INQRI’s Focus on Dissemination and Implementation

Marita G. Titler, PhD, RN, FAAN, Deleise S. Wilson, PhD, RN, Barbara Resnick, PhD, CNRP, FAAN, Leah L. Shever, PhD, RN 

With our paper, “Dissemination and Implementation: INQRI’s Potential Impact,” we explored the implementation strategies, challenges, and lessons learned from conducting five INQRI funded implementation studies. We also presented two case examples of other INQRI studies to illustrate dissemination strategies. We repeatedly saw that INQRI teams used common implementation strategies across studies which addressed education, ongoing interaction with sites, use of implementation tools, and visibility of the projects on the study units. However, many studies experienced some challenges with institutional review board reviews. Several of the PIs were concerned about the short-time dedicated to the actually implementation phase of the research. Despite this challenge, the teams found that success in the engagement of site coordinators and nurses involved with their projects and the development of tools for other hospitals to use for improving practice. We would encourage researchers interested in pursuing dissemination and implementation projects to focus on understanding the importance of context, as well as the complexity of implementation, and ensuring good communication with clinicians and study sites.

This post is part of our week-long blog carnival focused on the Medical Care supplement.  Click here to access all posts in this carnival.

INQRI Demonstrates Lessons Learned, Recommendations for the Future

José A. Pagán, PhD 

This special issue of Medical Care nicely summarizes many of the key accomplishments of the INQRI program in terms of pushing the frontier of what is known about the linkages between nursing care and health care quality.

INQRI not only has provided resources for nursing researchers to show the role of nursing care on the delivery of high quality health care services, but the program has also increased awareness about the importance of nursing care in the research conducted in other disciplines.

The provision of financial and technical resources through the INQRI program to make interdisciplinary work possible has brought together researchers from different disciplines (economics, business, engineering and many others) that typically would have not thought about getting involved in nursing research. I suspect some of this is due to the lack of a scholarly community large enough to sustain high impact conversations and policy discussions about the role of nurses in health care quality. INQRI has taken us a step closer to having a critical mass of interdisciplinary nursing researchers.

The methodological challenges in implementation science may seem large but the work funded by INQRI in this area shows clear lessons learned and provides recommendations to advance methods, including the need to develop standards for implementation methods as well as identifying the potential benefits of thinking about reporting standards.

Dr. Pagán is a Professor and Chair of the Department of Health Management & Policy in the School of Public Health at the University of North Texas Health Science Center at Fort Worth and a member of INQRI's National Advisory Committee. 

This post is part of our week-long blog carnival focused on the Medical Care supplement.  Click here to access all posts in this carnival. 

Methodology Issues in Implementation Science

Robin Newhouse, PhD, RN, NEA-BC, FAAN, Kathleen Bobay, PhD, RN, NEA-BC, Patricia C. Dykes, DNSc, RN, FAAN, FACMI, Kathleen R. Stevens, EdD, RN, ANEF, FAAN, Marita Titler, PhD, RN, FAAN 

In our article, “Methodology Issues in Implementation Science,” we identified some of the methodological challenges experienced by INQRI teams in the conduct of their projects and provided recommendations for future methods development. Although evidence-based practices improve patient outcomes, they are often underused for a number of health conditions. This underuse adds to the proliferation of unexplained and unjustified variations in practices and we believe that implementation science holds promise for expanding what is known about improving health care delivery, outcomes, and value. Based on the four INQRI case studies we reviewed, we recommend the following strategies to advance methods in implementation science: 1) the development of a core set of implementation concepts and metrics; 2) the creation of standards for implementation methods; and 3) the endorsement of reporting standards for implementation studies. Implementation science is the link between effective interventions, practice, and patient outcomes. To generate usable knowledge needed to leverage health system change and realize broad health care improvements, the methodological issues identified must be addressed to build implementation science.

This post is part of our week-long blog carnival focused on the Medical Care supplement.  Click here to access all posts in this carnival.

Upcoming Webinar: Translation of a Transitional Care Nursing Intervention for People with Serious Mental Illness

Don't forget: next Wednesday is our next webinar:

Please join for the sixth presentation in a series providing the study findings from INQRI's final cohort of grantees.  This session features Dr. Nancy Hanrahan presenting study findings regarding her team's work to translate the Transitional Care Model intervention to meet the complex needs of persons with serious mental illness in public managed care.

Information to join the webinar:

Topic: Webinar - Translation of a Transitional Care Nursing Intervention for People with Serious Mental Illness
Date: Wednesday, March 27, 2013
Time: 12:00 pm, Eastern Daylight Time (GMT -04:00, New York)
Event Number: 571 936 565
Event Password: tcm-smi

Register now.

Learn more about this INQRI team led by Dr. Phyllis Solomon and Dr. Nancy Hanrahan.

New Mechanisms for Linking Research and Policy

Impact 2.0: New mechanisms for linking research and policy supported a series of small research projects examining the use of online social networking services to link research and policy in Latin America.

