So You Discovered Something that Might Save Lives…Now What?
New center provides researchers with resources needed to implement their findings in diverse real-world settings
When Nicole Stadnick was a doctoral student in clinical psychology, she studied ways to collaborate with caregivers to improve outcomes for children with autism spectrum disorder. As she collected evidence for best practices, she started to realize just how difficult it might be to get these evidence-based interventions adopted and scaled in many diverse community health settings—particularly those with fewer resources.
Borsika Rabin trained as a pharmacist and then as a public health researcher working across diverse populations, settings and health topics. Like Stadnick, she found that many programs that are effective in preventing cancer in high-resource settings will not work for communities that have fewer resources and more complex problems. This leaves the patients most in need without viable solutions, deepening existing health disparities.
Throughout the history of medicine and science, researchers like Stadnick and Rabin have discovered evidence of promising ways to improve health outcomes for patients and communities—only to have those findings languish in papers published in scientific journals.
To help bridge this gap between research findings and their application in the real world, UC San Diego launched the Dissemination and Implementation Science Center (DISC) earlier this year. The center will provide researchers and practitioners with the training, technical assistance, mentoring and resources they need to conduct research that is meaningful in real-world settings, and implement these findings for the equitable benefit of diverse communities served in a variety of health settings.
“Most health studies focus on how well interventions designed to reduce illness and death fare in ideal settings, but little is known about how to scale them up effectively in real-world settings,” Stadnick said. “As a result, many life-enriching interventions fail to reach their full potential. The promise of dissemination and implementation science, a relatively new area in health sciences, is to acknowledge the realities of communities and settings as we design ways to improve care in various contexts.”
The UC San Diego DISC, administratively housed in the Altman Clinical and Translational Research Institute at UC San Diego, is funded by the Office of the Vice Chancellor of Health Sciences at UC San Diego and led by UC San Diego School of Medicine faculty members Borsika Rabin, assistant professor in the Department of Family Medicine and Public Health; Gregory Aarons, professor and director of the Child and Adolescent Services Research Center, Department of Psychiatry; Lauren Brookman-Frazee, professor and associate director of the Child and Adolescent Services Research Center, Department of Psychiatry; and Nicole Stadnick, assistant professor and investigator in the Child and Adolescent Services Research Center, Department of Psychiatry.
The UC San Diego DISC provides leadership and guidance in conducting research in dissemination and implementation science, funding for pilot grants, education, and training in dissemination and implementation science methodologies, and consultation and mentoring to researchers and community partners.
In addition, the center is committed to advancing dissemination and implementation science to promote health equity and justice through training, research and community engagement activities. The overarching goal is to build capacity and a dissemination and implementation science community that will maximize the public health impact of research.
The UC San Diego DISC already comprises more than 200 members and investigators, offers a doctoral course and leads a seminar series and monthly journal club. In addition, the center offers the Autism Research and Practice Continuing Medical Education series, in which the latest research and actionable strategies for translating research to practice are discussed. The team plans to post a call for pilot grant applications and host an Advanced Mixed Methods Workshop this fall.
“Dissemination and implementation science is a way of helping researchers identify which new interventions and strategies are most relevant and needed in the community, understand how they can be used in routine care and ensure that evidence-based interventions are accessible to the community,” Brookman-Frazee said.
The UC San Diego DISC plans to engage experts across the broader UC San Diego campus, collaborating with teams at the Rady School of Management, Jacobs School of Engineering, Scripps Institution of Oceanography and other organizations.
“Dissemination and implementation science doesn’t fit squarely in one discipline, such as psychology or public health,” Aarons said. “Our transdisciplinary nature is what makes it exciting—we can take ideas and ways of thinking from many fields, including engineering, public policy, organizational development and economics to make sure our study designs and methods will make the biggest impact.”
Community engagement is also important throughout the dissemination and implementation process, the UC San Diego DISC team said. They plan to collaborate with community partners to make sure every study or intervention includes the voices of the stakeholders at all relevant levels, including health system leaders, clinicians, patients, community members, families and caregivers.
These days, Stadnick works with community-based health systems providing care to children with mental health needs and their families from diverse socioeconomic and racial/ethnic backgrounds. Together, they are exploring various delivery models—different approaches to prevention and treatment—that are tailored to each family’s needs. In particular, Stadnick is partnering with pediatric primary care clinics to implement an evidenced-based mental health screening intervention for children with autism spectrum disorder.
Rabin continues her work in cancer control, including efforts to increase colorectal cancer screening and follow-up in community health clinics in San Diego County. She is also involved in multiple initiatives through the Veterans Administration and provides training and resources on implementation science to cancer researchers to ensure the relevance and maximize the impact of their research on diverse communities and those and most in need.
“For any implementation to be successful, we need engagement from all decision makers—the ‘funders, doers and users,’” Rabin said. “We hear from our health care partners that even if we provide them with the most state-of-the-art programs, they won’t be successful if we don’t take into account the needs, resources, priorities and preferences of their clinic and health system, as well as the specific characteristics and realities of the patients they serve.”
“In traditional clinical trials, we try to control for and exclude factors that could influence the outcomes of your primary hypothesis. But in dissemination and implementation science, we’re trying to account for and measure all of these factors, not get rid of them. This allows us to have a more contextual and complex understanding of what works, for whom, under what circumstances. This is at the heart of dissemination and implementation science and practice.”