOR OF
THE NATIONAL INSTITUTE OF
NURSING RESEARCH.
AND DR. HOLLY STORKEL, PROGRAM
OFFICER FOR THE LANGUAGE PROGRAM
AT NIDCD.
AND ALL OUR PANELISTS HAVE
TREMENDOUS EXPERTISE AN
EXPERIENCE IN IMPLEMENTATION
SCIENCE.
SO, I WILL ADDRESS A QUESTION TO
EACH OF OUR PANELISTS, AND AT
THE END WE'LL WRAP UP WITH A
COUPLE OF COMMENTS FROM EACH OF
THEM.
I WOULD ALSO STATE THAT I'M
HAPPY TO HAVE COMMENTS FROM ANY
OF YOU ON ANY OF THE QUESTIONS.
WE'LL START WITH A PERSON I
ADDRESSED THE QUESTION TO.
TO KICK US OFF, CURRENT RESEARCH
IS DEVOTED TO DEVELOPING
EVIDENCE-BASED INNOVATIONS THAT
IMPROVE A PERSON'S HEALTH AND
QUALITY OF LIFE.
AND AS DR. LANE-FALL MENTIONED,
IT'S ESTIMATED THAT IT TAKES ONE
TO TWO DECADES FOR FINDINGS FROM
RESEARCH STUDIES TO BE
IMPLEMENTED IN CLINICAL CARE.
MY FIRST QUESTION TO DR.
LANE-FALL IS THE MOST COMMON
BARRIERS TO CHANGE TEND TO BE
TIME AND MONEY.
YET SOMETIMES ORGANIZATIONS ARE
SPENDING TIME AND MONEY
DELIVERING CARE THAT'S KNOWN TO
BE LESS EFFECTIVE OR
INEFFECTIVE.
I THINK YOU ALLUDED TO THIS WHEN
YOU TALKED ABOUT
DEIMPLEMENTATION, MAYBE STOPPING
THE THINGS THAT AREN'T THE BEST
WAYS TO DELIVER CARE.
SO, WHAT HAVE BEEN THE MOST
EFFECTIVE WAYS TO ENCOURAGE
CLINICIANS TO STOP USING
INTERVENTIONS THAT WE KNOW DON'T
WORK?
>> SO THAT'S A GREAT QUESTION
AND I APPRECIATE IT.
NOW, I THINK ABOUT THE SOCIAL
ECOLOGICAL MODEL A LOT,
SOMETHING WE USE IN
IMPLEMENTATION SCIENCE A FAIR
BIT.
IT WAS CREATED FIRST BY A CHILD
LOGISTHO BUT IF YOU'VE SEEN
THE CONCENTRIC CIRCLES, A
FAMILY, COMMUNITY, SOCIETY,
THAT'S WHAT I'M TALKING ABOUT.
I THINK ABOUT FOMENTING OR
FACILITATING BEHAVIOR CHANGE I
THINK ABOUT THAT MODEL.
WE OFTEN FOCUS ON AN INDIVIDUAL,
BUT AN INDIVIDUAL IS EMBEDDED
WITHIN A SYSTEM.
AND SO IT CAN BE MORE EFFECTIVE
TO FOCUS ON THE SYSTEM AND
UNDERSTAND THE CONSTRAINTS ON
THAT PERSON'S BEHAVIOR AND TO
ADDRESS THOSE CONSTRAINTS.
ONE OF THE THINGS I THINK ABOUT
IN ADDITION IS REL IEE
OF AUTONOMY OF THE PERSON WHOSE
BEHAVIOR I'M TRYING TO CHANGE.
IF YOU HAV AUTONOMOUS ACTOR
YOU MAY NEED TO CONVINCE THEM TO
DO THE SAME.
IF YOU HAVE PEOPLE WHOSE
BEHAVIOR IS MORE CONTAINED BY
ENVIRONMENT THAN IF YOU GO TO
THEIR BOSS, TO THEIR
ENVIRONMENT, THAT MAY BE MORE
EFFECTIVE.
SO, I REALLY TRY TO DECOMPOSE
THE WORK SYSTEM, THAT'S WHERE
SOME HUMAN FACTORS ENGINEERING
PRINCIPLES COME IN.
AND UNDERSTAND SORT OF WHO IS
PULLING THE STRINGS.
AND THEN LOOK AT THAT, AND START
TO TARGET THOSE, THOSE STRINGS.
I'M CURIOUS WHAT THE OTHER FOLKS
THINK ABOUT THAT.
>> YEAH, YEAH.
ANY OTHER COMMENTS?
SO ONE OF THE THINGS YOU
MENTIONED, MEGHAN, WAS STUDY
ABOUT BPPV IN EMERGENCY I E
SETTINGS.
TAKE THASELE,KE SAY AFTER
THE STUDY IS OVER, PHYSICIANS GO
BACK TO ORDERING CT SCANS WHEN
SOMEBODY COMES IN WITH
DIZZINESS.
HOW WOULD YOU APPROACH THAT
SITUATION?
>> SO WHEN I>> THINK ABOUT WHAT
DRIVES BEHAVIOR, I THINK ABOUT
INCENTIVES, DISINCENTIVES.
IF SOMEONE ESPECIALLY LET'S SAY
SOMEONE WHO KNEW THEY SHOULD BE
DOING THE DIX HALL AND CANALITH,
IT'S EASIER TO ORDER THE SCAN
THAN THE MANEUVER.
HOW DO YOU MAKE IT EASIER?
YOU COULD MAKE IT HARDER TO
ORDER A CT SCAN, IF AN EMERGENCY
DEPARTMENT YOU DON'T WANT TO DO
THAT BUT IS THERE AN EASIER WAY
TO DO THE RIGHT THING, IT'S WHAT
KIRBER AND COLLEAGUES WERE
MAKING RESOURCES AVAILABLE AT
THE POINT OF CARE.
AS YOU'RE TRYING TO TRANSLATE
INTO SUSTAINABLE CHANGE,
YOU WANT TO THINK ABOUT WHAT ARE
THE STRUCTURAL CHANGES YOU CAN
MAKE TO MAKE IT EASIER TO DO IT.
IS IT THAT YOU PUT SOMETHING ON
A WALL, IS IT THAT YOU DO AUDIT
AND FEEDBACK, IS IT THAT YOU
GIVE AN INCENTIVE TO A
DEPARTMENT WHO PERFORMS WELL?
DO YOU HAVE A PATIENT TO COME IN
AND TALK ABOUT THE HARM, HOW
MUCH THEY WERE CHARGED FOR A CAT
SCAN THEY DIDN'T NEED?
LOTS OF OTHER POTENTIAL
INTERVENTIONS OR STRATEGIES THAT
YOU COULD USE.
I WANT TO LOOK AT WHAT IS
DRIVING THAT BEHAVIOR BECAUSE
USUALLY THAT'S THE START OF IT,
THAT'S AT THE ROOT OF IT.
>> HOLLY WANTED TO SAY
SOMETHING.
>> YEAH, NOW MAYBE CHANGED BASED
ON WHAT YOU SHOULD, TALK ABOUT
YOU HOW YOU UNDERSTAND THOSE
SYSTEMS AND HOW YOU HAVE TO
WORRY ABOUT SYSTEMS BEING
DIFFERENT IN DIFFERENT SETTINGS
AND SO ON, AND PART OF THIS
IS -- WHY I'M ASKING, I THINK WE
OFTEN FOCUS ON THE INDIVIDUAL IN
OUR MISSION AREA AND ALWAYS
THINK, WELL, IF THEY JUST KNEW
THEY SHOULD DO THAT, THEY WOULD
DO THAT.
BUT IT'S WAY MORE COMPLICATED
THAN THAT.
SO, I THINK WE'RE ALSO NOT USED
TO THINKING ABOUT A PERSON
OPERATING IN A SYSTEM, HOW DO WE
UNDERSTAND THE SYSDE
MEOUND LOOKING AT
UNDERSTANDING THE SYSTEM.
WHAT CAN YOU TELL US THERE TO
DIRECT OUR THOUGHTS?
>> ONE OF MY FAVORITE TOOLS FOR
LOOKING AT WORK SYSTEMS IS
SYSTEMS ENGINEERING INITIATIVE
FOR PATIENT SAFETY MODEL WHICH
COMES OUT OF THE LAB AT THE
UNIVERSITY OF WISCONSIN.
THE SEEPS MODEL DECOMPOSES A
WORK SYSTEM INTO PEOPLE, TOOLS,
TECHNOLOGY, ENVIRONMENT, AND I
THINK POLICIES AND PROCEDURES
ARE THE FIVE COMPONENTS OF IT.
THAT'S USUALLY WHERE I START, TO
DECOMPOSE THE WORK SYSTEM TO
UNDERSTAND WHO IS WORKING WITHIN
IT, WHAT TOOLS THEY ARE WORKING
WITH, WHAT ENVIRONMENT THEY ARE
IN, AND WHAT POLICIES AND
PROCEDURES MIGHT GOVERN THEIR
BEHAVIOR.
THERE'S USUALLY INSIGHT TO BE
GAINED IN THAT.
A LOT OF THIS WORK IS
QUALITATIVE.
THERE MAY BE OBSERVATIONAL WORK
THAT YOU DO.
