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（由申请人提供）： 候选人：Andrew Quanbeck 博士，是一名卫生系统工程师，寻求在实施科学领域开展独立研究职业，专注于成瘾和药物滥用治疗的临床领域。在接受过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：糟糕的比率统计数据。采用基于证据的我将实施过程制定为具有潜在不同价值观的医疗保健利益相关者在不确定性下做出的一系列决策，并从系统角度说明实施可能失败的多种方式。多属性效用理论从主要医疗利益相关者的角度评估基于证据的成瘾治疗实践的感知价值，并将其作为识别和减轻失败的潜在原因的基础。致力于解决医疗保健的实施问题，并指导职业奖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，我在这个领域几乎没有经验。 Gustafson 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 篇有关该主题的文章，他将指导我发展实现我的职业目标所需的多属性效用理论和实施科学方面的专业知识。 。 Gustafson 将由世界级的指导团队加入，其中包括人口健康科学教授 John Mullahy 博士和卫生经济学（特别是药物滥用领域）国际知名权威 Ramon Aldag 教授；管理学院前院长、行为决策专家 Oguzhan Alagoz 博士、工业与系统工程副教授、医疗决策专家 Barbara Bowers 博士、护理学教授、国际权威；在混合方法研究；兰德尔·布朗博士，家庭医学副教授兼威斯康星大学成瘾医学住院医师项目负责人环境：威斯康星大学作为研究型大学享有世界声誉，在公立大学中总体排名第二。大学工程学院的健康增强系统研究中心 (CHESS) 为开展医疗保健实施科学研究提供了无与伦比的环境，在过去的 25 年里，CHESS 因其系统的创新应用而享有国际声誉。 CHESS 位于工业与系统工程系，致力于医疗保健领域的工程原理和设计，特别是在组织和个人变革领域，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，拥有大量实施研究数据以及与实施科学领域无与伦比的研究参与者的联系，可以检查不同医疗机构之间的跨领域实施问题。研究计划：该研究计划利用 CHESS 提供的强大研究环境，通过研究一组医疗保健诊所，寻求实施名为 A-CHESS 的基于证据的成瘾实践。该研究计划的目标是开发和试点测试一种多属性实用程序。该模型从多个利益相关者的角度评估基于证据的实践的感知价值，行为决策科学、健康经济学、经济学和博弈论等多个领域都提出了有助于解释人们如何在不确定性下做出决策的想法。我会首先寻求发展在三个试点诊所中使用混合方法的多属性实用模型。 然后，我将通过对参与实施的诊所的管理人员、工作人员和患者进行调查来测试该模型与 A-CHESS 的采用情况之间的关系。目标将阐明如何将多属性效用模型整合到综合实施策略中，并将生成初步数据以进行前瞻性 R01 实施研究来测试该策略，最终为职业发展和研究计划的实现提供数据驱动的方案。方法使用多属性效用理论评估基于证据的实践采用的潜在影响，这是一种在健康经济学文献中得到广泛认可的方法，所得产品将成为评估基于证据的实践采用的前景的诊断工具。完善实施策略，使采用对关键利益相关者更具吸引力。