Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science

Abstract Background Many interventions found to be effective in health services research studies fail to translate into meaningful patient care outcomes across multiple contexts. Health services researchers recognize the need to evaluate not only summative outcomes but also formative outcomes to assess the extent to which implementation is effective in a specific setting, prolongs sustainability, and promotes dissemination into other settings. Many implementation theories have been published to help promote effective implementation. However, they overlap considerably in the constructs included in individual theories, and a comparison of theories reveals that each is missing important constructs included in other theories. In addition, terminology and definitions are not consistent across theories. We describe the Consolidated Framework For Implementation Research (CFIR) that offers an overarching typology to promote implementation theory development and verification about what works where and why across multiple contexts. Methods We used a snowball sampling approach to identify published theories that were evaluated to identify constructs based on strength of conceptual or empirical support for influence on implementation, consistency in definitions, alignment with our own findings, and potential for measurement. We combined constructs across published theories that had different labels but were redundant or overlapping in definition, and we parsed apart constructs that conflated underlying concepts. Results The CFIR is composed of five major domains: intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation. Eight constructs were identified related to the intervention (e.g., evidence strength and quality), four constructs were identified related to outer setting (e.g., patient needs and resources), 12 constructs were identified related to inner setting (e.g., culture, leadership engagement), five constructs were identified related to individual characteristics, and eight constructs were identified related to process (e.g., plan, evaluate, and reflect). We present explicit definitions for each construct. Conclusion The CFIR provides a pragmatic structure for approaching complex, interacting, multi-level, and transient states of constructs in the real world by embracing, consolidating, and unifying key constructs from published implementation theories. It can be used to guide formative evaluations and build the implementation knowledge base across multiple studies and settings.http://deepblue.lib.umich.edu/bitstream/2027.42/78272/1/1748-5908-4-50.xmlhttp://deepblue.lib.umich.edu/bitstream/2027.42/78272/2/1748-5908-4-50-S1.PDFhttp://deepblue.lib.umich.edu/bitstream/2027.42/78272/3/1748-5908-4-50-S3.PDFhttp://deepblue.lib.umich.edu/bitstream/2027.42/78272/4/1748-5908-4-50-S4.PDFhttp://deepblue.lib.umich.edu/bitstream/2027.42/78272/5/1748-5908-4-50.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/78272/6/1748-5908-4-50-S2.PDFPeer Reviewe

Comparison of the phase-field approach and cohesive element modeling to analyze the double cleavage drilled compression fracture test of an elastoplastic material: Phase-field approach and cohesive elements for DCDC

International audienceBrittle material Mode I fracture may be characterized by the double cleavage drilled compres- sion test. For linear elastic materials, the critical energy release rate, or fracture toughness, can be estimated simply using the linear elastic fracture mechanics. For other types of constitutive behavior, the material parameter has to be determined with numerical fracture modeling. In this paper, we have used two approaches, the phase-field damage model and the cohesive ele- ments, in order to estimate the critical energy release rate of an elastoplastic material. Firstly, we assessed the numerical models and discussed their parameters by comparison of available data from double cleav- age drilled compression experimental tests run on a sil- ica glass. Both phase-field damage and cohesive zone models were able to reproduce fracture initiation at the observed macroscopic stress for the linear elastic mate- rial. However, the material toughness could not be pre- dicted by the phase-field approach due to the result dependence on the model regularization parameter. Secondly, an elastoplastic methyl methacrylate poly- mer was submitted to the compression test in our lab. Both models were then extended for elastic-perfectly plastic materials. Crack initiation was obtained at the observed macroscopic strain for similar critical energy release rate ranges for both approaches, providing good confidence in the estimated material toughness

Racial differences in antilipemic use and lipid control in high-risk older adults: Post–Medicare Part D

BACKGROUND: Older blacks are less likely to receive guideline-recommended antilipemic therapy and achieve lipid control than older whites due in part to out-of-pocket costs. We sought to determine whether racial differences in antilipemic use and lipid control narrowed after Medicare Part D’s implementation. METHODS: This before-after study included 1091 black and white adults age >70 with coronary heart disease and/or diabetes mellitus from the Health Aging and Body Composition Study. Primary outcomes were antilipemic use and LDL-C control. Key independent variables were race, time (pre- vs. post-Part D), and their interaction. RESULTS: Before Part D, fewer blacks than whites reported taking an antilipemic (32.70% vs 49.35%) and this difference was sustained after Part D (blacks 48.30% vs whites 64.57%). Multivariable generalized estimating equations confirmed no post Part D change in racial differences in antilipemic use (adjusted ratio of the odds ratios [AROR] 1.07, 95% CI 0.79–1.45). Compared to whites, more blacks had poor lipid control both before Part D (24.30% vs 12.36% respectively) and after Part D (24.46% vs 13.72% respectively), with no post Part D change in racial differences in lipid control (AROR 0.82, 95% CI 0.51–1.33). CONCLUSION: While antilipemic use increased after Medicare Part D for both races, this policy change was associated neither with a change in lipid control for either racial group nor in the racial differences in antilipemic use or lipid control