Sustainability from an Evidence Integration Triangle Perspective

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Sustainability from an Evidence Integration
Triangle Perspective

• Russell E. Glasgow, Ph.D.
• Deputy Director, Implementation Science
• Division of Cancer Control and Population
  Sciences National Cancer Institute
• Society of Behavioral Medicine
• April 2011

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OVERVIEW

• Definitions and Focus
• Learning Health Care Systems (Setting level)
• Problem-Solving Ability and Training (Indiv.)
• Evidence Integration Triangle perspective
• Implications for Sustainability

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Sustainability Focus
Definitions
Learning Health Care
Evidence Integration Triangle
Problem Solving
Sustainability

• Issue 1 Activities, Processes, or Outcomes
• Issue 2 Static vs. Dynamic Conceptualization

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Rapid Learning Health Care Systems
Current Gap
DI What we know
Evidence Integration Triangle
Future Directions/DI Opportunities

• Data Collected
• With real (and complex) patients
• By real-world staff
• Under real-world conditions and settings
• And evaluated through real-time data (often with
  Electronic Health Records)

Tunis,S.R. Carino,T.V. Williams,R.D. Bach,P.B.
A Rapid Learning Health System. Health Affairs
(supplement). 200726(2)140-149.
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Evidence on Problem-Solving Training (PST)
Definitions
Learning Health Care
Evidence Integration Triangle
Problem Solving
Sustainability

• Consistent evidence that PST improves long-term
  outcomes for
• Social skills
• Depression
• Weight loss
• Many other behaviors and conditions

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Evidence Integration Triangle Translation Across
the Continuum
Intervention Program/Policy(Prevention or
Treatment) (e.g., design key components
principles external validity)
Feedback
Feedback
Evidence
Stakeholders
Practical Measures (e.g., actionable
longitudinal measures)
Implementation Process (e.g., stakeholder
engagement team-based science CBPR patient
centered care)
Feedback
Multi-Level Context Multi-Level Context
Intrapersonal/Biological Policy
Interpersonal Community/Economic
Organizational Social/Environment
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Implications of Learning Systems, PST, and EIT
for Sustainability
Definitions
Learning Health Care
Evidence Integration Triangle
Problem Solving
Sustainability

• To maintain or continue improvement need to adapt
  and respond to changing content
• Iterative cycles of measurement, comparison to
  goal, adaptation, implementation, measurement,
  etc.

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IF AN INTERVENTION WORKS
AND NOBODY CAN USE OR SUSTAIN IT..
DOES IT STILL MAKE AN IMPACT?
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More Information

• Glasgow RE, HMC Research TranslationAm J Health
  Behav 2010Nov-Dec 34(6)833-840
• SBM Symposium on Sustainability What Does It
  Mean?
• (Chambers, Kaplan, Wasserman, Glasgow)
• Friday April 29, 845- 1015