I USUALLY LIKE TO COMBINE
OBSERVATION WITH EITHER
INTERVIEWS OR FOCUS GROUPS OR
O THEM. SOMETIMES ALL
RVATIONS ARE USEFUL
BECAUSE SOMETIMES PEOPLE DON'T
HAVE INSIGHT INTO WHAT THEY DO.
THEY WILL TELL WHAT YOU THEY
THINK THEY DO BUT THAT'S
DIFFERENT THAN WHAT THEY
ACTUALLY DO SO OBSERVATIONS ARE
HELPFUL.
INTERVIEWS OR FOCUS GROUPS ARE
HELPFUL BECAUSE THEN YOU
UNDERSTAND WHY PEOPLE DO WHAT
THEY DO AND YOU CAN UNDERSTAND
THEIR MOTIVATION IN A WAY YOU
CAN'T ACTUALLY OBSERVE.
SO THAT'S USUALLY WHERE I'LL
START.
BUT IN TERMS OF THE STICKINESS
AND EFFECTIVENESS OF
INTERVENTIONS, SYSTEMS-BASED
INTERVENTIONS TEND TO BE MORE
EFFECTIVE, A BIGGER STICK THAN
INDIVIDUAL INTERVENTIONS.
>> I'LL FOLLOW UP ON THE HEALTH
CARE EXAMPLE A LITTLE BIT MORE.
SO, YOU TALKED A LITTLE BIT
ABOUT DATA SCIENCE AN THAT'S
POTENTIALLY PART OF THE EQUATION
HERE.
EVERYONE IS TALKING ABOUT A.I.
AND HOW A.I. CAN DRIVE CLINICAL
CARE.
SO, DO YOU THINK THAT THERE'S A
ROLE HERE FOR A.I.ELPING TO
FORMULATE DIAGNOSES AND
APPROPRIATE TREATMENTS?
>> I THINK THERE ARE ROLES FOR
A.I. IN HEA CARE HND RESEARCH
WE DON'T YET APPRECIATE.
THERE ARE DEFINITELY ROLES FOR
A.I. IN TRYING TO FACILITATE
CLINICAL CARE BUT ONE OF THE
CHALLENGES TO A.I. IS THAT SOME
A.I. MODELS ARE NOT EXPLAINABLE.
SO THERE'S THIS CONCEPT
EXPLAINABLE A.I., ESPECIALLY
WHEN YOU'RE DEALING WITH
PROVIDERS WHO WANT TO UNDERSTAND
WHAT THE A.I. IS DOING.
AND THERE CAN BE A HESITATION ON
THE PART OF PROVIDERS TO USE
A.I. WHERE THEY DON'T KNOW WHAT
WENT INTO THE MODEL.
WE KNOW THAT A.I. MODELS
ESPECIALLY IF THEY ARE BUILT
WITH DATA
AT COME FROM SKEWED
POPULATIONS CAN PERPETUATE BIAS.
THERE'S SOME REALLY
UNDERSTANDABLE HESITANCY ABOUT
A.I.
BUT IT IS A VERY, VERY POWERFUL
TOOL SO I THINK IT DOES PLAY A
ROLE.
WHERE A.I. CAN STREAMLINE
WORKFLOW, THAT CAN HELP.
IN HANDOFFS AND COMMUNICATION
WHEN I SAY I'LL MAKE IT EASIER
FOR SOMEONE TO DO THEIR JOB,
THEY ARE LISTENING, RIGHT?
IF YOU DO THE HANDOFF YOU'LL
SPEND LESS TIME ON THE PHONE,
LESS TIME TRYING TO FIGURE OUT
WHAT HAPPENED IN SURGERY.
THEY GO, OH, THAT SOUNDS GRADE.
IF -- GREAT.
IF WE CAN GET A.I. TO MAKE WORK
EASIER THAT'S A POSSIBILITY.
THERE'S WORK FOR ANALYZING DATA,
WE CAN CREATE ENORMOUS DATA
CORPUSES, LOTS OF QUALITATIVE
DATA, WE HAVE LOTS OF
OBSERVATIONS, FIELD NOTES,
POLICIES, A ROLE FOR A.I. IN
HELPING MAKE SENSE OF CONTEXT AS
WELL SO WE CAN DEVICE
IMPLEMENTATION STRATEGIES MORE
APPROPRIATE FOR CONTEXT WHICH I
THINK MAY GET T ONE OF HOLLY
QUESTIONS THINKING ABOUT WORK
SYSTEMS DIFFERENTLY,
UNDERSTANDING CONTEXT IN
DIFFERENT SYSTEMS CAN GIVE US
INSIGHT INTO THAT.
>> YEAH, GREAT, THANKS.
SO NEXT QUESTION IS FOR DR.
ZENK.
THERE ARE A NUMBER OF NIH-WIDE
PROGRAMS TO HELP ADVANCE
IMPLEMENTATION AND DISSEMINATION
RESEARCH.
HOW, SHANNON, DO YOU THINK
KNOWLEDGE GAINED CAN HELP
ADVANCE THE FIELD?
>> THANK YOU SO MUCH.
I THINK THIS IS AN EXCITING TIME
FOR NIH AND FOR THIS AREA OF
SCIENCE.
WE DO KNOW THAT NIH AND OTHER
FEDERAL AGENCIES HAVE INVESTED A
LOT OF MONEY IN RESEARCH BUT YET
WE STILL HAVE SUBOPTIMAL HEALTH
OUTCOMES AND REALLY TREMENDOUS
DISPARITIES.
SO, WHERE I SEE THIS FITTING IN
IS WE CAN'T JUST STOP WITH
AMAZING DISCOVERIES, WE NEED TO
TAKE THE NEXT STEP IN TERMS OF
FIGURING OUT HOW TO MOVE INTO
PRACTICE AND POLICY.
I'M ENCOURAGED BY HOW
IMON SCIENCE IS BEING
EMBRACED AND INCORPORATED ACROSD
MULTIPLE ASPECTS OF NIH, AND
NIDCD'S COMMITMENT AS WELL.
SO, YOU MENTIONED IMPROVE.
SO THAT'S AN EXAMPLE OF ONE NIH
INITIATIVE THAT HAS REALLY
INCORPORATED IMPLEMENTATION
SCIENCE ACROSS MULTIPLE PARTS,
NOT ONLY THE HUB, THE CENTERS OF
EXCELLENCE, THERE'S COMMUNITY
IMPLEMENTATION PROJECTS, AND SO
THERE'S REALLY, AS WE THINK
ABOUT REALLY MAKING A DENT AND
IMPROVING MATERNAL HEALTH
OUTCOMES, IMPLEMENTATION SCIENCE
IS SEEN AS A CRITICAL PART OF
THAT.
SO I THINK IMPROVE IS ONE
EXAMPLE BUT I THINK THAT'S JUST
ONE.
I THINK WE SEE IMPLEMENTATION
SCIENCE BEING INTEGRATED IN MANY
OTHER INITIATIVES ACROSS NIH.
SO TWO OTHER EXAMPLES THAT I'LL
MENTION, ONE IS CARE FOR HEALTH,
COMMUNITIES ADVANCING RESEARCH
EQUITY FOR HEALTH, AND COMPASS,
COMMUNITY PARTNERSHIPS TO
ADVANCE SCIENCE FOR SOCIETY.
I WOULD SAY BOTH OF THOSE ALSO
REALLY HELP TO GET AT THIS
REDUCING NO-DO GAP REFERRED TO
IN IMPLEMENTATION SCIENCE AS
WELL AS DISPARITIES WE SEE IN
THAT NO-DO GAP.
SO FOR ComPASS PROGRAM, A MAIN
PART IS FUNDING COMMUNE
ORGANIZATIONS THEMSELVES,,
DEVELOP, DESIGN, IMPLEMENT
STRUCTURAL INTERVENTIONS THAT
WILL ADDRESS SOCIAL DETERMINANTS
OF HEALTH, REALLY UPSTREAM
FACTORS THAT AFFECT THE HEALTH
OF THEIR COMMUNITIES.
IT SHIFTS THE MODEL OF HOW WE
TYPICALLY DO RESEARCH TO FUNDING
COMMUNITY ORGANIZATIONS, TO LEAD
THIS RESEARCH.
A LOT OF THOSE INTERVENTIONS THE
COMMUNITY ARE FOCUSED ON REALLY
ARE TO SCALE UP AND OPTIMIZE
EXISTING PROGRAMS, POLICIES,
PROCEDURES AT THE
ORGANIZATIONAL, CITY, COUNTY,
STATE LEVEL.
SO, YOU KNOW, EVEN THOUGH, YOU
KNOW, THE STRENGTH OF COMPASS IS
INTERVENTION SITES ARE ACROSS
THE COUNTRY, 25 SITES FOCUSED ON
POPULATIONS THAT EXPERIENCE A
WIDE VARIETY OF HEALTH
DISPARITIES BUT REALLY ONE OF
THE BINDING THREADS OF THAT
PROGRAM IS THAT THE STRUCTURAL
INTERVENTION FOCUS, WHICH WILL
HELP TO PROVIDE NEW KNOWLEDGE
ABOUT THE METHODS AND BEST
APPROACHES TO ACTUALLY MOVE
SCIENCE AND DISCOVERIES INTO
PRACTICE AND INTO POLICY.
