Conceptualizing the problem of implementation: a systems engineering perspective applied in substance abuse treatment

 描述(由申请人提供)：候选人：安德鲁·昆贝克，博士，健康系统工程师，寻求在实施科学领域开展独立研究，专注于成瘾和药物滥用治疗的临床领域。系统工程师借鉴不同科学领域的理论和原理，并将它们应用于现实世界中的问题。在接受专注于医疗保健系统的系统工程师培训后，我对医疗保健中的一个关键问题特别感兴趣：基于证据的做法采用率的糟糕统计数据。我将实施过程表述为医疗保健利益相关者在不确定情况下做出的一系列决定，这些决定具有潜在的不同价值，并从系统的角度说明了实施可能失败的许多方式。我的近期目标是学习和应用多属性效用理论的技术，从关键医疗保健利益相关者的角度评估成瘾治疗循证实践的感知价值，并将其作为识别和缓解失败的潜在原因的基础。我的长期职业目标是努力解决医疗保健中的实施问题，而一个有指导的职业奖项将帮助我获得所需的进一步培训。发展计划：多属性效用理论属于决策分析的一般学科，这是一个我几乎没有经验的领域。我的主要导师(古斯塔夫森博士)是将多属性效用理论应用于医疗保健问题的先驱，发表了33篇关于这个主题的文章。古斯塔夫森博士将指导我发展多属性效用理论和实现科学方面的专业知识，以实现我的职业目标。Gustafson博士将加入世界一流的指导团队，包括人口健康科学教授和国际知名的健康经济学(特别是在药物滥用领域)权威John Mullahy博士；管理学教授、管理学院前院长和行为决策专家Ramon Aldag博士；工业与系统工程副教授和医疗决策专家Oguzhan Alagoz博士；护理学教授和混合方法研究国际权威Barbara Bowers博士；家庭医学副教授和威斯康星大学成瘾医学住院医师项目负责人Randall Brown博士。环境：威斯康星大学是享誉全球的研究型大学，在公立大学中总体研究支出排名第二。该大学工程学院的健康增强系统研究中心(CHESS)提供了一个无与伦比的环境来进行医疗保健实施科学的研究。在过去的25年里，CHESS以其将系统工程原理和设计创新地应用于医疗保健，特别是在组织和个人变革领域的创新应用而享誉国际。CHESS设在工业与系统工程系，在使威斯康星大学成为世界领先的卫生系统工程研究部门的研究资金方面发挥了关键作用。Chess目前拥有两项R01级别的NIH实施研究，拥有实施研究数据的宝库以及与研究参与者的联系，这在实施科学领域是无与伦比的，允许检查不同医疗保健组织之间的交叉实施问题。研究计划：该研究计划利用国际象棋提供的强大研究环境，通过研究一组寻求实施名为A-国际象棋的循证上瘾实践的医疗诊所来实现。研究计划的目标是开发和试行一种多属性效用模型，从多个利益攸关方的角度评估循证实践的感知价值。决策科学、健康经济学、行为经济学和博弈论等几个领域都提出了一些想法，可以帮助解释人们如何在不确定的情况下做出决定。我将首先寻求在三个试点诊所使用混合方法来开发多属性实用模型。该文件的内容 模型将通过对诊所经理、工作人员和患者的定性访谈来开发和验证。然后，我将通过对参与实施的诊所的管理人员、员工和患者进行调查，来测试该模型与A-国际象棋的接受程度之间的相关性。实现这些目标将阐明如何将多属性效用模型整合到一个全面的实施战略中，并将产生初步数据，以进行对该战略进行预期的R01实施研究。最终，职业发展和研究计划的实现将提供一种数据驱动的方法，使用多属性效用理论来评估循证实践采用的潜在影响，这一方法在卫生经济学文献中得到了很好的确立。由此产生的产品将是一种诊断工具，用于评估循证做法采用的前景，并改进执行战略，使采用对关键利益攸关方更具吸引力。

 DESCRIPTION (provided by applicant): Candidate: Andrew Quanbeck, Ph.D., is a health systems engineer seeking to launch an independent research career in implementation science, focused in the clinical area of addiction and drug abuse treatment. Systems engineers draw upon theories and principles from diverse scientific fields and apply them to problems in the real world. Having been trained as a systems engineer with a focus on healthcare systems, I have become especially interested in a critical problem in healthcare: the abysmal statistics on the rate of adoption of evidence-based practices. I formulate the process of implementation as a series of decisions made under uncertainty by healthcare stakeholders with potentially divergent values, and illustrate the many ways that implementation can fail from a systems perspective. My near-term goal is to learn and apply the technique of multi-attribute utility theory to assess the perceived value of an evidence-based practice for addiction treatment from the perspective of key healthcare stakeholders, and use it as a basis to identify and mitigate potential causes of failure. My long-term career goal is to work towards solving the problem of implementation in healthcare, and a mentored career award will help me gain the further training I need to do it. Development plan: Multi-attribute utility theory falls under the general discipline of decision analysis, a field with which I have little experience. My primary mentor (Dr. Gustafson) is a pioneer in applying multi-attribute utility theory to healthcare problems, with 33 articles publishd on the topic. Dr. Gustafson will guide me in developing the expertise in multi-attribute utility theory and implementation science I need to fulfill my career goals. Dr. Gustafson will be joined by a world-class mentoring team, including Dr. John Mullahy, Professor of