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      Designing for Accelerated Translation (DART) of emerging innovations in health

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          Abstract

          Accelerating innovation translation is a priority for improving healthcare and health. Although dissemination and implementation (D&I) research has made significant advances over the past decade, it has attended primarily to the implementation of long-standing, well-established practices and policies. We present a conceptual architecture for speeding translation of promising innovations as candidates for iterative testing in practice. Our framework to Design for Accele rated Translation (DART) aims to clarify whether, when, and how to act on evolving evidence to improve healthcare. We view translation of evidence to practice as a dynamic process and argue that much evidence can be acted upon even when uncertainty is moderately high, recognizing that this evidence is evolving and subject to frequent reevaluation. The DART framework proposes that additional factors – demand, risk, and cost, in addition to the evolving evidence base – should influence the pace of translation over time. Attention to these underemphasized factors may lead to more dynamic decision-making about whether or not to adopt an emerging innovation or de-implement a suboptimal intervention. Finally, the DART framework outlines key actions that will speed movement from evidence to practice, including forming meaningful stakeholder partnerships, designing innovations for D&I, and engaging in a learning health system.

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          A practical, robust implementation and sustainability model (PRISM) for integrating research findings into practice.

          Although numerous studies address the efficacy and effectiveness of health interventions, less research addresses successfully implementing and sustaining interventions. As long as efficacy and effectiveness trials are considered complete without considering implementation in nonresearch settings, the public health potential of the original investments will not be realized. A barrier to progress is the absence of a practical, robust model to help identify the factors that need to be considered and addressed and how to measure success. A conceptual framework for improving practice is needed to integrate the key features for successful program design, predictors of implementation and diffusion, and appropriate outcome measures. A comprehensive model for translating research into practice was developed using concepts from the areas of quality improvement, chronic care, the diffusion of innovations, and measures of the population-based effectiveness of translation. PRISM--the Practical, Robust Implementation and Sustainability Model--evaluates how the health care program or intervention interacts with the recipients to influence program adoption, implementation, maintenance, reach, and effectiveness. The PRISM model provides a new tool for researchers and health care decision makers that integrates existing concepts relevant to translating research into practice.
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            Convergence of Implementation Science, Precision Medicine, and the Learning Health Care System: A New Model for Biomedical Research.

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              Accelerating Digital Mental Health Research From Early Design and Creation to Successful Implementation and Sustainment

              Mental health problems are common and pose a tremendous societal burden in terms of cost, morbidity, quality of life, and mortality. The great majority of people experience barriers that prevent access to treatment, aggravated by a lack of mental health specialists. Digital mental health is potentially useful in meeting the treatment needs of large numbers of people. A growing number of efficacy trials have shown strong outcomes for digital mental health treatments. Yet despite their positive findings, there are very few examples of successful implementations and many failures. Although the research-to-practice gap is not unique to digital mental health, the inclusion of technology poses unique challenges. We outline some of the reasons for this gap and propose a collection of methods that can result in sustainable digital mental health interventions. These methods draw from human-computer interaction and implementation science and are integrated into an Accelerated Creation-to-Sustainment (ACTS) model. The ACTS model uses an iterative process that includes 2 basic functions (design and evaluate) across 3 general phases (Create, Trial, and Sustain). The ultimate goal in using the ACTS model is to produce a functioning technology-enabled service (TES) that is sustainable in a real-world treatment setting. We emphasize the importance of the service component because evidence from both research and practice has suggested that human touch is a critical ingredient in the most efficacious and used digital mental health treatments. The Create phase results in at least a minimally viable TES and an implementation blueprint. The Trial phase requires evaluation of both effectiveness and implementation while allowing optimization and continuous quality improvement of the TES and implementation plan. Finally, the Sustainment phase involves the withdrawal of research or donor support, while leaving a functioning, continuously improving TES in place. The ACTS model is a step toward bringing implementation and sustainment into the design and evaluation of TESs, public health into clinical research, research into clinics, and treatment into the lives of our patients.
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                Author and article information

                Journal
                J Clin Transl Sci
                J Clin Transl Sci
                CTS
                Journal of Clinical and Translational Science
                Cambridge University Press (Cambridge, UK )
                2059-8661
                June 2019
                30 July 2019
                : 3
                : 2-3
                : 53-58
                Affiliations
                [ 1 ] Department of Psychiatry, Washington University School of Medicine , St. Louis, MO, USA
                [ 2 ] Brown School of Social Work and Public Health, Washington University , St. Louis, MO, USA
                [ 3 ] Office of the Director, Division of Cancer Control and Population Sciences, National Cancer Institute , Rockville, MD, USA
                [ 4 ] Department of Pediatrics, Washington University School of Medicine , St. Louis, MO, USA
                [ 5 ] Department of Medicine, Washington University School of Medicine , St. Louis, MO, USA
                Author notes
                [* ] Address for correspondence: A. T. Ramsey, PhD, Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Ave., St. Louis, MO 63110, USA. Email: aramsey@ 123456wustl.edu
                Article
                00386 S2059866119003868
                10.1017/cts.2019.386
                6746422
                31528365
                9d86fc1c-a32f-4322-b153-bf770b81fe5d
                © The Association for Clinical and Translational Science 2019

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence ( http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.

                Page count
                Figures: 1, Tables: 2, References: 19, Pages: 6
                Product
                Categories
                Special Communications
                Implementation, Policy and Community Engagement

                designing for dissemination and implementation,stakeholder partnerships,learning health system,implementation science,precision medicine,speed of translation

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