Expanding and Enhancing Implementation Learning
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We know that too many effective innovations don’t get into the hands of those who need them the most, in part because most people don’t participate in the research that makes them effective in the first place. It takes years, if not decades, for effective innovations to be used by providers because barriers at the training, organizational, financial, and community levels are not addressed, and the innovations are often not developed with the community end-users in mind. Most clinical research studies involve highly resourced settings and not the communities that could benefit from the research (and, in turn, could share their perspective and wisdom that can benefit other settings).
Scientists from across the U.S. recently called on the National Institutes of Health (NIH) and health funding agencies to rectify the fact that Black and other scientists of color are less likely to be successfully funded through the federal grant process. Growing evidence suggests that a key reason for why this disparity exists is because the topics and settings that comprise applications from Black and other scientists of color either involve community-based research/health disparities, and/or include communities that may not have the same level of resources as large, urban health centers for example. Moreover, they involve questions that are more along the spectrum of real-world implementation and community-based research, rather than those studies which comprise the vast majority of federally-funded research.
Akin to community-based participatory research, implementation science is about changing healthcare practice to promote healthier lives, especially in the context of organizational and resource constraints. But without greater emphasis on implementation science among funders and study sections, we risk losing a generation of talent. It is heartening that some federal funding agencies in addition to VA, notably the National Heart, Lung, and Blood Institute (NHLBI), National Cancer Institute (NCI), and the Patient-Centered Outcomes Research Institute (PCORI) have put out more calls for implementation research and, more recently, as a vehicle to support the elimination of health disparities.
However, even with a growing demand for implementation science-focused research, we don’t have enough trained scientists in this field. With health equity and extensive focus on underserved and marginalized populations baked into its overall goal, QUERI launched the Advancing Diversity in Implementation Leadership (ADIL) initiative to promote implementation, quality improvement, and evaluation leadership opportunities to grow the pipeline of expertise in implementation and evaluation science from populations that reflect the diversity of the Veterans we serve. Cultivating a diverse workforce is integral to QUERI’s mission and its 2021-2025 strategic goals, and to QUERI’s leading role in advancing implementation/quality improvement science and evidence-based policy. Complementing VA and NIH diversity programs, QUERI emphasizes career advancement for implementation “practitioners” in addition to the traditional academic pathway as a means of enhancing leadership opportunities and reducing disparities in hiring and promotion processes.
This issue features the core QUERI initiatives to grow the pipeline of implementation scientists across VA and beyond, notably through the Center for Evaluation and Implementation Resources (CEIR) and our QUERI Learning Hubs. The ultimate goal is to compound the growing pipeline of diverse talent by further democratizing and demystifying implementation science and applying it beyond the ivory tower to settings that need implementation support the most. It also ensures that the goal of health equity, as outlined in the recent Executive Order, also ensures achievement in the context of the other quintuple aim goals (e.g., workforce experience, consumer experience, quality, and outcomes) that ultimately maximize and sustain improved health for Veterans.
Amy Kilbourne, PhD, MPH
Melissa Braganza, MPH
QUERI Program Manager