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

概念化实施问题：系统工程视角应用于药物滥用治疗

• 批准号: 9256452
• 负责人: Andrew Quanbeck
• 金额: $ 15.47万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-05-01 至 2020-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9256452
• 关键词: Academy; Address; Adopted; Adoption; Area; Award; Behavioral; Car Phone; Clinic; Clinical; Data; Decision Analysis; Decision Making; Development Plans; Diagnostic; Discipline; Discipline of Nursing; Doctor of Philosophy; Drug abuse; Economics; Engineering; Environment; Evidence based practice; Expenditure; Failure; Family Practice; Federally Qualified Health Center; Funding; Game Theory; Goals; Head; Health; Health Sciences; Health Technology; Health system; Healthcare; Healthcare Systems; Home environment; Individual; Industrialization; Influentials; International; Interview; Investments; Learning; Linear Models; Literature; Medical; Medical Research; Medicine; Mentors; Methods; Modeling; Names; Nurses; Participant; Patients; Performance; Plant Roots; Play; Positioning Attribute; Problem Solving; Process; Public Health; Receiver Operating Characteristics; Research; Research Methodology; Research Personnel; Research Subjects; Residencies; Running; Science; Series; Surveys; System; Techniques; Testing; Training; Uncertainty; United States National Institutes of Health; Universities; Utility Theories; Wisconsin; Work; addiction; authority; base; behavioral economics; career; career development; college; design; evidence base; experience; falls; health care quality; health economics; implementation research; implementation science; improved; innovation; interest; mHealth; mid-career faculty; novel strategies; population health; professor; programs; prospective; public health relevance; research and development; research to practice; statistics; substance abuse treatment; theories; tool; treatment organization; uptake

 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.

 描述（由适用提供）：候选人：Andrew Quanbeck博士，是一名卫生系统工程师，寻求从事实施科学领域的独立研究职业，重点是成瘾和药物滥用治疗的临床领域。系统工程师借鉴了不同科学领域的理论和原则，并将其应用于现实世界中的问题。我接受了专注于医疗保健系统的系统工程师的培训，我对医疗保健中的关键问题特别感兴趣：关于循证实践采用率的糟糕统计数据。我将实施过程作为一系列决策，这是在医疗保健利益相关者具有潜在不同价值观的不确定性下做出的，并说明了从系统角度来看实施可以失败的许多方式。我的近期目标是学习和运用多属性公用事业理论的技术，以评估从关键医疗保健利益相关者的角度添加循证实践的感知价值，并将其用作识别和减轻潜在失败原因的基础。我的长期职业目标是致力于解决医疗保健实施问题，而事业奖项将有助于我获得进一步的培训。发展计划：多属性效用理论属于决策分析的一般学科，我几乎没有经验。我的主要导师（Gustafson博士）是将多属性效用理论应用于医疗保健问题的先驱，有关该主题的33篇文章。 Gustafson博士将指导我发展多属性实用学理论和实施科学的专业知识，以实现我的职业目标。 Gustafson博士将与世界一流的心理团队一起加入，包括人口健康科学教授和国际知名的健康经济学机构（部分是在药物滥用领域）； Ramon Aldag博士，管理学院教授，​​前管理学院前院长，行为决策专家；工业与系统工程副教授，医疗决策专家Oguzhan Alagoz博士；芭芭拉·鲍尔斯（Barbara Bowers）博士，护理教授和混合方法研究的国际机构；家庭医学副教授兼威斯康星大学成瘾医学居住计划的负责人Randall Brown博士。环境：威斯康星大学在全球范围内享有研究大学的声誉，在整体研究支出中公立大学中排名第二。该大学工程学院健康增强系统研究中心（CHESS）提供了无与伦比的环境，以进行医疗保健实施科学研究。在过去的25年中，国际象棋因其系统工程原理和设计在医疗保健方面的创新应用，特别是在组织和个人变革领域的创新应用。国际象棋位于工业与系统工程系中，在使威斯康星大学成为研究资金方面的威斯康星大学成为世界领先的卫生系统工程研究系方面发挥了关键作用。 Chess目前是两项R01级NIH实施研究的所在地，它拥有实施研究数据以及与研究参与者的联系，这些数据在实施科学领域是无与伦比的，从而允许研究不同医疗机构之间的交叉切割实施问题。研究计划：研究计划将基于强大的研究环境来利用国际象棋为一组寻求实施基于证据的成瘾实践A-Chess的实践而提供的医疗诊所提供了支持。研究计划的目的是制定和试点测试一个多属性实用程序模型，该模型从多个利益相关者的角度评估了基于证据的实践的价值。几个领域 - 决策科学，卫生经济学，行为经济学和游戏理论以及其他所有领域都提出了可以帮助解释人们如何在不确定性下做出决策的想法。将首先寻求在三个试点诊所中使用混合方法方法开发多属性实用模型。内容的内容 模型将通过与诊所经理，员工和患者的定性访谈开发和验证。然后，我将通过调查经理，员工和从事实施的诊所的患者进行测量，测试该模型与A-CHESS的接收如何相关。实现这些目标将阐明如何将多属性实用程序模型整合到全面的实施策略中，并将生成初步数据以进行前瞻性R01实施研究测试该策略。最终，实现职业发展和研究计划将提供以数据为基础的含义，以评估使用多属性效用理论采用基于证据的实践的潜在影响，这种方法在健康经济学文献中已经建立了良好的方法。最终的产品将是评估循证实践采用和完善实施策略的诊断工具，以使收养对关键利益相关者更具吸引力。