Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact.
Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact.
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DOI：
10.1097/mlr.0b013e3182408812
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发表时间：
2012-03
期刊：
影响因子：
3
通讯作者：
Stetler C
中科院分区：
文献类型：
--
作者：
Curran GM;Bauer M;Mittman B;Pyne JM;Stetler C
本研究提出了将临床有效性和实施研究的设计部分相结合的方法。与独立进行这些研究方向相比，这种混合可以带来好处。例如，更快速的转化收益、更有效的实施策略以及对决策者更有用的信息。本研究提出了“混合有效性-实施”类型，描述了其使用的基本原理，概述了必须面对的设计决策，并提供了几个现实世界的例子。有效性-实施混合设计是一种在评估临床有效性和实施方面先验地双重关注的设计。我们提出了 3 种混合类型：(1) 测试临床干预对相关结果的影响，同时观察和收集实施信息； (2) 临床和实施干预/策略的双重测试； (3) 测试实施策略，同时观察和收集临床干预对相关结果影响的信息。本文提出的混合类型必须被视为仍在进化中的结构。尽管传统的临床有效性和实施试验可能仍然是将临床干预从功效研究转向公共卫生影响的最常见方法，但明智地使用所提出的混合设计可以加快将研究结果转化为常规实践的速度。
This study proposes methods for blending design components of clinical effectiveness and implementation research. Such blending can provide benefits over pursuing these lines of research independently; for example, more rapid translational gains, more effective implementation strategies, and more useful information for decision makers. This study proposes a “hybrid effectiveness-implementation” typology, describes a rationale for their use, outlines the design decisions that must be faced, and provides several real-world examples. An effectiveness-implementation hybrid design is one that takes a dual focus a priori in assessing clinical effectiveness and implementation. We propose 3 hybrid types: (1) testing effects of a clinical intervention on relevant outcomes while observing and gathering information on implementation; (2) dual testing of clinical and implementation interventions/strategies; and (3) testing of an implementation strategy while observing and gathering information on the clinical intervention’s impact on relevant outcomes. The hybrid typology proposed herein must be considered a construct still in evolution. Although traditional clinical effectiveness and implementation trials are likely to remain the most common approach to moving a clinical intervention through from efficacy research to public health impact, judicious use of the proposed hybrid designs could speed the translation of research findings into routine practice.