"Scaling-out" evidence-based interventions to new populations or new health care delivery systems
"Scaling-out" evidence-based interventions to new populations or new health care delivery systems
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DOI：
10.1186/s13012-017-0640-6
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发表时间：
2017-09-06
影响因子：
7.2
通讯作者：
Brown, C. Hendricks
中科院分区：
文献类型：
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作者：
Aarons, Gregory A.;Sklar, Marisa;Brown, C. Hendricks
背景资料：实施经证实有效的治疗和干预措施对于以更低的成本改善患者健康结果至关重要。当循证干预（EBI）在与先前发现有效的环境非常相似的环境中忠实地实施时，预期EBI的类似益处是合理的。然而，实施科学的一个目标是尽可能广泛地扩大EBI的使用，以促进最大的公共卫生影响。当实施EBI在一个新的设置，或针对新的人群，必须考虑是否有足够的理由，EBI将有类似的好处，发现在早期trials.Discussion：在本文中，我们引入了一个新的概念，实施称为“扩展”时，EBI适应新的人口或新的交付系统，或两者兼而有之。使用现有的外部有效性理论和多层次的中介建模，我们提供了一个逻辑框架，以确定什么样的新的经验证据是必要的干预措施，以保持其基于证据的标准，在这个新的背景下。激励性问题是，是否可以合理地预期横向扩展会产生如先前研究中所发现的人群水平的有效性，以及需要进行哪些额外的经验评估来测试这种全新的有效性试验。我们提出了评估方案，以评估是否扩展的结果在最终的健康outcome of interest.Conclusion：在缩放到健康或服务提供系统或人口/社区的背景下，是不同的设置，EBI最初进行测试，有情况下，翻译的时间较短是可能的。我们认为，在适度不同的环境或不同的人群中实施EBI有时可以从先前有效性试验的影响证据中“借用力量”。根据对EBI和环境的适应性和程度，认为有必要收集更多的经验数据。我们在本文中的论点是概念性的，我们提出了正式的中介等价性的实证检验在后续文件。
Background: Implementing treatments and interventions with demonstrated effectiveness is critical for improving patient health outcomes at a reduced cost. When an evidence-based intervention (EBI) is implemented with fidelity in a setting that is very similar to the setting wherein it was previously found to be effective, it is reasonable to anticipate similar benefits of that EBI. However, one goal of implementation science is to expand the use of EBIs as broadly as is feasible and appropriate in order to foster the greatest public health impact. When implementing an EBI in a novel setting, or targeting novel populations, one must consider whether there is sufficient justification that the EBI would have similar benefits to those found in earlier trials.Discussion: In this paper, we introduce a new concept for implementation called "scaling-out" when EBIs are adapted either to new populations or new delivery systems, or both. Using existing external validity theories and multilevel mediation modeling, we provide a logical framework for determining what new empirical evidence is required for an intervention to retain its evidence-based standard in this new context. The motivating questions are whether scale-out can reasonably be expected to produce population-level effectiveness as found in previous studies, and what additional empirical evaluations would be necessary to test for this short of an entirely new effectiveness trial. We present evaluation options for assessing whether scaling-out results in the ultimate health outcome of interest.Conclusion: In scaling to health or service delivery systems or population/community contexts that are different from the setting where the EBI was originally tested, there are situations where a shorter timeframe of translation is possible. We argue that implementation of an EBI in a moderately different setting or with a different population can sometimes "borrow strength" from evidence of impact in a prior effectiveness trial. The collection of additional empirical data is deemed necessary by the nature and degree of adaptations to the EBI and the context. Our argument in this paper is conceptual, and we propose formal empirical tests of mediational equivalence in a follow-up paper.