Population Health Sciences and an internationally known authority on health economics (particularly in the area of drug abuse); Dr. Ramon Aldag, Professor of Management, former President of the Academy of Management and an expert on behavioral decision-making; Dr. Oguzhan Alagoz, Associate Professor of Industrial & Systems Engineering and an expert in medical decision making; Dr. Barbara Bowers, Professor of Nursing and an international authority on mixed-methods research; and Dr. Randall Brown, Associate Professor of Family Medicine and head of the University of Wisconsin Addiction Medicine Residency program. Environment: The University of Wisconsin has a worldwide reputation as a research university, ranking second among public universities in overall research expenditures. The University's College of Engineering's Center for Health Enhancement Systems Studies (CHESS) offers an unparalleled environment to conduct research on healthcare implementation science. Over the past 25 years CHESS has developed an international reputation for its innovative application of systems engineering principles and designs to healthcare, specifically in areas of organizational and individual change. Housed in the Department of Industrial & Systems Engineering, CHESS has played a key role in making the University of Wisconsin the world's leading health systems engineering research department in terms of research funding. CHESS, currently home to two R01-level NIH implementation studies, holds a trove of implementation research data and connections with research participants that is unparalleled in the field of implementation science, allowing examination of cross-cutting implementation issues between different healthcare organizations. Research plan: The research plan capitalizes on the strong research environment CHESS affords by studying a group of healthcare clinics seeking to implement an evidence-based practice for addiction named A-CHESS. The objective of the research plan is to develop and pilot test a multi-attribute utility model that assesses the perceived value of an evidence-based practice from multiple stakeholder perspectives. Several fields- decision science, health economics, behavioral economics, and game theory, among others-all suggest ideas that can help explain how people make decisions under uncertainty. I will first seek to develop the multi- attribute utility model, using a mixed methods approach, in three pilot clinics. The content of the model will be developed and validated through qualitative interviews with clinic managers, staff, and patients. Then, I will test how the model correlates with the uptake of A-CHESS by surveying managers, staff, and patients from clinics engaged in implementation. Achieving these aims will elucidate how to integrate the multi-attribute utility model into a comprehensive implementation strategy, and will generate preliminary data to conduct a prospective R01 implementation study testing this strategy. Ultimately, fulfillment of the career development and research plan will offer a data-driven means of assessing the potential impact of evidence-based practice adoption using multi-attribute utility theory, an approach that is well-established in the health economics literature. The resulting product will be a diagnostic tool for assessing the prospects of evidence-based practice adoption and refining implementation strategies to make adoption more appealing to critical stakeholders.