SO WE'RE JUST AT THE BEGINNING
OF THIS PROGRAM.
IT'S A 10-YEAR PROGRAM BUT WE'RE
GOING TO LEARN I THINK L A LOT
FROM THAT PROGRAM, INCLUDING IN
THE AREA OF IMPLEMENTATION
SCIENCE.
AND CARE FOROR HEALTH WHICH DR.
TUCCI KNOWS WELL IS ANOTHER
NIH-WIDE PROGRAM THAT HAS PAID
ATTENTION TO AND IS INTEGRATING
IMPLEMENTATION SCIENCE INTO ITS
FOCUS.
SO THE PILOT PROGRAM OF THAT
CARE FOR HEALTH IS FOCUSED ON
PRIMARY CARE, RESEARCH NETWORK
HUBS, DEVELOPING THOSE ACROSS
THE COUNTRY, INCLUDING TO
ACCELERATE ADOPTION OF RESEARCH
ADVANCES INTO PRACTICE.
SO I THINK THAT'S ANOTHER GOOD
SIGN THAT THE FUTURE IS BRIGHT
FONDING, WE HOPE, IN
TERMS OF IMPLEMENTATION SCIENCE.
AND THEN THOSE ARE, YOU KNOW,
REALLY BIG NIH INITIATIVES, BUT
THERE'S A VARIETY OF FUNDING
OPPORTUNITIES AVAILABLE TO
RESEARCHERS, THERE'S A VERY
IMPLEMENTATION RESEARCH, SO IT'S
SUPPORTED BY A WIDE VARIETY OF
INSTITUTES AND CENTERS,
INCLUDING NIDCD, SO PRETTY MUCH
ANY TOPIC A RESEARCHER IS
INTERESTED IN THEY SHOULD BE
ABLE TO FIND A HOME IN TERMS OF
FUNDING SUPPORT ACROSS THE NIH.
>> THANK YOU.
CAN YOU SAY A LITTLE BIT MORE,
SHANNON, ABOUT COMPASS AND THE
STRUCTURAL INTERVENTIONS?
I THINK THAT'S VERY, VERY
UNIQUE.
IT'S NOT THE WAY WE'VE BEEN
ACCUSTOMED TO DELIVERING
RESEARCH QUESTIONS IN THE PAST.
>> YEAH, YEAH, I THINK THE FOLK
THRUST IS REALLY TO THINK
UPSTREAM AT FACTORS AT THE
LEVELS OF SYSTEMS, STRUCTURES,
POLICIES, AND HOW THEY HAVE
TREMENDOUS IMPLICATIONS FOR
HEALTH AND HEALTH DISPARITIES.
SO TRYING T PUSHVENTIONS
UPSTREAM FROM WHERE WE OFTEN
THINK OF IN TERMS OF PROXIMAL
INTERVENTIONS TO THINKING ABOUT
THE CAUSES OF THE CAUSES, SO TO
SPEAK, ADDRESSING THOSE FACTORS.
THERE AGAIN SOME OF THAT WORK IS
FOCUSED IN THIS AREA ABOUT
TAKING WHAT WE KNOW THAT WORKS
ON A SMALL SCALE AND THEN
ROLLING IT UP TO HAVE A BROADER
COMMUNITY OR POPULATION-WIDE
IMPACT.
>> GREAT.
THANK YOU.
ALL RIGHT.
SO FOR DR. WEBB HOOPER, TO BUILD
CAPACITY YOU NEED KEY LEADERS
WITHIN AN ORGANIZATION, TO BE ON
BOARD WITH GOALS, AND YOU NEED A
CRITICAL MASS OF PEOPLE WITHIN
THE ORGANIZATION WHO CAN MOVE
THE WORK FORWARD.
SO, A LOT OF NIH SUPPORT IS
DIRECTED AT INDIVIDUAL
INVESTIGATORS.
FOR EXAMPLE, CAREER DEVELOPMENT,
RESEARCH GRANTS ARE MADE TO AN
INDIVIDUAL BUT SOME OF THESE
CAPACITY-BUILDING PAIN POINTS
ARE MORE AT THE SYSTEMS LEVEL.
I THINK WE ALLUDED TO THIS A
LITTLE BIT A MOMENT AGO.
WHAT DO YOU THINK THAT NIH AND
NIDCD CANN DO TO SUPPORT SYSTEMS
CHANGE?
>> FIRST I WANT TO THANK YOU FOR
THE OPPORTUNITY TO BE HERE AND
PARTICIPATE ON THE PANEL.
AND THIS IS A REALLY IMPORTANT
QUESTION THAT YOU ASKED, IN
TERMS OF THINKING ABOUT MY
POSITIONALITY IN THIS TOPIC,
PERSPECTIVE THAT I'M APPROACHING
THIS IS REALLY FROM MORE THAN
ONE.
ONE IS BEFORE I JOINED NIH I WAS
A PROFESSOR, AND A BEHAVIORAL
SCIENTIST.
WHEN YOU MENTIONED COGNITIVE
BEHAVIORAL, THERAPY, YES, IT
DOES WORK TO TREAT ALMOST
EVERYTHING.
AND SO I WORKED IN CANCER CENTEN
ATTENDING CLINICAL PSYCHOLOGIST
AND RESEARCHER.
WANTING TO BRING EVIDENCE-BASED
INTERVENTIONS INTO THE ONCOLOGY
SPACE.
AND I'LL MENTION TWO SPECIFIC
EXAMPLES.
I'LL ANSWER YOUR QUESTION ABOUT
WHAT I THINK NIH CAN DO BECAUSE
I THINK ABOUT WHAT NIH DID TO
HELP FACILITATE THAT WORK AND
NOW BEING ON THIS SIDE OF NIH, I
THINK MORE ABOUT WHAT WE CAN DO.
AND SO ONE EXAMPLE WAS WANTING
TO BRING -- INCREASE THE
PREVALENCE OF INCREASE UPTAKE OF
HPV VACCINATION IN CHILDREN,
FROM AR PREVENTION SPEER
TECH -- PERSPECTIVE.
ALSO PSYCHOLOGICAL AND
BEHAVIORAL SERVICES FOR PEOPLE
DIAGNOSED WITH CANCER, ANY
VARIETY OF CANCERS.
SO IN BOTH CASES, YOU HAVE
EVIDENCE-BASED INTERVENTIONS,
YOU'RE IN LARGE HEALTH SYSTEMS
THAT I THINK THE PROVIDERS AND
THE SYSTEM UNDERSTAND THE
IMPORTANCE OF THESE FACTORS, BUT
YOU'RE SEEING MINIMAL UPTAKE,
SEEING VERY FEW SERVICES BEING
OFFERED, AND YOU'RE SEEING A LOW
UTILIZATION EVEN WHEN THE
SERVICES EXIST.
WE WANT TO ADDRESS THOSE ISSUES.
SO, ONE OF THE THINGS THAT WE
BENEFITED FROM WAS NIH SUPPORT
TO BE ABLE TO CONDUCT THIS WORK.
I WILL SAY THAT MOST OF THE
GRANTS, WE THINK ABOUT R01
EQUIVALENT GRANTS, THOSE MIGHT
BE FOR AN INVESTIGATOR LEVEL,
YOU CAN CONDUCT EFFECTIVE
RIGOROUS DISSEMINATION AND
IMPLEMENTATION SCIENCE USING AN
R01.
WE'VE DONE THAT.
AND OTHER KINDS OF MECHANISMS
THAT EVEN THOUGH IT'S FOR, YOU
KNOW, AN INVESTIGATOR OR A
MULTIPLE P.I. TEAM, IT'S THAT
LEVEL OF FUNDING.
YOU CAN BE SUCCESSFUL.
HOWEVER, YOU WILL HAVE TO OBTAIN
THE BUY-IN OF PEOPLE WITHIN THE
SYSTEM AT MULTIPLE LEVELS BEFORE
THE PROJECT IS EVEN SUBMITTED.
YOU'RE DOING, YOU KNOW, THINGS
LIKE QUALITY IMPROVEMENT
PROJECTS, THINGS YOU CAN DO
WITHIN THE SYSTEM TO GAIN
PROOF-OF-CONCEPT FOR YOUR WORK
AND GENERATE INITIAL DATA ON THE
PROCESS VARIABLES, YOUR ABILITY
TO ENGAGE WITH PARTNERS IN THE
SYSTEM.
WE DID BOTH OF THOSE THINGS IN
TERMS OF ENGAGEMENT WITH THE
SYSTEM, WE KNEW WE HAD TO NOT
ONLY THINK ABOUT THE END USER SO
WOULD THE CHILDREN BE
VACCINATED, WOULD THE PEOPLE WHO
HAVE BEEN DIAGNOSED WITH CANCER
WHO HAVE A TOBACCO HISTORY,
WOULD THEY BE WILLING TO ENGAGE
IN COGNITIVE BEHAVIORAL THERAPY,
FOR OTHER ADDICTIONS, WE ALSO
HAD TO WORK WITH PROVIDERS, WORK
WITH CLINICIANS WHO WOULD BE,
YOU KNOW, IN THE ROOMS TALKING
WITH PATIENTS AND ENCOURAGING
THEM TO PARTICIPATE.
