Evidence-based treatments can take upwards of 17 years to move from dissemination to routine clinical practice. Along the way, patients miss out on meaningful treatment and intervention while billions of dollars go towards duplicate efforts and ineffective initiatives. This is often not due to a lack of effort but a misalignment of expertise in implementation science. Clinicians and healthcare systems need the right guidance and tools to seamlessly train staff and integrate the most up-to-date, evidence-based solutions in a sustainable and scalable manner.
Closing the Gap Between Scientific Discovery and Patient Care
At the DCRI, our experts have studied what makes a solution stick and put that knowledge into practice time and time again. They are adept at identifying entry points for intervention throughout a study's life cycle and assessing the feasibility of a program within a variety of clinical and community settings. Most importantly, DCRI practicing physicians and operational experts utilize their real-world experience to center a program's appropriateness on multiple patient populations to ensure maximum reach and long-term effectiveness.
Our Services
- Design and Oversight of Clinical Trials: Building and guiding clinical trials that meet regulatory standards and lead to improved implementation.
- Stakeholder Engagement: Collaborating with clinic, patient, community, and corporate stakeholders to understand the key factors necessary for the successful introduction and acceptance of new guidelines, therapies, products, or services.
- Knowledge Dissemination: Employing proven and innovative strategies to expedite the dissemination of published results and facilitate implementation.
Implementation Science in Action
Implementation science methods encourage the adoption of evidence-based practices in real-world settings. The following studies utilized a multi-level intervention approach to achieve their aims. This approach involved identifying barriers and addressing gaps that hinder the translation of evidence into practice. By creating multifaceted interventions, researchers can tailor strategies to overcome these barriers, thereby enhancing the uptake of evidence-based practices.
AIM-Back: Pathways for Pain Management
The AIM-Back Trial sought to enhance the quality of life of veterans who suffer from low back pain by improving access to non-pharmacological pain management interventions. Conducted in primary care clinics at Veteran's Health Administration (VHA) facilities, two clinical pathways were implemented and evaluated low back pain interference and physical function. Several sites have sustained these pathways of care beyond the trial. The full results of this trial are expected in late 2024.
CardioHealth Alliance: Partnering to Provide Proactive Evidence-Based Health Care
In 2019, leading cardiologists at Stanford and Duke Universities identified a backward trend in risk factors and outcomes related to heart disease. To address this issue, the CardioHealth Alliance was formed to engage clinicians, data scientists, healthcare leaders, life science partners, and policymakers to improve the care and health of patients across therapeutic areas, including cardiovascular, renal, and metabolic diseases. The Alliance’s work is guided by DCRI implementation science experts who utilize real-world data to inform care, develop and test new practices, and expedite the translation of evidence into practice. This approach allows the Alliance to improve patient outcomes in real-time. The Alliance supports projects ranging from small observational studies to large implementation science trials in underrepresented populations.
COORDINATE-Diabetes: Improving Adoption of Evidenced-Based Therapies
The COORDINATE-Diabetes team was tasked with addressing the difficulties encountered by clinicians, patients, and healthcare systems in implementing guideline-recommended treatments for individuals with Type 2 diabetes and cardiovascular disease. To tackle this challenge, DCRI experts randomized 42 cardiology clinics across the U.S. into two groups: an intervention arm that emphasized evidence-based care and another that followed standard care. The intervention was multifaceted, involving the creation of a clinic-specific interdisciplinary care pathway, the provision of audit and feedback reports, the distribution of educational tools to both providers and patients, and additional resources. Trial results were revealed in a late-breaking session at ACC in 2023 and showed a significant 23.4% absolute difference in the prescription of all three evidence-based therapies between the standard care and intervention groups. This comprehensive intervention effectively enhanced the adoption of evidence-based therapies among adults with Type 2 diabetes and atherosclerotic cardiovascular disease (ASCVD).
RACE-CARS: Improving Survival Rates
The RACE-CARS Trial aims to improve the survival rates of patients who experience sudden cardiac arrest in community or outpatient settings. Our experts have devised a three-pronged intervention strategy currently being implemented in collaboration with emergency medical service agencies across 31 counties in North Carolina. The first intervention focuses on enhancing 911 telecommunicator recognition and performance of telecommunicator-assisted CPR. The second intervention seeks to boost first responder performance and increase the availability of automated external defibrillators. The third intervention involves conducting mass community training in hands-only CPR. The trial is expected to conclude in 2026.
Partnering for Meaningful Change
The DCRI collaborates across academic, industry, government, and community organizations to foster a collective of partners committed to innovative patient-centered solutions.
DCRI’s First Implementation Summit
Evidence-based therapies for cardiorenal metabolic disease can only be implemented when partners collaborate. On February 27, 2024, the first DCRI Implementation Summit on “Scalability, Spread, and Sustainability” brought together clinical researchers, payers, funders, and pharmaceutical industry leaders to collaborate on ideas to improve knowledge translation in cardiology research. Key themes from the meeting included aligning stakeholders, disseminating implementation strategies, working with community partners, funding and producing impactful implementation research, and training current and future generations of experts.
DCRI Implementation Science Collaborative
The DCRI Implementation Science Collaborative is comprised of Duke experts recognized across their respective disciplines for rigorous clinical research and science-backed approaches to implementation that result in meaningful outcomes for patients and healthcare delivery systems.
