Translating Research into Policy and Practice: Who’s Influencing Whom?

Jon F. Kerner, Ph.D.Deputy Director, Division of Cancer Control

& Population SciencesAcademy Health

Research Translation Interest Group National Health Policy Conference

February 13, 2007

Who Makes Policy?

Who Controls Major Federal Programs for Children and Families: Rube Goldberg Revisited. The Institute for Educational Leadership. Washington DC: 1995.

THE CANCER CONTROL CONTINUUM

Cancer Control Continuum

Prevention

Focus

• Tobacco Control• Diet• Physical Activity• Sun Exposure• Virus Exposure• Alcohol Use• Chemoprevention

Detection• Pap Test• Mammography• FOBT• Endoscopy• PSA Informed

Decision Making

Treatment• Health Services

and Outcomes Research

• Clinical Trials

Survivorship• Palliation• Coping• Health Promotion

Diagnosis• Informed

Decision Making

• Clinical Follow-up

• Imaging

Cross Cutting Issues

• Communications• Surveillance• Social Determinants and Health Disparities• Genetic Testing• Decision-Making• Evidence-Based Health Care• Quality of Cancer Care• Epidemiology

http://appliedresearch.cancer.gov/

•Promising molecule or gene target•Candidate protein biomarker•Basic epidemiologic finding

•Phase III trials•Regulatory approval•Partnerships•Production/commercialization•Phase IV trials –approval for additional uses

•Payment mechanism(s) established to support adoption•Health services research to track adoption

•Partnerships and collaboration (academia, government, industry)•Intervention development•Phase I/II trials

•Adoption of advance by providers, patients, public•Payment mechanism(s) in place to enable adoption•To community health

providers•To patients and public

•Dissemination & Implementation Research

to study how best to support D&I

(of new drug, assay, device, behavioral intervention, educational materials,

training)

Basic Science Discovery

LateTranslation

EarlyTranslation Dissemination Adoption

The Translation Continuum

•Data collection to support outcomes research, intervention refinement, health services and other research; and to inform provider practices

Translating Research to Reduce the Burden of Cancer

Source: Reuben SH. 2005

THE DISCOVERY-DELIVERY CONTINUUM

DiscoveryDiscovery DevelopmentDevelopment DeliveryDelivery

Public Public Health Health

PracticePractice

Primary Primary Care Care

PracticePractice

Disease Disease Specialty Specialty PracticePractice

Diffusion

… the passive process by which a growing body of information about an intervention, product, or technology is initially absorbed and acted upon by a small body of highly motivated recipients (Lomas, 1993).

Bridging the Gap: A Synergistic Model

Getting Evidence-Based Cancer Control Interventions Into Practice

Science PushDocumenting, improving,and communicatingthe intervention forwide population use

Delivery CapacityBuilding the capacity of relevant systems to deliver the intervention

GOAL: To increase the adoption, reach and impact of evidence-based cancer control

ULTIMATE GOAL:Improve population health

and well being

Market Pull/ DemandBuilding a marketand demand for theintervention

-based Increase the number of systems providing evidence cancer control-Increase the number of practitioners providing evidence based cancer control

-Increase the number of individuals receiving evidence based cancer control

Tracy Orleans ( RWJF) – Designing for Dissemination Conference Presentation, 9/ 02

Dissemination

Active process through which the information needs (pull) of target groups working in specific contexts (capacity) are assessed, and information is “tailored” to increase awareness of, acceptance of, and use of the lessons learned from science.

Publication

Bibliographic databases

Submission

Reviews, guidelines, textbook

Negative results

variable

0.3 year

6. 0 - 13.0 years50%

46%

18%

35%

0.6 year

0.5 year

9.3 years

Dickersin, 1987

Koren, 1989

Balas, 1995

Poynard, 1985

Kumar, 1992

Kumar, 1992

Poyer, 1982

Antman, 1992

Negative results

Lack of numbers

Expertopinion

Inconsistentindexing

It takes 17 years to turn 14 per cent of original researchIt takes 17 years to turn 14 per cent of original research to the benefit of patient careto the benefit of patient care

17:14

Original research

Acceptance

Implementation

E.A. Balas, 2000

Translational Research vs. Research Translation

"Cutting-Edge" "State-Of-The-Art" "Resource-Limited"

Academic Cancer& Medical Centers

CCOPs & ACoSApproved CancerPrograms

Municipal & RuralHospitals & Clinics

TRANSLATION

Evidence-basedKnowledge

“The transfer of evidenced-basedknowledge into routine

or representative practice”

PublicHealth &ClinicalPractice

Glasgow, R SBM (2005) 26th Annual SBM Meeting, Symposium #22:Disseminating Behavioral Medicine Research: Making the Translational Leap.

What is Evidence…..?Surveillance DataSystematic Reviews of Multiple

Research StudiesExpert Opinion/Narrative ReviewsA Single Research StudyProgram/Policy EvaluationWord of Mouth/MediaMarketing/LobbyingPersonal Experience

OBJECTIVE

SUBJECTIVE

INTEGRATION

Explicit Evidence-Based Knowledge

InformedApplication

Tacit Clinicaland

Contextual Knowledge

“The informed combination of evidence-basedknowledge and local contextual knowledge

into policy & practice applications.”

Adapted from Glasgow, R SBM (2005) 26th Annual SBM Meeting, Symposium #22:Disseminating Behavioral Medicine Research: Making the Translational Leap.

Integrating Research with Practice/Policy

Integrating research with practice/policy requires the development of a common language and common understanding about the meaning of knowledge translation, knowledge integration, and the nature of evidence.

New and expanded investments in dissemination and implementation research are needed to review existing models and develop new conceptual frameworks to integrate science with service practice and policy.

Research/practice/policy partnerships will be critical in all aspects of future intervention, dissemination and implementation research, as well as diffusion, dissemination and implementation of research results.

Tacit & ContextualKnowledge

From Experience

ExplicitExplicitKnowledgeKnowledge from from

Research EvidenceResearch Evidence

Making Translation Decisions: Do We Have the Right Stuff?

Does the impact of research on policy application depend on the relationship between research and application agencies?

ExecutiveBranch

Regulatory(e.g. FDA, EPA)

Research(NIH, NSF)

Research& Application(e.g. AHRQ)

Application & Research(e.g. CDC)

Application(e.g. CMS, HRSA)

“To him who devotes his life to science, nothing can give

more happiness than increasing the

number of discoveries, but his cup of joy is full when the results of his studies

immediately find practical applications.”

~Louis Pasteur

Our goal is to turn knowledge into applications that benefit people.