SO, THERE WAS YEARS OF WORK THAT
WENT INTO THE ENTIRE PROJECT.
WE WERE ULTIMATELY SUCCESSFUL
BUT I THINK WHAT NIH CAN DO TO
FACILITATE THATTA IS TO MAKE
EXPLICIT THE INTERESN THIS
KIND OF WORK.
WE KNOW THE CURRENCY FOR
ACADEMIC CENTERS AND
RESEARCHERS ARE PUBLICATIONS AND
NUMBER OF GRANTS.
AND SO I THINK IF NIH CAN BE
MORE EXPLICIT AND NIDCD CAN BE
EXPLICIT THAT WOULD BE ONE
THING.
WE SAW THIS EVEN WHEN WE LOOKED
AT -- WHEN THE PANDEMIC STARTED.
THERE WAS THIS INFLUX OF
INTEREST IN COMMUNITY ENGAGED
SCIENCE.
IT HAD ALREADY BEEN A PART OF
NIH IN THE PAST BUT YOU REALLY
SAW AN ELEVATED AMOUNT OF
ATTENTION TO COMMUNITY ENGAGED
SCIENCE.
WITH THAT MANY INSTITUTES
AND CENTERS WITHIN NOTICES OF
FUNDING OPPORTUNITY INCLUDING AN
INTEREST IN PROJECTS THAT WOULD
BE COMMUNITY ENGAGED SCIENCE AND
AS A RESULT WE SAW THREE,
FOUR-FOLD INCREASES IN THE
NUMBER OF APPLICATIONS THAT CAME
IN FOCUSED ON COMMUNITY ENGAGED
SCIENCE TOPICS.
I THINK NIH MAKING THAT CLEAR, I
THINK PROGRAM OFFICIALS AND
OTHERS DEVELOPING RESEARCH
CONCEPTS WHEN THEY ARE THINKING
ABOUT THAT, THEY CAN INTEGRATE A
SYSTEMS LEVEL FOCUS AND SOME
TOPICS LISTED OFNTEREST TO THE
INSTITUTE I THINK WOULD BE
IMPORTANT.
WITH THAT, SOMETIMES IT DOES
REQUIRE REVISING OR MAKING SURE
THERE ARE SPECIFIC REVIEW
CRITERIA, SO REVIEWERS PICK UP
AND UNDERSTAND THE DIFFERENCES
BETWEEN THE KINDS OF PROJECTS
THAT WOULD BE DISSEMINATION
IMPLEMENTATION SCIENCE, HYBRID
EFESS IMPLEMENTATION
STUDIES THAT MAY NOT BE ON THE
RADAR OF REVIEWERS, SO THEY MAY
HAVE, YOU KNOW, LOWER IMPACT
SCORES OVERALL.
I THINK HAVING SOME EXPLICIT
CRITERIA AROUND WHAT RIG
PROJECTS LOOK LIKE WOULD BE ALSO
SOMETHING TO CONSIDER.
AND THEN OF COURSE I THINK
ENCOURAGING PROJECTS THAT REALLY
ARE FOCUSED ON CENTERING
PARTNERSHIPS, AT ANY LEVEL OF
ANY SYSTEM YOU'RE GOING TO NEED
PARTNERS.
SO I THINK REQUIRING
INVESTIGATORS TO DEMONSTRATE
THAT THEY HAVE DONE THE LEG WORK
PRIOR TO SUBMITTING TO DEVELOP
THOSE PARTNERSHIPS WOULD BE
IMPORTANT.
INVESTIGATORS AND SYSTEMS EYE
LIKE RESPOND TO NIH AND TO
RESPOND TO THE THINGS THAT NIH
DOES THAT WE'RE INTERESTED IN.
SO I THINK MAKING THAT EXPLICIT
IN WHAT WE'RE DOING, PROVIDING
THE MECHANISMS AND RESOURCES TO
DO IT WHETHER A SPECIFIC RFA ON
THIS TOPIC OR IF IT'S
INCORPORATING IT INTO, YOU KNOW,
THE PARENT DISSEMINATION AND
IMPLEMENTATION SCIENCE PAR THAT
DR. ZENK MENTIONED, I THINK ALL
THOSE CAN BE IMPORTANT.
>> DO YOU KNOW OF EXAMPLES OF
D&I RESEARCH THAT TAKES PLACE IN
A HEALTH SYSTEM OR IN A
COMMUNITY THAT THEN ESTABLISHES
AN ONGOING RELATIONSHIP?
SO ONE OF THE CHALLENGES I THINK
IS DEVELOPING ALL OF THESE
PARTNERS, YOU KNOW, AND
DEVELOPING TRUST, AND I THINK
THE CARE FOR HEALTH PROGRAM THAT
SHANNON ALLUDED TO ATTEMPTS TO
GO INTO A COMMUNITY AND NOT JUST
HAVE A FIVE-YEAR FUNDING CYCLE,
BUT SOMETHING THAT'S ONGOING.
SO IT SEEMS LIKE ONGOING
RELATIONSHIPS ARE IMPORTANT FOR
D&RCH TO CHANGE THE WAY
THAT HEALTH SYSTEMS WORK.
SO, ARE WE DOING THAT
EFFECTIVELY?
ARE THERE WAYS WE COULD DO IT
BETTER WITHIN THE TRADITIONAL
R01 MODEL?
>> I THINK AS I'LL TAKE THE
FIRST STAB AT THIS, I THINK
WE'RE NOT DOING AS WELL AS WE
COULD BUT I DON'T THINK IT'S ALL
ON THE PART OF NIH.
I THINK INVESTIGATORS WHO ARE
DEVELOPING INTERVENTIONS AND
TREATMENTS SHOULD THINK AT THE
OUTSET IF I DEVELOP SOMETHING
EFFECT
EFFECTIVE WHERE DO I WANT IT TO
GO, NOT THE ENDPOINT THE PEER
REVIEWED PEER
REVIEWED PUBLISH CASE IN THE
GH E JOURNAL.
BRINGING PARTNERS IN AT THE
BEGINNING SO IF SUCCESSFUL YOU
HAVE BUY IN, IF THIS IS
SUCCESSFUL THEY WOULD
IMPLEMENTING.
YOU WANT THE INTERVENTION THEN
WELL INTEGRATED INTO AN EXISTING
SYSTEM.
AN EXAMPLE I DEVELOP A TOBACCO
CESSATION INTERVENTIONCECULTURAN
ADULTS.
IF EFFECTIVE, I WANTED TO MAKE
SURE IT COULD BE DISSEMINATED AS
WIDELY AS POSSIBLE, NOT SIT ON
THE SHELF OR JUSTING IN -- JUT
BE IN A JOURNAL.
WHAT MIGHT BE IT SYSTEM TO HAVE
THE INFRASTRUCTURE TO
DISSEMINATE IF SUCCESSFUL, I
THOUGHT ABOUT THAT AT THE
BEGINNING, BROUGHT IN THOSE
PARTNERS, CHOSE TO ENGAGE THE
QUIT LINE.
THERE'S A TOBACCO QUIT LINE IN
EVERY STATE.
THERE ARE TWO COMPANIES WHO
OPERATE ABOUT 80% OF THE
COUNTRY'S QUIT LINES.
IF WE CAN DEVELOP AN
INTERVENTION WE WANT THEM EARLY
AND WANT TO DISCUSS WITH THEM
THE POTENTIAL OF INTEGRATING
THIS INTO THEIR MODEL OF CARE.
SO WE DID THAT AT THE VERY
BEGINNING BEFORE WE
NTED
BE INTERVENTIONVE WHICH WAS A
VIDEO-BASED INTERVENTION AND
TRANSLATED INTO A MOBILE HEALTH
FORMAT ONCE WE DEMONSTRATED IN A
LARGE TRIAL, WE HAVE A PILOT
FEASIBILITY, CONDUCTED ON PILOT
FUNDS, TO DEMONSTRATE THAT THIS
COULD WORK.
AND THEN WE INTEGRATED THROUGH
FUNDING INTO A QUIT LINE, TESTED
IT, AFTER EFFECTIVE AND
DEMONSTRATED TO BE EFFICACIOUS
BOTH OF THE LARGEST QUIT LINES
PICKED THAT INTERVENTION UP.
IT'S NOW INTEGRATED INTO 80% OF
THE COUNTRY'S QUIT LINES,SOMEONY
AS BEING BLACK OR AFRICAN
AMERICAN, THEY HAVE THE OPTION
OF RECEIVING THIS INTERVENTION.
THAT'S MY BIGGEST MOST PROUD AS
AN INTERVENTIONIST, THAT'S WHAT
YOU WANT, YOU WANT YOUR
INTERVENTION TO REACH PEOPLE.
WE'RE ABLE TO GENERATE AND THEY
ARE ABLE TO GENERATE THEIR OWN
DATA ON UTILIZATION, ARE PEOPLE
INTERESTED, PICKING IT UP, WHAT
ARE THE OUTCOMES, AND COMPARE TO
PEOPLE WHO ELECTED NOT TO
RECEIVE BECAUSE IT'S OPTIONAL.
I THINK AT THE BEGINNING YOU
WANT TO THINK ABOUT THE LONG
GAME, IF YOU SOMETHING EFFECTIVE
WHERE IS IT GOING NEXT?
>> THANK YOU.
