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 MedicineApril 2011

OVERVIEW

Definitions and Focus

Learning Health Care Systems (Setting

level)

Problem-Solving Ability and Training

(Indiv.)

Evidence Integration Triangle perspective

Implications for Sustainability

Sustainability Focus

Issue 1: Activities, Processes, or Outcomes

Issue 2: Static vs. Dynamic Conceptualization

Definitions Learning Health Care

Evidence Integration TriangleProblem Solving

Sustainability

Rapid Learning Health Care SystemsData 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

Current Gap D&I: What we know

Evidence Integration Triangle

Future Directions/D&I Opportunities

Evidence on Problem-Solving Training (PST)

Consistent evidence that PST improves long-term outcomes for:

•Social skills

•Depression

•Weight loss

•Many other behaviors and conditions

Definitions Learning Health Care

Evidence Integration TriangleProblem Solving

Sustainability

Evidence Integration Triangle Translation Across the Continuum

Implementation Process(e.g., stakeholder engagement;

team-based science; CBPR; patient centered care)

Implementation Process(e.g., stakeholder engagement;

team-based science; CBPR; patient centered care)

Practical Measures(e.g., actionable & longitudinal

measures)

Practical Measures(e.g., actionable & longitudinal

measures)

Intervention Program/Policy(Prevention or Treatment)

(e.g., design; key components; principles; external validity)

Intervention Program/Policy(Prevention or Treatment)

(e.g., design; key components; principles; external validity)

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Multi-Level Context• Intrapersonal/Biological • Policy• Interpersonal • Community/Economic• Organizational • Social/Environment

Feed

back

Feedback

Feedback

Evidence

Stakeholders

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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.

Definitions Learning Health Care Evidence Integration TriangleProblem Solving

Sustainability

AND NOBODY CAN USE OR SUSTAIN IT…..

IF AN INTERVENTION WORKS

DOES IT STILL MAKE AN IMPACT?

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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