Implementation and Evaluation Science
The goal of the Implementation and Evaluation Science Program in the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery is to improve health care delivery processes and outcomes and reduce the time it takes to translate evidence-based practices into routine use.
Health care practices that are developed and studied in controlled research environments often languish or fail when they move to real-world settings such as patients' daily lives or busy clinic and hospital settings.
Researchers in the Implementation and Evaluation Science Program aim to address this knowledge-practice gap by engaging stakeholders to identify needs and preferences. The program team tailors interventions and strategies to increase adoption of patient-centered and evidence-based practices and assesses outcomes to identify not only whether interventions are effective but how they could be improved.
This approach can increase the likelihood that interventions and practices will ultimately improve patient outcomes and reduce costs, while being responsive to the needs of patients and care teams.
The Implementation and Evaluation Science Program team provides timely consultation and scientific support aligned with Mayo Clinic's practice priorities, resulting in collaborations that:
- Support innovation and continuous learning. Program experts provide consultation on evaluation methods and research approaches that enable rapid and reliable assessment and practice transformation. This includes evaluation and implementation methods that use data to inform refinement of interventions and their implementation.
- Transform delivery of care and patient experience. To ensure that interventions and practice changes meet patients' and care teams' needs, program researchers work with clinical and operational teams to develop evaluation approaches that include diverse perspectives and that utilize data to inform implementation and evaluate effectiveness.
- Enhance and accelerate decision-making. The center's implementation and evaluation experts partner with stakeholders to support validation and implementation of novel digital and artificial intelligence-based clinical decision-support tools. They also support the development and implementation of shared decision-making tools.
- Seek to eliminate racism. The program applies sociocultural lenses that seek and engage the perspectives of diverse stakeholders to promote a just and inclusive work environment. It aims to identify factors related to racial disparities in care delivery, including ways in which the implementation of clinical practices may exacerbate disparities.
The Implementation and Evaluation Science Program comprises a multidisciplinary team of researchers with diverse backgrounds in:
- Behavioral science and health communication
- Human-computer interaction
- Implementation science and process evaluation
- Qualitative and mixed method research
- Stakeholder engagement and formative evaluation
The team has expertise in methods to plan, guide and evaluate projects, including:
- Designing novel, pragmatic study proposals and protocols
- Engaging stakeholders to understand their needs, preferences and values
- Assessing implementation context and setting to identify barriers and facilitators to success
- Applying appropriate implementation and evaluation theories, models and frameworks
- Evaluating a range of outcomes using quantitative, qualitative and mixed methods approaches
The Implementation and Evaluation Science Program team collaborates on multiple practice-transforming projects.
Risk communication during the COVID-19 pandemic
The program team implemented and evaluated a community-engaged, bidirectional pandemic crisis and emergency risk communication framework with immigrant and refugee populations during the COVID-19 pandemic.
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- Brewer LC, Asiedu GB, Jones C, Richard M, Erickson J, Weis J, Abbenyi A, Brockman TA, Sia IG, Wieland ML, White RO, Doubeni CA. Emergency preparedness and risk communication among African American churches: Leveraging a community-based participatory research partnership COVID-19 initiative. Preventing Chronic Disease. 2020; doi:10.5888/pcd17.200408.
- Wieland ML, Asiedu GB, Lantz K, Abbenyi A, Njeru JW, Osman A, Goodson M, Ahmed Y, Molina LE, Doubeni CA, Sia IG, Rochester Healthy Community Partnership COVID-19 Task Force. Leveraging community engaged research partnerships for crisis and emergency risk communication to vulnerable populations in the COVID-19 pandemic. Journal of Clinical and Translational Science. 2020; doi:10.1017/cts.2020.47.
Home-based tampon sampling for endometrial cancer
In this formative evaluation, the team conducted community focus groups with Black and white women to explore the acceptability and feasibility of a home-based tampon sampling approach for endometrial cancer.
