Implementation Science is the scientific study of methods and strategies that facilitate the adoption of evidence-based practices and research findings into routine health care and public health settings with the goal of improving the quality and effectiveness of health services and pediatric care.

The field of implementation science seeks to systematically close the gap between what we know and what we do and answer the question, “How can we overcome the research-to-practice gap to integrate the “thing” into practice.” This is done by identifying and addressing the barriers that hinder and/or facilitators that support the uptake of proven health interventions and evidence-based practices. This relatively new field includes the study of influences on healthcare professionals and organizational behavior.

Implementation science is a scientific discipline focused on understanding the best ways to implement evidence-based practices and de-implement non-evidence-based practices in real world settings.

Key features of implementation science:

• Enhances evidence-based healthcare.
• Focuses on strategies and outcomes.
• Contains rigorous scientific methods and conceptual frameworks.
• Multi-disciplinary science; closely aligned with clinical epidemiology, behavioral medicine, and social science.

Implementation strategies are actions taken to enhance adoption, implementation, and sustainability of evidence-based interventions. They may be educational, organizational, financial, or technological in nature.

Clinical Futures Projects Involving Implementation Science Methodology:

Eliminating Monitor Overuse (EMO)

Continuous pulse oximetry monitoring of oxygen saturation is a common intervention used while treating bronchiolitis. However, overuse of pulse oximetry monitoring in stable patients no longer needing extra oxygen can lead to prolonged hospitalizations, increased risk of harm, and contribute to alarm fatigue. The EMO trial has two goals. The first seeks to identify effective strategies for de-implementing the overuse of pulse oximetry practices in infants experiencing bronchiolitis. The second centers on sustainability – or understanding how best to maintain these reductions in pulse oximetry practices over time. Prior work has shown successful reductions in the use of pulse oximetry in the short term.

Faculty Contributor: Chris Bonafide, MD, MSCE

Implementing the Sleep Well! Intervention in Urban Primary Care

Behavioral sleep problems such as insomnia and insufficient sleep are associated with deleterious childhood physical and mental health outcomes. However, these outcomes are modifiable, particularly in early development. This K23 project addresses a critical need for accessible, evidence-based behavioral sleep interventions for lower-socioeconomic status (SES) children. Sleep Well!, an effective behavioral sleep intervention was adapted so that its contents and service delivery methods are appropriate for lower-SES preschoolers and the primary care context. Pilot data support feasibility and acceptability of the intervention.

Faculty Contributor: Ariel Williamson, PhD

Health Coaching to Improve Comprehensive HIV and Sexually Transmitted Infection Prevention in Adolescent Primary Care

Pediatric primary care providers (PCPs) are well-­positioned to expand pre-­exposure prophylaxis (PrEP) delivery as HIV and sexually transmitted infection (STI) infection rates continue to rise in the United States. However, sexual health service delivery in primary care is hampered by PCP time constraints and competing demands. There is a critical need for both behavioral interventions to increase PrEP uptake and reduce STIs in adolescents and implementation strategies to disseminate PrEP and enhanced sexual health services in adolescent primary care. This trial’s main goals are implementation optimization and testing of a PrEP-inclusive health coaching intervention to reduce HIV and STI incidence among adolescents and young adults, which aims to be scalable across primary care networks.

Faculty Contributor: Sarah Wood, MD, MPH