Two types of projects were supported: (i) action research projects involved both implementing and evaluating a specific use of one or more online social networking services to link research and policy or researchers and policymakers, and (ii) more conventional ones evaluated existing initiatives implemented by third parties. A five-member jury evaluated the submissions and its members provided advice and support to the researchers at various moments during the project, but no specific framework or theoretical approach was imposed. Proposals were accepted from a variety of disciplinary perspectives as long as they addressed, through a formal research process, the impact of web 2.0 and online social networking services on the links between research and public policy, with an overall objective of documenting the design, implementation and impact of actions undertaken to link of knowledge generation and policy definition.

  Click here to access the full research report on new mechanisims for linking research and policy

Do Nurses Resist Implementing Evidence-Based Improvements to Patient Care?

This morning, several INQRI grantees were featured on the Robert Wood Johnson Foundation Human Capital blog, responding to a recent article which found that resistance from nursing leaders and other barriers prevent nurses from implementing evidence-based practices, even when those practices could improve patient outcomes.

Click here to read the post and leave a comment.

More Videos From The INQRI 2012 National Conference

We are pleased to share with all of you the final three recordings from our National Conference, which convened in Washington, DC at the end of April. Below you will see a video from Dr. Susan Hassmiller discussing the role of INQRI in the development and implementation of the Future of Nursing and the Campaign for Action. The two videos following Dr. Hassmiller's comments are panel discussions on "Dissemination & Implementation" and "The Business Case for Changes Nursing". Feel free to share these videos and comment on them either on the blog or their respective Youtube pages.

INQRI and the Future of Nursing



In this session from the 2012 INQRI national conference, RWJF's advisor for nursing, Susan Hassmiller shares her thoughts about INQRI's role in the Future of Nursing and the Campaign for Action.


INQRI Panel: Dissemination and Implementation - INQRI's Potential Impact 




Presented by INQRI grantees: Marita Titler, Deleise Wilson, Barbara Resnick and Leah Shever. Moderated by Polly Pittman. At INQRI's national conference (April 26-27, 2012), a select group of INQRI grantees used their findings as the basis for discussions about the relationship between their research and trends in interdisciplinary collaboration, methodology and implementation science, quality measurement, dissemination and implementation, and the business case for nursing.

INQRI Panel: The Business Case for Changes in Nursing To Improve Quality and Value



Presented by INQRI grantees: Olga Yakusheva, Doug Wholey and Kevin Frick. Moderated by INQRI Co-Director Mark Pauly. At INQRI's national conference (April 26-27, 2012), a select group of INQRI grantees used their findings as the basis for discussions about the relationship between their research and trends in interdisciplinary collaboration, methodology and implementation science, quality measurement, dissemination and implementation, and the business case for nursing.

It's All About Impact

At last week's annual meeting, we spent a lot of time talking about impact. We discussed strategies for ensuring that research results could be used to foster change. We talked about messaging ideas to best communicate about research. We heard from end users or stakeholders about what they need to hear from researchers. We learned techniques for evaluating research. Everything boils down to this: how do we make sure we have an impact?

So, it was very timely to read Robin Mockenhaupt's guest blog at Ventureneer.com. Last month Mockenhaupt, Chief of Staff at the Robert Wood Johnson Foundation, attended the Social Impact Exchange conference. Here she shares her perspective on the value of strategic collaborations in scaling for social impact.

How are you sure your work has impact?

INQRI FallTIPS Study Profiled by AHRQ

We're thrilled to announce that FallTIPS, an INQRI team's fall prevention tool kit, is being featured on AHRQ's Healthcare Innovations Exchange.  Led by Patricia Dykes and Blackford Middleton, the team created a tool designed to prevent patient falls by translating an individual patient's fall risk assessment into a decision support intervention that communicates fall risk status, and creates a tailored plan that is accessible to care team members (including patients and family members).

The profile on the Innovations Exchange features a recap of the intervention, how it was designed and offers suggestions for ways other sites can adopt and sustain the innovation.

Click here to access the profile.

Cohort 5 Projects Start TODAY

We are pleased to announce that our six newly-funded research projects begin today.

Over the past four years, INQRI grants have supported research to establish links between nursing and the quality of care delivered to people within and across a variety of health care settings. This year’s grants will support studies that focus on disseminating and implementing programs that have proven effective. Each new  team receives an 18-month grant of up to $300,000 to support a project that explores the relationship between nursing and health care with a focus on developing evidence on how to disseminate and implement programs that are known to work. INQRI will share the results of this research with policy-makers, hospital administrators and others who make decisions about how nursing resources are distributed to improve quality and patient outcomes.

