Scientific innovations are created every day, but how do we ensure that they are used efficiently and reach the people who need them most? David Chambers, DPhil, deputy director for implementation science in the Division of Cancer Control & Population Sciences at the National Cancer Institute, tackled that question during his June 25 grand rounds lecture titled “Advancing the Science of Implementation in Cancer Control: An NCI Perspective."
In essence, Chambers said, medicine faces an implementation problem.
The medical community “hasn’t done a great job figuring out how to best adopt and integrate a range of different health interventions into the very diverse settings and populations that would benefit from them,” he said.
It can take a long time for medical innovations to reach patients. The interval between initial publication and when a discovery begins to benefit patients in the clinic can often be 17 years or more. “If we don’t do a good job of building streams of knowledge, then what’s the point of this or that wonderful study?” Chambers asked.
The solution to which professionals have turned is the field of implementation science, which attempts to find ways to streamline information dissemination and implementation processes.
“Implementation science is the study of getting people and programs and healthcare systems to start doing the things that the medical literature tells us we should be doing,” says Steven L. Bernstein, MD, professor of emergency medicine and public health (health policy), and director of the Yale Center for Implementation Science, who introduced Chambers at the grand rounds. “So, it’s the question of ‘how do we translate research evidence into actual practice and policy?’”
Innovations need to be invented with broader implications in mind, Chambers said, rather than just as a solution to a medical problem. “The challenge is that we don’t subject a lot of our interventions to this test,” he said. “We don’t really think about ‘for whom is this designed? For what settings? For what populations?’”
“If we can’t implement the necessary service around them, then what’s the benefit?” Chambers said. “We need to be asking the questions now about how well are our practice settings able to incorporate findings as they’re rolling out.”
Some fields, such as cancer and cardiology, lend themselves more easily to implementation science and policies than others do, Bernstein says, because there is such a vast body of knowledge in those fields. But more and more divisions of healthcare are taking on implementation strategies.
A good example is tobacco treatment, in which Bernstein specializes. He says that even though there are seven FDA-approved medications that treat nicotine dependency, fewer than 10 percent of all smokers receive those medicines in any given year. That’s because “we treat tobacco or smoking much less than we treat other chronic diseases like high blood pressure or high cholesterol,” he says.
To address that problem, Bernstein began delivering tobacco treatment to smokers who came to the emergency department for other medical issues, but had not been treated for their tobacco use.
In 2018 Yale created the Center for Implementation Science, formalizing many of the implementation science practices that Bernstein and others had been utilizing for years. The Center works closely with the School of Public Health’s Center for Methods in Implementation and Prevention Science, led by Donna Spiegelman, ScD, Susan Dwight Bliss Professor of Biostatistics. Thanks to the work of both centers, implementation science-based practices have been incorporated into fields at Yale ranging from substance use and addiction, to women’s health, to cancer prevention, Bernstein says.
In his grand rounds, Chambers pointed out the need for healthcare professionals to recognize that change in scientific research is both swift and inevitable.
“As we recognize that medicine, science—everything—is evolving, we need to ask whether existing interventions that are currently being delivered should be sustained forever,” he said.