>> THERE ARE A COUPLE PLACES
WHERE THE NIH STRUGGLES TO
SUPPORT TEAMS THAT WANT TO
INCORPORATE COMMUNITIES.
ONE IS THAT IF YOU HAVE AN
INTERVENTION IN MIND IT'S GREAT
TO GO TO A COMMUNITY AND PARTNER
WITH THEM.
SOMETIMES COMMUNITIES RESME
PRIORITIESESRE NOT THE
SAME AS THE INVESTIGATOR,
THERE'S SOME INVESTMENT REQUIRED
TO ESTABLISH THE RELATIONSHIP IN
THE FIRST PLACE.
IT'S NOT CLEAR WHETHER THAT'S
RESPONSIBILITY OFIL THE
INVESTIGATORS AND INSTITUTIONS
OR WHETHER THE NIH SHOULD PLAY A
ROLE IN THAT BUT THERE'S NO
MECHANISM TO START TO ESTABLISH
THOSE RELATIONSHIPS.
SOMETIMES WHEN RELATIONSHIPS
ALREADY EXIST THEY CAN BE
LEVERAGED SUCCESSFULLY TO WRITE
A GRANT BUT IT'S HARDER WHEN
YOU'RE AT EARLIER STAGE.
ANOTHER ISSUE WE'VE ENCOUNTERED
AS PART OF THE IMPLEMENTATION
SCIENCE HUB AND IMPROVE
INITIATIVE IS THAT THE
STRUCTURES IN THE NIH, YOU COULD
SAY CREATING A BIOSKETCH, AS WE
PUT TOGETHER OUR IMPLEMENTATION
HUB, A PARTNER SAID IS THAT?
WE HAD TO WRITE IT.
OTHER CENTERS IN THE INITIATIVE
WHERE THEY HAD TO PUT TOGETHER
TEN OR FIFTEEN OR TWENTY
BIOSKETCHES BECAUSE THEY
COULDN'T SUBMIT THE APPLICATION
WITHOUT A DOCUMENT, RIGHT?
THERE WASN'T A WAY TO SAY THIS
IS A COMMUNITY PARTNER, THEY
DON'T HAVE A BIOSKETCH, CAN WE
STILL MOVE FORWARD, SO THERE'S
STRUCTURAL THINGS THAT COULD
CHANGE TO HELP.
AND THE LENGTH OF FUNDING
MECHANISMS YOU'VE HEARD ABOUT.
SOMETIMES MAKE IT DIFFICULT FOR
SUSTAINMENT BUT I THINK THERE
ARE POTENTIALLY SOME MECHANISMS,
WHETHER COMPETING RENEWALS OR
OTHERS THAT MIGHT HELP, BUT THE
FIVE-YEAR FOUR-TO FIVE-YEAR
TIMELINE CAN BE CHALLENGING FOR
COMMUNITIES.
>> IT'S ONE THING THE CARE FOR
HELP INITIATIVE IS HOPING TO
ADDRESS BUT THAT'S ONE PROBLEM.
>> HOLLY?
>> EVERYONE COVERED THAT WELL.
>> WE DO HAVE AN INTRAMURAL
PROGRAM AS WELL.
ONE OF THE STRENGTHS OR
ADVANTAGES IS WE'RE NOT RELIANT
ON THESE FIVE-YEAR FUNDING
CYCLES.
WE'RE ACCOUNTABLE AT THE BACK
END.
SO WE HAVE THE CAPACITY TO
DEVELOP LONGSTANDING
RELATIONSHIPS AND SEE OUR
DISCOVERIES THROUGH TO
IMPLEMENTATION SO I THINK
THINKING ABOUT HOW THE
INTRAMURAL PROGRAM, RIGHT, CAN
ADVANCE THE FIELD IS IMPORTANT
AS WELL.
>> GREAT POINT.
NEXT QUESTION IS FOR DR.
STORKEL.
A KEY CHALLENGE FOR
COMMUNICATION DISORDERS
RESEARCHERS WHO WANT TO ENGAGE
IN DISSEMINATION AND
IMPLEMENTATION RESEARCH IS
BUILDING THESE PARTNERSHIPS WITH
D&I EXPERTS, COMMUNITY MEMBERS,
PROFESSIONALS, SYSTEM LEADERS
LIKE THOSE IN SCHOOLS AND
HOSPITALS.
TIME AND EFFORT ARE NEEDED TO
ESTABLISH THESE RELATIONSHIPS AS
WE'VE JUST DISCUSSED, AND
POTENTIAL PARTNERS FACE
CHALLENGES PARTICIPATING IN
COLLABORATIONS, PARTICULARLY DUE
TO HEAVY DEMANDS FOR THEIR TIME.
SO, DR. STORKEL, WHAT ADVICE DO
YOU HAVE FOR RESEARCHERS WHO ARE
LOOKING TO ESTABLISH THESE
RELATIONSHIPS AND BUILD
COMPETENCIES FOR
MULTI-DISCIPLINARY TEAM?
>> WE'VE COVERED A LOT OF GOOD
POINTS, REALLY GOOD CHALLENGES.
ONE OF THE THINGS YOU HEAR IS
YOU HAVE TO START BUILDING THAT
PARTNERSHIP BEFORE YOU REALLY
NEED IT.
IN SOME WAYS A DATING ANALOGY
WORKS, SECOND DATE ISN'T GETTING
THERE,NTING GOING ZERO
TO A HUNDRED, YOU HAVE TO BUILD
UP RELATIONSHIP AND
UNDERSTANDING, HOW DOES THAT
START?
MUCH LIKE DATING YOU HAVE TO GO
WHERE THE PEOPLE ARE YOU WANT TO
COLLABORATE WITH.
THEY ARE NOT GOING TO KNOCK ON
YOUR DAY, HEY, WERE YOU THINKING
ABOUT DOING A RESEARCH PROJECT?
I MIGHT BE INTO THAT.
YOU'VE GOT TO GO TO WHERE THE
PEOPLE ARE.
YOU NEED TO FIGURE OUT WHERE ARE
THE PRACTITIONERS, THE PATIENTS,
AND GO TO THEM AND LISTEN TO
THEM, FIND OUT WHAT IT IS THAT
THEY ARE TALKING ABOUT THAT THEY
ARE CONCERNED ABOUT.
YOU CAN ALSO CREATE EVENTS TO
ATTRACT THE PARTNERS TO YOU.
SO, FOR EXAMPLE, IF YOUR
PRACTITIONER BASE NEEDS TO DO
PROFESSIONAL DEVELOPMENT HOURS,
CONTINUING EDUCATION, YOU CAN
OFFER THAT ACTIVITY FOR FREE SO
THEY WILL COME TO YOU AND YOU
CAN FIND OUT MORE ABOUT WHAT
THEY ARE DOING.
I SAW ON SOCIAL MEDIA ONE OF OUR
P.I.s HAD AN OPEN LAB, INVITED
REFERRAL SOURCES AND
PARTICIPANTS TO COME AND FIND
OUT WHAT THEY HAD BEEN DOING
RESEARCH ON.
L ATTENDED.
PEOPLE CAME AND SEEMED REALLY
INTERESTED TO LEARN MORE WHAT
WAS HAPPENING.
I ALSO ENCOURAGE SOME LEGAL
CYBER STALKING.
PEOPLE HAVE LOTS OF INFORMATION
ON THEIR WEB PAGE AND PEOPLE
RARELY TAKE ADVANTAGE OF IT.
BUT THERE'S STRATEGIC PLANS,
ANNUAL REPORTS, THERE'S MINUTES
FROM MEETINGS THAT CAN START TO
HELP YOU UNDERSTAND LIKE WHAT IS
THIS GROUP INTERESTED IN, AND
YOU MIGHT NOT FIND A GROUP WHO
IS NECESSARILY SPECIFICALLY
INTERESTED IN HEARING AN OLDER
ADULT BUT MIGHT BE INTERESTED IN
OLDER ADULT ADULTS AND THERE ME
COMMON GROUND.
YOU HAVE TO TAKE THAT TIME TO
GET TO KNOW PEOPLE.
AND WHEN YOU'RE STARTING TO WANT
TO ACTUALLY COLLABORATE, YOU
ALSO WANT TO THINK OF A
CONTINUUM OF ENGAGEMENT.
YOUR SECOND DATE ISN'T GETTING
MARRIED.
IT'S MORE LET'S MEET IN A PUBLIC
PLACE, DO AN EVENT THAT TAKES
EXACTLY ONE HOUR SO WE'RE
INVESTING THIS MUCH TIME, GETS
TO THE ISSUE OF TIME MANAGEMENT
YOUR PARTNERS NOT BE READY TO
JUMP ON BOARD, GRANT
APPLICATION, CREATING
BIOSKETCHES.
THINK ABOUT DIFFERENT WAYS YOU
CAN INVOLVE POTENTIAL PARTNERS
IN A WAY THAT PROTECTS THEIR
TIME, THAT LETS THEM GET TO KNOW
YOU.
SO, FOR EXAMPLE, A COMMUNITY
ADVISORY BOARD IS ONE WAY THAT
IS A PRETTY LIGHT LIFT FOR OTHER
MEMBERS TO HAVE INVOLVEMENT IN
YOUR RESEARCH.