- Ridgeway JL, Albertie ML, Williams S, Pantoja E, Stephenson N, Pacheco-Spann L, Ball CT, Radecki Breitkopf C, Bakkum-Gamez JN, Chase L, Destephano CC, Sherman Me. Development of novel home-based tampon sampling for endometrial cancer: Findings from community-based focus groups with Black and white women. Journal of Clinical and Translational Science. 2021; doi:10.1017/cts.2021.787.
ECG AI-Guided Screening for Low Ejection Fraction (EAGLE)
The EAGLE study is a randomized trial to validate an artificial intelligence (AI) algorithm that screens for low ejection fraction from an electrocardiogram (ECG) and recommends actions that providers can take to make a diagnosis. This project team partnered with the larger research team and the clinical practice to understand user preferences and experiences with the clinical decision-making tool.
- Yao X, McCoy RG, Friedman PA, Shah ND, Barry BA, Behnken EM, Inselman JW, Attia ZI, Noseworthy PA. Clinical trial design data for electrocardiogram artificial intelligence-guided screening for low ejection fraction (EAGLE). Data in Brief. 2019; doi:10.1016/j.dib.2019.104894.
- Yao X, McCoy RG, Friedman PA, Shah ND, Barry BA, Behnken EM, Inselman JW, Attia ZI, Noseworthy PA. ECG AI-Guided Screening for Low Ejection Fraction (EAGLE): Rationale and design of a pragmatic cluster randomized trial. American Heart Journal. 2020; doi:10.1016/j.ahj.2019.10.007.
Home-based pulmonary rehabilitation with health coaching
Program researchers worked with physician-scientists to increase access to evidence-based care in the home setting. The goal of this project was to develop a novel pulmonary rehabilitation approach that makes technology and telephonic health coaching available to patients with chronic obstructive pulmonary disease (COPD). Implementation and evaluation science experts helped assess feasibility, including acceptability among patients.
Nurse-based care coordination to reduce hospital readmissions
This pragmatic trial compares the effectiveness of adult medical care coordination versus the usual standard of care in reducing unplanned hospital readmissions among high-risk patients. The project team is using an integrated mixed methods assessment of patients' and clinicians' experiences with the program to gain a comprehensive understanding of implementation and dissemination.
Using the electronic heath record (EHR) to control cancer symptoms
This research aims to implement and evaluate an EHR-supported system of symptom monitoring and management for patients with cancer during and after active treatment. The project team is conducting the cluster randomized pragmatic clinical trial across 18 disease groups and clinical practice sites at Mayo Clinic in Rochester, Minnesota, and the Mayo Clinic Health System.
- Chlan LL, Ridgeway JL, Tofthagen CS, Hamann BR, Mele KE, Dozois D, Ness SM, Peterson LJ. Iterative development and pilot testing of an intervention fidelity monitoring plan for the enhanced, electronic health record-facilitated pragmatic clinical trial: Implications for training and protocol integrity. Contemporary Clinical Trials Communications. 2021; doi:10.1016/j.conctc.2021.
- Finney Rutten LJ, Ruddy KJ, Chlan LL, Griffin JM, Herrin J, Leppin AL, Pachman DR, Ridgeway JL, Rahman PA, Storlie CB, Wilson PM, Cheville AL. Pragmatic cluster randomized trial to evaluate effectiveness and implementation of enhanced EHR-facilitated cancer symptom control (E2C2). Trials. 2020; doi:10.1186/s13063-020-04335-w.
- Wintheiser GA, Ruddy KJ, Herrin J, Rahman PA, Pachman DR, Leppin AL, Rutten LJF, Lee MK, Griffin JM, Tofthagen C, Chlan LL, Ridgeway JL, Mitchell SA, Cheville AL. Receptivity to a nurse-led symptom management intervention among highly symptomatic patients with cancer. JNCI Journal of the National Cancer Institute. 2021; doi:10.1093/jnci/djab172.
