National Institutes of Health Approaches to Dissemination and Implementation Science: Current and Future Directions

摘要

To address the vast gap between current knowledge and practice in the area of dissemination and implementation research, we address terminology, provide examples of successful applications of this research, discuss key sources of support, and highlight directions and opportunities for future advances. There is a need for research testing approaches to scaling up and sustaining effective interventions, and we propose that further advances in the field will be achieved by focusing dissemination and implementation research on 5 core values: rigor and relevance, efficiency, collaboration, improved capacity, and cumulative knowledge. Despite the demonstrable benefits of many new medical discoveries, we have done a surprisingly poor job of putting research findings into practice. The ultimate goal of new discoveries is to enhance human health, yet most discoveries are slow to or never fulfill this promise. The challenge of moving health research innovations from discovery to practice is complex and multifaceted. 1 For example, in clinical practice, modern medications that dissolve blood clots are one of the best illustrations of efficacious medical care. 2 Nevertheless, substantial portions of the population who could benefit from these medicines do not receive them. In addition, although the most recent evidence suggests that approximately 80% of people with hypertension are aware that they have this problem, only about 70% of these individuals receive treatment, and only about 50% have their blood pressure controlled even in the short to medium term. 3 This suggests that only about half of people with high blood pressure are being successfully treated, apart from consideration of the challenging issues associated with long-term medication adherence. The disconnect between the percentage of those who could potentially benefit from an evidence-based therapy and those who actually do benefit appears across all areas of health, 4–6 with the final percentage of those benefitting from an efficacious intervention often being as low as 1% to 5%. 7 The challenges for public health practice are similar. As but one example, only about 65% of individuals older than 65 years have received the pneumococcal vaccine despite evidence that it offers life-extending protection for the elderly. 8.