THAT'S USUALLY SET UP ASAL
SOMETHING LIKE A MONTHLYEETING
THAT'S ONLY AN HOUR LONG WITH A
LITTLE BIT OF PREP BEFORE, A
LITTLE AFTER.
SO IT'S VERY TIME LIMITED, THIS
IS WHAT THE TIME IS THAT I'M
ASKING OF YOU.
AND Y OFOURSE THE TOPIC
NEEDS TO BE SPECIFIED.
BUT THERE'S STILL FLEXIBILITY IN
THAT TOO WHERE YOU CAN BRING
THINGS TO THE COMMUNITY ADVISORY
BOARD AND MIGHT FIND OUT THEY
DON'T HAVE THOUGHTS ABOUT THAT
OR I DIDN'T PRESENT THAT IN A
YOU START TO LEARN THA L CAPACIY
BUILDING PART OF WHAT DO THEY
KNOW ABOUT RESEARCH, A LOT OF
TIMES WE MAKE ASSUMPTIONS THAT
EVERYONE KNOWS HOW RESEARCH
WORKS OR EVERYONE IS ON THE SAME
PAGE, SO YOU START TO LEARN THE
KINDS OF THINGS THAT YOU NEED TO
HELP YOUR PARTNERS UNDERSTAND
AND BE READY TO PARTICIPATE IN
AND WHAT'S REALISTIC IN THAT
REGARD.
THE OTHER THING THAT'S COME UP
HERE IS CURRENCY.
SO CURRENCY IS REALLY IMPORTANT
THAT YOUR PARTNERS NEED TO GET
SOMETHING OUT OF THIS.
THEY ARE NOT JUST HELPING YOU.
THAT'S NOT A PARTNERSHIP.
THEY DO THINGS FOR YOU AND YOU
GET A LOT OUT AND THEY GET
NOTHING.
EVERYONE HAS TO GET SYO
OUT OF IT.
THERE HAS TO BE SOME EQUITY
IN WHAT YOU'RE GETTING.
SO CURRENCY GETS AT WHAT DO YOU
GET OUT OF THIS THAT YOU CAN
SPEND THAT IS USEFUL TO YOU?
FOR SOME PARTNERS MAYBE THAT'S
PUBLICATIONS AND GRANTS.
FOR A LOT OF PARTNERS THAT'S NOT
IT AT ALL.
THEY WANT TO MAYBE BRING ON A
NEW SERVICE THEY CAN BILL FOR,
FOR EXAMPLE.
WE SHOULDN'T IGNORE THE FACT
THAT THERE ARE FINANCIAL
PRESSURES AND DIFFERENT
ENVIRONMENTS THAT DRIVE SOME OF
WHAT HAPPENS.
THEY MIGHT BE MOTIVATED BY
YUTCOMES OR BY BETTER USE
OF THEIR WORKFORCE AND THINGS
LIKE THAT.
SO YOU REALLY NEED TO UNDERSTAND
WHAT IT IS THAT MOTIVATES THEM
AND MAKE SURE THAT THEY ARE ABLE
TO GET THEIR CURRENCY OUT OF THE
PARTNERSHIP AND THAT YOU'RE NOT
JUST TAKING, YOU'RE GIVING, AND
THERE'S SOME RECIPROCITY BETWEEN
THE
WO.
THE LAST THING I WANT TO TALK
ABOUT TOO IS I THINK SOMETIMES
YOU CAN FIND PEOPLE IN AN
ORGANIZATION THAT RESONATE WITH
YOU AND ARE ON BOARD WITH DOING
SOME TYPE OF A PROJECT.
WE'VE ALSO MENTIONED HERE
SYSTEMS.
YOU NEED MORE THAN JUST A
PERSON.
YOU NEED SYSTEMS INVOLVED.
SO, IT IS IMPORTANT TO HAVE FACE
TIME WITH LEADERSHIP AND TO
BUILD TRUST WITH PEOPLE IN
LEADERSHIP POSITIONS, NOT JUST
MAYBE THE FRONTLINE WORKERS WHO
MAY BE VERY MUCH MOTIVATED TO
SEE CHANGE IN THEIR PATIENTS AND
IMPROVE OUTCOMES.
YOU ALSO NEED TO GET THE BUY-IN
FROM HIGHER UP SO YOU NEED THINK
ABOUT THAT MULTIPLE LEVELS OF
ENGAGEMENT AND, AGAIN, A
DIFFERENT MAYBE CONTINUUM OF
ENGAGEMENT.
MAYBE THE CHAMPION IS SOMEONE
WHO IS GOING TO GIVE A LOT MORE
TIME AND BE VERY INVOLVED, BUT
YOU STILL NEED AT LEAST A LITTLE
BIT OF RELATIONSHIP WITH SOME
HIGHER-UP PEOPLE WHO ARE THE
ONES WHO ARE GOING TO APPROVE
YOUR CHAMPION'S TIME TOWARDS THE
PROJECT AND THINGS LIKE THAT.
SO YOU HAVE TO REALLY BUILD THAT
WHOLE SUPPORT AND TRUST WITHIN
THE ORGANIZATION AND NOT JUST AN
INDIVIDUAL PERSON.
>> I WOULD ADD ONE MORE THING TO
HOLLY'S COMMENTS, WHICH I AGREE
W WHEN WE'RE THINKING ABOUT
ENGAGING COMMUNITIES, SOME
INSTITUTIONS HAVE HISTORIES OF
EXTRACTIVE OR TRANSACTIONAL
RELATIONSHIPS WITH COMMUNITIES,
SO INVESTIGATORS ARE GOING INTO
COMMUNITIES THEY NEED TO
RECOGNIZE THAT.
IF THERE'S A HISTORY OF
INSTITUTION EXPLOITING A GIVEN
COMMUNITY, THAT PROBABLY NEEDS
TO BE RECOGNIZED AT SOME LEVEL,
OR IF INSTITUTIONS THEMSELVES
HAVE ADVERSARIAL RELATIONSHIPS
THAT MAY NEEDS TO BE
ACKNOWLEDGED AS PRECURSOR TO
DEVELOPING A PRODUCTIVE
PARTNERSHIP.
>> GREAT POINTS.
DR. LANE-FALL, SINCE YOU I THINK
CHAIR ONE OF THE STUDY SECTIONS
SIDERS THESE
APPLICATIONS, WHAT ARE IN THE
REVIEW PROCESS, AS, REVIEWERS AE
CONSIDERING PROPOSAL WHAT ARE
SOME MAJOR THINGS THAT TRIP UP
APPLICANTS?
>> ON BEHALF OF MYSELF AND NOT
THE NIH A PAPER WAS SPEAR NEEDED
BY ENOLA PROCTOR, IS THERE A
TEAM CAPABLE OF DOING THE WORK,
SOMEONE ON THE TEAM THAT'S AN
IMPLEMENTATION SCIENTIST THAT
DEMONSTRATED THEY ARE ABLE TO
ENGAGE IN THAT FIELD,
PUBLICATIONS, THEY HAVE GRANTS,
THEY HAVE SOME SORT OF
DEMONSTRATED ABILITY TO ENGAGE
WITH THE FIELD.
THEY DON'T NECESSARILY NEED TO
BE THE P.I. BUT THERE DOES NEED
TO BE SOMEONE STRONG IN
IMPLEMENTATION SCIENCE ON THE
TEAM WHO UNDERSTANDS THE FIELD.
YOU WANT TO MAKE SURE THAT THE
THING THAT'S GOING TO BE
IMPLEMENTED IS READY, THERE'S
SOME JUSTIFICATION THAT COMES IN
SIGNIFICANCE, RIGHT?
SHOULD THIS BE DONE, CAN IT BE
DONE, CAN IT BE DONE WELL?
BUT SHOULD IT BE DONE NEEDS TO
BE ADDRESSED EXPLICITLY.
ALSO THE PARTNERSHIP, COMMUNITY
PARTNERSHIP, WE WANT TO KNOW
TEAM B ENTIR OFT JUST RESEARCH J
STAKEHOLDERS THAT MIGHT BE
ENGAGED OR PART OF THIS.
THERE'S ACIFIC APPROACH TO
ENTS, SPECIFIC APPROACH
TO UNDERSTANDING THREATS TO
INFERENCE.
IT'S VERY COMMON TO SEE MIXED
METHODS, A REALLY E PUT OUT
ON QUALITATIVE METHODS AN
IMPLEMENTATION SCIENCE, I FORGET
WHICH INSTITUTE, IT'S HARD JUST
WITH NUMBERS.
IF PEOPLE AREN'T TALKING TO
FOLKS GETTING MORE RICH INSIGHT
THAT'S SOMETHING THAT CAN TRIP
FOLKS UP.
I'D SAY IT'S THOSE THINGS THAT
COME UP, BUT IT'S ALL CONTENT
AREAS, IT'S ALL HEALTH CARE
SETTINGS.
IT'S A REALLY INTERESTING SORT
OF SWATH OF STUDIES WE SEE.
I'LL OFTEN SEND PEOPLE TO NIH
REPORTER TO THE MATCHMAKER, TYPE
IN IMPLEMENTATION SCIENCE, CLICK
ON SIHH, STUDY SECTION, OR DIRH
IS THE OLD ONE.
YOU CAN SEE WHAT'S BEEN FUNDED.
