Translation of medical evidence into practice, policy, and public health improvements refers to the widespread dissemination and adoption of interventions that can have a significant effect on health. Although most interventions designed to improve population health target individuals, access to and delivery of these interventions depends on communities, health care delivery systems (HCDS), health care professionals, and government agencies. Effective translation has been slow and inconsistent across the spectrum of HCDS and communities in the United States,1–4
and such inconsistencies contribute to the current state of variable and suboptimal population health.5–7
Within U.S. HCDS, challenges with translation are perhaps best exemplified by the finding that dissemination of practice guidelines rarely changes practice.7
Researchers trained in implementation and dissemination science (IDS) are needed to facilitate the translation of evidence into practice. The National Institutes of Health (NIH) defines implementation
as “the use of strategies to adopt and integrate evidence-based health interventions and change practice patterns within specific settings” and dissemination
as “the targeted distribution of information and intervention materials to a specific public health or clinical practice audience.”8
IDS research aims to examine and promote changes at the intersection of health services
(interventions intended to improve health, such as specific treatments, tests, or behavioral strategies), delivery systems
(systems that facilitate the delivery of health services, such as hospitals, clinics, or community-or policy-based organizations), and communities
(groups of individuals, such as physicians, patients with diabetes, hospital administrators, or policy makers). These sets of actors collaboratively shape the reach, relevance, uptake, and diffusion of interventions.
During the past 30 years, clinical research has been redefined by the application of epidemiology and biostatistics theory and methods to biological, clinical, and population health sciences. This transformation has led to new approaches, methods, and training programs, which have yielded a generation of investigators specializing in relatively new fields such as clinical trials, clinical and social epidemiology, and evidence-based medicine. Recent mandates from stakeholder organizations (e.g., government agencies, payers) that direct researchers to translate knowledge gained from the publicly funded investment in biomedical sciences research into improved population health are similarly transforming IDS research.9
Further, there is a large and growing body of evidence that supports the effectiveness of intervention implementation strategies based on IDS principles10,11
(For example, the Cochrane Collaboration’s Effective Practice and Organisation of Care Group conducts systematic reviews on a wide variety of implementation strategies and tools.12
) However, even though IDS researchers require specific skills to help translate evidence into practice, there is a dearth of IDS training programs in the United States—in part because the skill set has not been adequately defined and continues to evolve. A directory of implementation science training programs provided by the March 2011 NIH Conference on Dissemination and Implementation Science identified only six “specialized programs” And 14 “general training programs with implementation science as [a] secondary or optional concentration” in this country.13
To help inform institutional efforts to develop and expand IDS research skills training for health care professionals, we propose in this article a conceptual framework that defines, organizes, and guides specific translational activities. Using this framework, we propose seven domains comprising twelve core competencies for IDS researchers. Finally, we describe the series of IDS-specific courses at the University of California, San Francisco (UCSF) that has evolved from this conceptual framework and supports the attainment of these core competencies.