Implementation Core (G)

Brown University, Providence RI

Investigators

Linked publications & trials

Abstract

Most non-pharmacological interventions that have shown promise improving outcomes for people living with dementia (PLWD) and their care partners (CPs), have neither been tested in health care settings (HCS) nor widely disseminated. To address this gap, the mission of the National Institute on Aging (NIA) IMbedded Pragmatic Alzheimer's disease (AD) and AD-Related Dementias (AD/ADRD) Clinical Trials (IMPACT) Collaboratory is to build the nation’s capacity to conduct embedded pragmatic clinical trials (ePCTs) in health care systems (HCS) for this population. However, implementing interventions into real-world care contexts is extremely challenging. If not done successfully, potentially clinically beneficial interventions may be deemed ineffective, impeding their adoption into practice and opportunity to improve care. The goal of IMPACT’s Implementation Core (IC) is to optimize strategies for implementing interventions evaluated in ePCTs for PLWD and their CPs to avoid this scenario. During the initial 5-year cycle, the IC worked towards that goal by supporting the conduct of ePCTs, training investigators, and generating knowledge. Several highlights are notable. IC members were among the most sought-after consultants among applicants for IMPACT Project grants. As many applicants lacked basic skills in implementation science principles, the IC developed a guidance document to inform the implementation strategies in their ePCTs. In addition, the IC collaborated with the Design and Statistics Core on a companion guidance document for estimating the sample size of the pilot studies for ePCTs based on achieving implementation endpoints. The IC participated in all IMPACT-wide training activities (annual workshop, videos for the Learning Library), and mentored 8 Faculty Scholars and 5 post-doctoral fellows. The IC generated 18 manuscripts and created 3 searchable iLibraries that collated key characteristics from 74 dementia care interventions. To generate experiential knowledge, IC members led an in-depth, qualitative study of implementation barriers and facilitators across 16 Pilot, Demonstration, and Supplement IMPACT Projects. In the renewal period the IC will build on its foundational work. Related to planning, monitoring, and evaluating intervention implementation in ePCTs for dementia care, the Specific Aims of the IC are: Aim 1. Support the design and conduct of ePCTs by providing guidance and consultation to investigators; Aim 2. Enhance investigator capacity by contributing to all IMPACT training activities, Aim 3. Develop and disseminate knowledge to advance best practices and methodologies in the field by addressing persistent gaps and learning from the experience of ePCTs supported by IMPACT. IMPACT: For ePCTs to be successful and improve care for PLWD and their CPs, persistent challenges implementing interventions in HCS must be addressed. This requires systematic attention to evidentiary practices in implementation science in the design and conduct of ePCTs, trained investigators to do this work, and incremental learning from ongoing and completed ePCTs. For these reasons, the IC is essential to achieving IMPACT’s mission.