IT'S JUST ACROSS THE BOARD CLEAN
COOK STOVES IN INDIA, IT'S, YOU
KNOW, GUN SAFETY, ACTUALLY NINR
WAS JUST FUNDED AT UNIVERSITY OF
PENNSYLVANIA, IT'S GUN SAFETY
AND KIDS.
IT'S ACROSS THE BOARD.
>> GREAT.
THANK YOU.
SO I THINK WE HAVE TIME FOR ONE
LAST QUESTION.
AND MEGHAN, WEKED ABOUTALS
EARLIER.
THIS HASRL TO DO WITH PROCESS AD
PROCEDURE AROUND PROMOTION AND
TENURE, EVALUATION OF PUBLISHING
AND FUNDING.
A LOT OF THIS IS GEARED MORE
TOWARDS TRADITIONAL RESEARCH
APPROACHES, NOT SO MUCH
IMPLEMENTATION SCIENCE.
SO, THIS IS A DISADVANTAGE, AND
THAT CAN DETERHERS, I,
THINK YOU ALLUDED TO THAT.
D&I CHAMPIONS ARE NEEDED TO
CHANGE EXISTING PROCESSES AND
PROCEDURES, TO BE MORE INCLUSIVE
OF D&I RESEARCH, EXAMPLES FROM
OTHER FIELDS THAT ARE
ENGAGED IN D&I RESEARCH CAN BE
USED TO IDENTIFY SPECIFIC
CHANGES THAT SUPPORT
INVESTIGATORS AND RESEARCH
ENDEAVORS, HOW CANUPPORT H
THIS?
>> I APPRECIATE THE QUESTION.
I'LL ASK MY PANELISTS TO
ABO TOO.
THE FUNDING IS PART OF IT,
RIGHT?
I'M AN ANESTHESIOLOGIST, MANY
RESEARCHERS IN ANESTHESIOLOGY
ARE IN BASIC SCIENCE, STUDYING
MECHANISMS OF ANESTHESIA.
BUT WHEN I SHOWED UP WITH MY
INTERVIEW GUIDE TO MY CHAIR,
VICE CHAIR FOR RESEARCH, THEY GO
WHAT IS THIS?
NIH FUNDS IT.
OH, THAT'S INTERESTING.
SO EVEN JUST FUNDING THE WORK I
THINK IS PART OF IT.
PUTTING OUT SPECIFIC CALLS FOR F
FUNDING OPPORTUNITIES, BUT THE
TRAINING COMMUNITIES THE NIH HAS
CREATEDR TIME ARE REALLY
PORTANT TOO.
ONE EXAMPLE WAS TIDRH, TRAINING
INSTITUTE ON RESEARCH AND
IMPLEMENTATION RESEARCH, I
FORGET WHAT IT STANDS FOR, A
TRAINING INSTITUTE ON
IMPLEMENTATION SCIENCE.
THERE'S AN OFFSHOOT, RUN OUT OF
WASHINGTON UNIVERSITY IN
ST. LOUIS, FOCUSED ON CANCER,
NIH PARTNERED WITH ACADEMY
HEALTH TO PUT ON THE CONFERENCE,
THE D&I CONFERENCE, THE
MOUTHFUL.
NHLBI HAS FUNDED A PROGRAM
CALLED RISE UNDER THE UMBRELLA
OF PRIDE PROGRAM TO INCREASE
REPRESENTATION FROM PEOPLE IN
HISTORICALLY DISADVANTAGED
BACKGROUNDS, THAT'S AN
IMPLEMENTATION SCIENCE TRAINING
PROGRAM OVER TWO YEARS,
PARTIALLY IN PERSON, PARTIALLY
REMOTE.
BUT THERE HAVE BEEN A NUMBER OF
DIFFERENT TRAINING OPPORTUNITIES
THE NIH HAS CREATED WHICH HAVE
SIGN-POSTED THE IMPORTANCE OF
THE FIELD TO THE NIH.
AND SO I THINK FROM THE FUNDING
OPPORTUNITIES, TRAINING
OPPORTUNITIES, HAVING
CONFERENCES LIKE THIS ONE, IT'S
REALLY ABOUTERATINGEN
CONVERSATION TO SHOWCASE T
IMPORTANCE OF IMPLEMENTATION
SCIENCE TO THE FIELD.
BUT WHERE CAN YOU GO FROM HERE?
I THINK IMPLEMENTATION SCIENCE
IS A SET OF TOOLS THAT'S GOING
TO BE USEFUL IN REALIZING THE
PROMISE OF INNOVATIONS THE NIH
HAS FUNDED.
AND ONE OF THE THINGS THAT I
TALK ABOUT, THAT I'VE TALKED
ABOUT RECENTLY, IS THAT JUST AS
EVERY CLINICAL TRIAL SHOULD HAVE
A BIOSTATISTICIAN, I BELIEVE
EVERY CLINICAL TRIAL SHOULD HAVE
AN IMPLEMENTATION SCIENTIST.
EVERY CLINICAL TRIAL SHOULD HAVE
SOMEONE THINKING ABOUT HOW DOES
THIS ACTUALLY GET INTO THE REAL
WORLD, EVEN IF THAT'S NOT THE
MAIN FOCUS OF THE TRIAL, IT
SHOULD BE A THOUGHT.
IT SHOULD BE PART OF THE
DISSEMINATION PROCESS, PART OF
THE PLANS FOR FUTURE RESEARCH,
SHOULD BEHINKING ABOUT
IMPLEMENTATION.
SO I THINK ONE OF THE THINGS THE
NIH COULD DO IS REALLY ASK
INVESTIGATORS TO CONSIDER
IMPLEMENTATION IMPLICATIONS OF
THE WORK THEY PROPOSE EVEN IF
IT'S THEORETICAL, MAYBE
SPECULATIVE, BUT AT LEAST THINK
ABOUT IT.
I'M REALLY EXCITED ABOUT WHAT
THE NIH HAS DONE SO FAR AND I
THINK THERE'S ADDITIONAL STEPS
THE NIH COULD TAKE TO SUPPORT
PEOPLE TRYING TO SORT OF BUILD
THEIR CAREERS ON THIS FIELD.
>> GREAT POINTS.
ANY OTHER COMMENTS?
>> YEAH, I ENDORSE ALL OF A THA.
I'D SAY FROM A PERSONAL
EXPERIENCE WE'VE PUT OUT NOW
SOME FUNDING OPPORTUNITIES THAT
HAVE REQUIRED COMMUNITY
ENGAGEMENT, UIRED
QUALITATIVE METHODS, HAVE GONE
TO PANELS THAT HAVEN'T TYPICALLY
LIKED THOSE THINGS.
WHEN YOU SAY YOU HAVE TO HAVE
THAT AS AN ENTRY INTO THIS
COMPETITION, PEOPLE DO IT AND
THAT THE STAMP OF
APPROVAL.
IT SORT OF SAYS NIH WANTS THIS.
AND THERE'S LOTS IN THE FIELD,
MANY ORGANIZATIONS HAVE BEEN
TALKING ABOUT THE IMPORTANCE OF
IMPLEMENTATION SCIENCE BUT I DO
THINK IT CARRIES MORE WEIGHT
WHEN NIH OR NIDCD ENDORSES
SOMETHING BECAUSE IT'S NOT ONLY
THIS IS IMPORTANT BUT WE'LL PAY
FOR IT.
BUT WE'LL PAY FOR IT IS THAT,
OH, THIS IS SERIOUS.
THEY MEAN BUSINESS.
SO I THINK IT IS EVERYTHING YOU
SAID.
I THINK IT'S ABSOLUTELY RIGHT,
IT ELEVATES THESE METHODS THAT
MAYBE HAVEN'T BEEN MAINSTREAM
AND START TO BRING THEM IN THE
MAINSTREAM GIVING THEM THIS
STAMP OF APPROVAL THAT'S VERY
MUCH RECOGNIZED.
>> THIS HAS BEEN A REALLY,
REALLY RICH DISCUSSION.
I APPRECIATE ALL OF THESE
COMMENTS.
SO WHAT WE'LL DO NOW IS JUST,
YOU KNOW, GIVE EACH OF YOU THE
OPPORTUNITY TO MAKE ANY FINAL
COMMENTS THAT YOU WOULD LIKE TO
MAKE STARTING WITH YOU, DR.
LANE-FALL.
>> SO FIRST I'LL THANK DR.
TUCCI, THANK THE PANELISTS.
THIS HAS BEEN A ROUSING
DISCUSSION, I APPRECIATE THE
OPPORTUNITY SS YOU.
I THINK MY BIG TAKEAWAY POINT IS
A SIMPLE ONE WHICH IS THAT WE
HAVE TO THINK ABOUT HOW TO GET
OUR INNOVATIONS AND PRACTICES OF
INTEREST INTO THE REAL WORLD.
WE HAVE TO THINK ABOUT IT AS
EVERY LEVEL, IT'S NOT THAT EVERY
SCIENTIST ISS GOING TONG BE FOCD
F IMPLEMENTATION BUT WE HAVE TO
THINK ABOUT THAT SORT OF LAST
MILE DELIVERY OF THE SCIENCE
THAT WE CREATE IF WE WANT TO
REALIZE AN IMPACT.