Click here to learn about these teams:

Michele Balas, Ph.D., R.N., A.P.R.N.-N.P., C.C.R.N., University of Nebraska Medical Center and William Burke, M.D., University of Nebraska Medical Center, principal investigators, Implementation and Dissemination of an Interdisciplinary Nurse-Led Plan to Manage Delirium in Critically Ill Adults;

Susan Beck, Ph.D., A.P.R.N., F.A.A.N., University of Utah and Nancy Dunton, Ph.D., Kansas University Medical Center, principal investigators, Dissemination and Implementation of Evidence-Based Methods to Measure and Improve Pain Outcomes;

Linda Flynn, Ph.D., Rutgers, The State University of New Jersey and Joel Cantor, Sc.D., Center for State Health Policy at Rutgers, The State University of New Jersey, principal investigators, Creation of a Nurse Manager Development Program to Increase Patient Safety;

Nancy Hanrahan, Ph.D., R.N., University of Pennsylvania and Phyllis Solomon, Ph.D., University of Pennsylvania, principal investigators, Translation of a Transitional Care Nursing Intervention for People with Serious Mental Illness;

Robin Newhouse, Ph.D., M.S., M.G.A., University of Maryland, Baltimore and Bonnie Spring, Ph.D., A.B.P.P., Northwestern University, principal investigators, Nurse-Led Intervention to Improve Screening and Treatment for Substance Abuse: An RCT of Hospitals; and

Maria Titler, Ph.D., R.N., F.A.A.N., University of Michigan School of Nursing and Paul Conlon, Pharm.D., J.D., Trinity Health, principal investigators, Implementation of a Risk Specific Fall Prevention Bundle to Reduce Falls in Hospitals.

INQRI Team Leaves Lasting Impression

CentraState Medical Center was one of the participating hospitals in a medication error study funded by the INQRI program: “Examining the Impact of Nursing Structures and Processes on Medication Errors.” Based on their findings, Linda Flynn, Dong Suh and team recommended that sites explore ways in which to reduce nurse interruptions while administering medications.

Acting on that recommendation, Jayne Craig, Ph.D., R.N., from CentraState has received funding to implement and test an intervention to reduce nurse interruptions.

In this new undertaking, CentraState Medical Center proposes to demonstrate whether an intervention designed to reduce nurse interruptions that occur at the time of medication administration (in contrast to those that occur during transcription, preparation, etc.) results in fewer medication errors in the community hospital, medical-surgical setting.

The principal investigator of the INQRI study was a guest blogger for us on Monday, discussing her work in regards to the Future of Nursing report published last week. Click here to read her post.

4th Annual NIH Conference on the Science of Dissemination and Implementation: Policy and Practice

March 21-22, 2011

Bethesda North Marriott Hotel & Conference Center

5701 Marinelli Road

Bethesda, MD, 20852

There is no fee to register for this conference. Please note: this year’s conference will NOT be available for viewing online.

There is a recognized need to close the gap between research evidence and clinical and public health practice and policy. How is this best accomplished? Dissemination and implementation research in health seeks to answer this question, and is gaining momentum as a field of scientific inquiry. The goal of the annual NIH Conference on the Science of Dissemination and Implementation is to facilitate growth in the research base by providing a forum for communicating and networking about the science of dissemination and implementation.

Researchers, evaluators and implementers who are interested in identifying opportunities and strategies for overcoming obstacles for dissemination and implementation research and evaluation are encouraged to attend this meeting. The goal is to engage in dialog, exchange ideas, explore contemporary topics and challenge one another to identify and test research approaches that will advance dissemination and implementation science.

To meet the goal of the conference—to stimulate conversation among researchers and experts in the field—the conference will include Panels of scientific leaders, and include Think Tanks in addition to traditional Plenary Sessions, Concurrent Oral Presentation Sessions and Poster Sessions. Sessions will be structured to encourage interaction and networking between participants.

Applicants are encouraged to submit abstracts for oral presentations/panels, posters, and think tanks (which applicants will lead). Descriptions of each type of session, and instructions for abstract submission, are described in the Call for Proposals.

Proposal Submission Deadline: 5:00 PM Eastern Time on November 12, 2010
Conference Registration Deadline: 11:59 PM Eastern Time on February 18, 2011

Click here for the Call for Proposals.
Click here to register.

Implementation Science and QUERI - a New Cyber Seminar

The VA's Health Services Research & Development Service (HSR&D) offers a series of free cyber seminars and they have just updated their list of sessions.  Click here to register for upcoming sessions or view archives.

Given the focus of INQRI's latest call for proposals, we think this one is of particular interest:

Tuesday, September 14, 12:00pm ET

QUERI Implementation Research
Health Systems Evidence – Evidence to Support Policymaking and Management (Part 1)
by Lori Greco, MHSc
Kaelan Moat, MSc.
Click here to register.

INQRI also hosted a webinar focused on Implementation Science and QUERI.  This past April, Brian Mittman, Ph.D., VA Quality Enhancement Research Initiative (QUERI), hosted a session for us as part of our webinar series on translation.  You can access the PowerPoint Presentation and Webinar Recording on the INQRI website.