Sustainability from an Evidence Integration Triangle Perspective Russell

Sustainability from an Evidence Integration Triangle Perspective Russell E. Glasgow, Ph. D. Deputy Director, Implementation Science Division of Cancer Control and Population Sciences National Cancer Institute Society of Behavioral Medicine April 2011

OVERVIEW Definitions and Focus Learning Health Care Systems (Setting level) Problem-Solving Ability and Training (Indiv. ) Evidence Integration Triangle perspective Implications for Sustainability

Definitions Learning Health Care Problem Solving Evidence Integration Triangle Sustainability Focus Issue 1: Activities, Processes, or Outcomes Issue 2: Static vs. Dynamic Conceptualization

Current Gap D&I: What we know Evidence Integration Triangle Future Directions/D&I Opportunities Rapid Learning Health Care Systems Data Collected: With real (and complex) patients By real-world staff Under real-world conditions and settings And evaluated through real-time data (often with Electronic Health Records) Tunis, S. R. ; Carino, T. V. ; Williams, R. D. ; Bach, P. B. A Rapid Learning Health System. Health Affairs (supplement). 2007; 26(2): 140 -149. 4

Definitions Learning Health Care Problem Solving Evidence Integration Triangle Sustainability Evidence on Problem-Solving Training (PST) Consistent evidence that PST improves longterm outcomes for: • Social skills • Depression • Weight loss • Many other behaviors and conditions

Evidence Integration Triangle Translation Across the Continuum Intervention Program/Policy ed Fe ck Evidence ba ed ba Fe ck (Prevention or Treatment) (e. g. , design; key components; principles; external validity) Stakeholders Practical Measures Implementation Process (e. g. , stakeholder engagement; team-based science; CBPR; patient centered care) Feedback (e. g. , actionable & longitudinal measures) Multi-Level Context • Intrapersonal/Biological • Policy • Interpersonal • Community/Economic • Organizational • Social/Environment 7

Definitions Learning Health Care Problem Solving Evidence Integration Triangle Sustainability Implications of Learning Systems, PST, and EIT for Sustainability • To maintain or continue improvement need to adapt and respond to changing content • Iterative cycles of measurement, comparison to goal, adaptation, implementation, measurement, etc. 8

IF AN INTERVENTION WORKS AND NOBODY CAN USE OR SUSTAIN IT…. . DOES IT STILL MAKE AN IMPACT? 9

More Information • Glasgow RE, HMC Research Translation…Am J Health Behav 2010; Nov-Dec 34(6): 833 -840 • SBM Symposium on Sustainability: What Does It Mean? (Chambers, Kaplan, Wasserman, Glasgow) Friday April 29, 8: 45 - 10: 15