On June 1st, health funders and other associates of the EVIR (Ensuring Value In Research) collaboration met at ZonMw in the Netherlands, to discuss their role in the dissemination and implementation of research.
The EVIR is an international collaboration initiative of health research funding agencies, agencies that represent funders and those involved in in setting research and developement policy. The aim is to advance the practice of health related research by working together to reduce waste and increase the value of health research. The EVIR is developing 10 guiding principles that:
Currently 24 agencies from eleven countries are associated in the EVIR collaboration and it is growing all the time.
The afternoon workshop was aimed at exploring and exchanging practices regarding guiding principle 10: "research knowledge that can lead to benefit should be effectively disseminated to end users".
Three funders, ZonMw (the Netherlands), NIHR (United Kingdom), and PCORI (United States), presented their implementation policies and the way they see their role in implementation of research. They all engage in dissemination and/or implementation activities in their own way, depending on their context and mandate.
The Netherlands Organisation for Health Research and Development
ZonMw funds health research and stimulates the use of the knowledge this research produces to improve health and care. ZonMw promotes implementation without taking over responsibility. Health care practice and insurers are responsible for quality and efficiency of healthcare, the government (including ZonMw) plays a stimulating/facilitating role. ZonMw commissions research and promotes implementation through 4 main lines:
1. Implementation criteria in application, midterm and final reports
2. Funding implementation programs and projects
3. Building capacity/infrastructure
4. Building knowledge base on implementation
Right from the start, researchers are asked to report for whom the results of their projects are relevant (e.g. other researchers, professionals, patients, or financers). Furthermore, they are asked to elaborate on what these parties should do with the results (e.g. change behaviour) and which strategy is necessary to achieve this (e.g. by informing or educating).
Funding implementation programs and projects
ZonMw has several quality improvement programs and grants specifically aimed at dissemination and implementation of promising research results (VIMP, max. €50,000). ZonMw also awards so called pearls to inspiring and remarkable projects.
The ZonMw Pearl is a prize, awarded to ZonMw projects which concern current healthcare issues, have exceptional results and involve cooperation with practice based stakeholders. These projects distinguish themselves through innovative approaches, newsworthiness, and/or remarkable collaborations.
ZonMw has a specialised implementation team which aids those working in the field to translate research to practice. Furthermore, ZonMw stimulates the use of academic workplaces and regional consortia. Lastly, it introduced implementation fellows in Dutch hospitals.
Implementation fellows had 3 years of training by a university implementation department. They have an advisory and operational role in implementation projects and implementation research. They help create networks/infrastructure and support hospitals regionally and nationally. Fellows have continued their work within the hospitals even after the ZonMw research grant ended.
Building knowledge base
ZonMw publishes research results on its website, thereby making them available for the wider public. The websites also features a tool which helps researchers make an implementation plan. Contact details of the implementation team members are available as well as examples of VIMP-grant and pearl awardees and links to ZonMw publications on implementation.
The most important lessons ZonMw has learned are that actively stimulating implementation helps and that strategies should be based on an analysis of the context of the projects. Using a variety of strategies (inform, educate, facilitate, steer) often proves successful, especially when used on multiple levels (individual, organisation, and system). Plenty of time and capacity (long term investment) should be reserved for implementation, as it continues long after the end of a project.
In the coming years, ZonMw aims to take implementation practice to a higher level by becoming a partner in quality cycles, collaborations, and initiatives along with other stakeholders in health care practice. To this end, it will enhance investment in implementation infrastructure and focus on appropriate research designs, reducing waste, and financial innovations. Systematic and robust impact measurement will enable ZonMw to attain, demonstrate, and increase its societal relevance.
The National Institute for Health Research
The NIHR was established in April 2006 as part of the UK government’s health research strategy 'Best Research for Best Health' and is funded by the Department of Health. It has five objectives:
The NIHR is an integrated health research system that supports a broad range of activities including research funding programmes, research infrastructure, and training and fellowships.
NIHR does not fund the implementation of research but it does play an active role in dissemination and knowledge exchange.
It uses the Adding Value in Research Framework to raise the probability of impact through its research management process.
The NIHR supports dissemination in a number ways; these include
1. Active/enhanced project level dissemination
2. Collaborations for Leadership in Applied Health Research and Care (CLAHRCs)
3. The NIHR Journals Library
4. The work of the NIHR Schools for research (not discussed at the meeting)
5. The NIHR Dissemination Centre
The 13 Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) are funded by the National Institute for Health Research and undertake high-quality applied health research focused on the needs of patients and support the translation of research evidence into practice with the wider NHS and Public Health. CLAHRCs are collaborative partnerships between a university and the surrounding NHS organisations, focused on improving patient outcomes through the conduct and application of applied health research. They create and embed approaches to research and its dissemination that are specifically designed to take account of the way that health care is increasingly delivered across sectors and a wide geographical area. They are co-funded by regional health structures, with funding especially for implementation science.