SO MY PUSH, MY SOAP BOX WOULD BE
PLEASE JUST CONSIDER
IMPLEMENTATION AND IF IT'S
SOMETHING YOU'RE INTERESTED IN,
YOU KNOW, TALK TO ME, TALK TO
THE FIELD.
WE'RE HAPPY TO HAVE YOU.
>> DR. WEBB HOOPER?
>> THANK YOU AGAIN FOR HAVING
ME.
FOR ALL OF YOU BEING HERE AND
PAYING ATTENTION.
MY TAKEHOME MESSAGE IS THAT THIS
IS JUST A REALLY GREAT
OPPORTUNITY TO TALK ABOUT THIS
CRITICAL TOPIC.
WE WANT TO MAKE SURETHA
END USERS OF WHATEVER
INTERVENTION WE'RE WORKING ON
HAVE THE OPPORTUNITY TO BENEFIT
FROM IT.
AND WE WANT TO MAKE SURE THAT
BENEFIT IS REALIZED IN AN
EQUITABLE WAY SO NO POPULATIONS
ARE LEFT BEHIND.
AND SO IMPLEMENTATION SCIENCE IS
OFTEN THOUGHT ABOUT AT THE END.
AND SO I AGREE FULLY THAT HAVING
SOMEONE ON THE TEAM TO CONTINUE
TO BRING THAT TO THE FOREFRONT
AND TO REMIND INVESTIGATORS AND
RESEARCH TEAMS AND ALL PARTNERS
THAT THIS IS SOMETHING THAT WE
WANT TO THINK ABOUT.
WE DO TALK ABOUT SCALABILITY AND
SUSTAINABILITY.
WHICH ARE IN THE REALM OF
DISSEMINATION IMPLEMENTATION
SCIENTISTS.
I THINK THERE'S STILL RELATIVELY
FEW CARD-CARRYING D&I
SCIENTISTS, SO THERE MIGHT BE A
NEED TO HAVE MORE IN TERMS OF
NG PROGRAMS, THOSE THAT
REALLY FACILITATE AND REQUEST OR
AT LEAST STRONGLY ENCOURAGE
CROSS-DISCIPLINARY MENTORING
TEAMS.
SO, SOMETIMES THE MENTOR MAY NOT
HE -- IMPLEMENTATION SCIENCE
MENTOR MAY NOT BE AT THE
INSTITUTION OF THE INVESTIGATORS
BECAUSE THEY MAY NOT HAVE
SOMEONE THERE.
THEY CAN'T GO TO THE BIOSTATS
DEPARTMENT, THERE'S NOT SOMEONE
THERE SOMETIMES THOSE PROJECTS
CAN BE REVIEWED IN A LESS
FAVORABLE WAY IF A MENTOR IS NOT
ON SITE, WITH THE IDEA THAT HOW
CAN THEY, YOU KNOW, REALLY
MENTOR THE TRAINEE.
I THINK NOW WITH THE, YOU KNOW,
WITH THE WAY WE DO SO MUCH ON
ZOOM THAT HAS CHANGED IN TERMS
OF PEOPLE THINKING ABOUT HOW
THAT COULD HAPPEN.
BUT I THINK WE NEED TO BE
CONSIDERATE OF THE FACT THAT OUR
TRAINEES MAY NOT HAVE ACCESS TO
SOMEONE WHO IS AT THEIR -- IN
THEIR DEPARTMENT OR EVEN THEIR
INSTITUTION TO DO THIS WORK.
WE NEED TO ENCOURAGE THAT.
I AGREE ABOUT ASKING
INVESTIGATORS WHEN
USTAINABILITY, TO THINK
ABOUT MORE IN TERMS OF
DISSEMINATION AND IMPLEMENTATION
SCIENCE FRAMEWORK.
WE WANT TO ENCOURAGE HOLISTIC
RESEARCH WHERE PEOPLE ARE NOT
THINKING ABOUT JUST, YOU KNOW, A
MOLECULE OR A SET OF ORGANS BUT
WANT PEOPLE TO THINK ABOUT THE
WHOLE PERSON AND I THINK THIS IS
PART OF THINKING ABOUT THE WHOLE
INTERVENTION AND WHOLE TREATMENT
TO THINK ABOUT HOW IT WILL
ULTIMATELY BE IMPL
I THINK WE CAN GET THERE.
>> DR. ZENK?
>> YEAH, THANKS SO MUCH.
I REALLY ENJOYED THIS AND HAVE
LEARNED A LOT.
I GUESS THERE'S A FEW THINGS I
WOULD EMPHASIZE.
ONE IS JUST ENCOURAGING THAT
EQ LENSEQLLYEAINGEA
ATTENTION TO EQUITY AT EVERY
STEP ALONG THE PROCESS.
THINKING ABOUT ALL TYPES OF
SETTINGS, YOU TACKED TALKED ABT
AT THE BEGINNING, HOSPITAL
CLINICS, WORK SITES, SCHOOLS.
IT'S JUST -- YOU KNOW, CRIMINAL
LEGAL SETTINGS, SO MANY MORE
WHERE WE NEED TO MOVE DISCOVERY
INTO PRACTICE.
AND THEN YOU MIGHT GUESS THAT
I'M FROM THE NURSING INSTITUTE
AND SO I AM GOING TO EMPHASIZE
HOW IMPORTANT IT IS TO BRING
NURSES INTO THE CONVERSATION,
NOT ONLY TO LEAD RESEARCH BUT BE
INVOLVED IN ANY OF THE PROJECTS
YOU'RE TALKING ABOUT.
NURSES ARE IN ALL OF THESE
SETTINGS AND PLAY SUCH A
CRITICAL ROLE IN THEIR SUCCESS.
YOU WILL HAVE FEWER HEADACHES
AND MUCH MORE LIKELIHOOD OF
SUCCESS IF YOU ENGAGE NURSES IN
YOUR TEAMS EARLY ON.
>> GREAT POINTS.
>> WONDERFUL.
I HATE TO BE LAST HERE.
EVERYONE HAD SUCH GOOD COMMENTS.
I THINK I'LL PULL THAT TOGETHER
THAT GOING BACK TO WHERE MEGHAN
STARTED US, HAVING PARTNERS,
THINKING FROM THE VERY BEGINNING
WHAT DOES THIS LOOK LIKE IN THE
END, HOW DO WE REALLY GET THERE.
SO TO BE MORE CONCRETE ABOUT
THAT, WHAT I WOULD ENCOURAGE IS,
YOU KNOW, AS YOU'RE DEVELOPING
YOUR INTERVENTION, MAYBE STILL
WORKING ON THE MECHANISMS OF HOW
THINGS WORK, YOU HAVE TO FIGURE
OUT WHAT DOES THE REAL WORLD
LOOK LIKE.
MOST OF US DON'T WORK IN THE
REAL WORLD.
WE WORK IN LABS.
AND SO THAT IS A GOOD STARTING
POINT FOR THINKING ABOUT WHAT
DOES THE END LOOK LIKE AS
GETTING THOSE PARTNERSHIPS ON
BOARD, STARTING TO DO SOME OF
THAT CONTEXT MAPPING TO SORT OF
UNDERSTAND LIKE HOW LONG IS A
PRIMARY CARE APPOINTMENT?
WHAT HAPPENS DURING THIS PRIMARY
CARE APPOINTMENT?
WHO DOES WHAT?
THE NURSE DOES SOMETHING, THE
DOCTOR DOES SOMETHING, SO ON.
THIS GIVES CONTEXT OF WHAT IS MY
VISION FOR HOW MY INTERVENTION
OR DIAGNOSTIC TEST OR WHATEVER
IT IS, HOW DOES IT FIT INTO THAT
PICTURE?
AS OPPOSED TO NOT HAVING THAT AT
ALL AND JUST MAKING THIS TOTALLY
PUZZLE O PICTURE OVER
HERE WITH YOUR INTERVENTION
WHERE THERE'S NO KNOWLEDGE OF
HOW IT COULD POSSIBLY FIT IN AT
THE END.
THAT'S A STARTING POINT TO THINK
ABOUT HOW WOULD I DO THIS IF I'M
NOT READY TO DO THE CLINICAL
TRIAL YET, WHAT WOULD IT LOOK
LIKE TO S BUILDING THAT
VISION SO THAT'S WHAT I WOULD
ENCOURAGE TO REALLY THINK ABOUT
THE REAL WORLD AND LEARN ABOUT
THE REAL WORLD WITH THOSE
PARTNERS AS YOU'RE STARTING YOUR
ENDEAVORS.
>> THANK YOU ALL.
WE'RE AT TIME BUT THIS HAS BEEN
SUCH A MEANINGFUL, MEATY,
THOUGHT-PROVOKING DISCUSS.
THANK YOU, DR. LANE-FALL FOR
COMING AND LEADING THE
DISCUSSION AND YOUR
PRESENTATION.
REALLY, REALLY APPRECIATE IT.
THANK YOU TO ALL OF OUR
PANELISTS.
THIS HAS BEEN BEEN JUST GREAT.
IVE ENJOYED EVERY MAN, THANK --Y
MINUTE.
IF YOU CAN STAY AROUND WE HAVE
REFRESHMENTS AND WE WELCOME
DISCUSSION.
THANK YOU ALL VERY MUCH.
[END OF PROGRAM]