Shared decision-making for individualized cardiovascular event prevention
This project aims to integrate a tool to facilitate shared decision-making about cardiovascular health into preventive care settings and study strategies that foster its adoption and routine use. The project team is conducting the trial at three diverse health care systems of the Mayo Clinic Care Network, a collaborative network linking more than 40 health systems around the globe with the research, education and clinical expertise of Mayo Clinic.
- Ridgeway JL, Branda ME, Gravholt D, Brito JP, Hargraves IG, Hartasanchez SA, Leppin AL, Gomez YL, Mann DM, Nautiyal V, Thomas RJ, Behnken EM, Torres Roldan VD, Shah ND, Khurana CS, Montori VM. Increasing risk-concordant cardiovascular care in diverse health systems: A mixed methods pragmatic stepped wedge cluster randomized implementation trial of shared decision making (SDM4IP). Implementation Science Communications. 2021; doi:10.1186/s43058-021-00145-6.
Video telemedicine for newborn resuscitation
In this study, members of the Implementation and Evaluation Science Program team assessed the implementation of video telemedicine for newborn resuscitation with the goal of better understanding health care providers' acceptance, utilization and integration of this technology in community hospital settings.
Nonpharmacological options in postoperative, hospital-based and rehabilitation pain management (NOHARM)
NOHARM is a clinical trial conducted across the Mayo Clinic enterprise. It promotes guideline-concordant use of nonmedication pain management strategies for patients after surgery. This intervention was designed to ensure that it's compatible with clinical workflows and that the materials patients receive are acceptable to them.
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Educational interventions on mammographic breast density: The Latinas Learning About Density (LLEAD) study
The LLEAD study is a randomized trial of written and interpersonal education on breast density that was conducted among Latinas in a federally qualified health center in Phoenix, Arizona. Experts from the Implementation and Evaluation Science Program conducted a process evaluation to understand if the study interventions were feasible in that setting and if they were implemented with fidelity.
- Patel BK, Ridgeway JL, Ghosh K, Rhodes DJ, Borah B, Jenkins S, Suman VJ, Norman A, Jewett M, Singh D, Vachon CM, Radecki Breitkopf C. Behavioral and psychological impact of returning breast density results to Latinas: Study protocol for a randomized clinical trial. Trials. 2019; doi:10.1186/s13063-019-3939-6.
- Ridgeway JL, Jenkins SM, Borah BJ, Suman VJ, Patel BK, Ghosh K, Rhodes DJ, Norman A, Ramos EP, Jewett M, Gonzalez CR, Hernandez V, Singh D, Sosa M, Radecki Breitkopf C, Vachon CM. Evaluating educational interventions to increase breast density awareness among Latinas: A randomized trial in a federally qualified health center. Cancer. 2021; doi:10.1002/cncr.34017.
Adjusting colorectal cancer screening guidelines to meet patient needs
Research has shown that the recommendations of primary care clinicians and gastroenterologists strongly influence whether patients are screened for colorectal cancer as well as what type of screening they choose — direct visualization, such as colonoscopy, or noninvasive options, such as stool-based screening. To better understand health care providers' preferences and practices for colorectal cancer screening, the Implementation and Evaluation Science Program team developed an online survey that was completed by 779 primary care clinicians and 159 gastroenterologists.
The researchers found that while colonoscopy is the most often recommended screening method, primary care clinicians tended to prefer noninvasive options, particularly for patients who were unwilling to undergo invasive procedures, concerned about taking time from work, unconvinced about the need for screening or refused other screening recommendations.
Previous research has demonstrated that the common practice of only recommending colonoscopy may reduce the number of patients who undergo screening, particularly among racial and ethnic minorities, and that offering noninvasive screening options is associated with greater adherence to testing. These findings suggest that primary care clinicians may tailor their colorectal cancer screening recommendations to the preferences of their patients, especially with the emergence of new, less invasive options, to ensure that patients receive the necessary care.
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