The Journals Library publishes comprehensive accounts of NIHR funded research within its own publicly and permanently available journals. Projects that are being funded as well as the ﬁnal published journal reports can be found here. The goal is knowledge transfer and mobilisation.
The NIHR Dissemination Centre produces three types of research summary aimed at health care commissioners, practitioners working in health and social care, patients, carers and other members of the public. Collaboration with evidence users helps ensure that research evidence is presented in ways that maximise uptake in health and social care practice. They scour around 100 journals and identify the most reliable, relevant and significant findings. Then they provide Themed Reviews, Highlights, and Signals to disseminate these findings as actionable, accessible, and trustworthy information.
The Patient-Centered Outcomes Research Institute
PCORI funds scientific research that can help patients and those who care for them make better-informed decisions about healthcare choices. To promote rapid availability of findings, PCORI commits to making results from all funded studies available on its website within 90 days after they are finalized, which occurs following an internal peer review process. Results are presented in two formats designed for a public and a clinical professional audience. To promote immediate access to findings that are published in the scientific literature, PCORI offers awardees the opportunity to request that PCORI cover the fees that journals charge to provide public access to these articles.
PCORI has a program on Dissemination and Implementation, which works to build awareness of research findings and promote their uptake in addition to overseeing the public release of findings.
Lay and clinicians abstracts of all PCORI findings are required by law to be available on PCORI website within 90 days of PCORI’s acceptance of the final research results, and indexed in the National Library of Medicine’s Medline.
PCORI Public Access to Journal Articles policy provides funds to cover open access fees and requires all publications to be deposited in PubMed Central (PMC).
The PCOR Translation Center and PCORI’s website provide infrastructure for transparent reporting. The Translation Center also prepares audio files, Spanish translations, and other translation products to aid PCORI in the dissemination of research findings.
Eugene Washington PCORI Engagement Awards Program
PCORI offers funds of up to $250,000 per project to support organizations with strong ties to end-user audiences to lay the groundwork for disseminating and implementing PCOR/CER results. PCORI intends for these projects to focus on strengthening the infrastructure and relationships necessary to actively disseminate and implement research results derived from PCORI or related studies.
PCORI Limited Competition Awards for Disseminating and Implementing Research Findings
This award program gives PCORI investigators the opportunity, following the generation of results from their PCORI research award, to propose the next step(s) for making their research results more useful, actionable, accessible, and available to targeted end-users of these findings. The goal is to move evidence developed with PCORI research funding toward practical use in improving health care and health outcomes.
These presentations were followed by round table discussions which resulted in the following key messages:
Funders should clearly distinguish between implementation research and implementation of research. The latter should ideally be part of every research project, although funders have to be aware of their political/mandate constraints. Implementation of research should not only target individuals (e.g. researcher, clinician), but also the structure and organisation of health care.
Implementation will be most successful if implementation questions are asked in the grant approval and research review process, therefore as early as possible if relevant. To answer these questions, researchers should think about the target audience and how they expect to reach them during every step of their project. Stakeholders should be involved at the inception of research projects. Engaging the right stakeholders will make it more likely that the needs and priorities of the health care field (e.g. health care professionals or patients) will be translated in good research questions.
Funders can further enable implementation by providing designated dissemination/implementation funding.
Implementation activities do not stop when research projects end. Often, results of implementation activities will only be visible after several years. Follow up requires long term engagement and investment in infrastructure, both by researchers and funders. One example is investing in specialised teams (e.g. on grant application, implementation, etc.) within funding agencies that researchers can ask for guidance. Another is providing funding for the training of implementation experts in the field.
By retrospectively looking at projects, funders can learn about factors that influence implementation. Analysis of past approaches, attempts and results can give new insights about how to shape follow up and evaluation of implementation success. Past experience has shown that explicit attention for de-implementing obsolete practices is imperative when introducing innovations.
Collaboration between clinicians and researchers can be enhanced by making use of existing networks. This implies knowing each other's perspective and using each other’s roles in knowledge production and implementation.
Impact of research will often be the result of successful implementation. However, impact analysis is more sophisticated and difficult, as (societal) impact can rarely be traced back to one project. Impact analysis asks for a more in depth investigation of contributing factors and context.
The attending funders found the workshop on implementation fruitful and will continue exploring other guiding principles in this manner. The next EVIR meeting will be held on November 2nd 2017 in Washington, D.C. and will include a workshop on setting research agendas with the meaningful involvement of those who will use and be affected by health-related research. PCORI will take the lead in organising this meeting, to be held adjacent to their annual conference.
Colophon Editors: Joey Gijbels, Barbara van der Linden, Matt Westmore, Kelly Dunham, Evelyn Whitlock.