WEBVTT

NOTE duration: "00:41:28.576"


NOTE Confidence: 0.9937474

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And so on.

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We're very happy to have

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00:00:03.760 --> 00:00:04.720
you here as well as

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all of us from the

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United States.

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I'm I'm Donna Spiegelman. I'm

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director of our Center on

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Methods for Implementation

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and Prevention Science.

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I'm professor of

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Public Health.

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And I'm very pleased to

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have as our, center's,

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guest,

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for our seminar today, doctor

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00:00:25.235 --> 00:00:26.134
Carol Lewis,

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who is deputy director of

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the Center for Translational

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Research and Implementation Science, otherwise

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known as CITRIS, at the

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National Heart, Lung, and Blood

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Institute at the National Institutes

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of Health of the United

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States.

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As CITRIS is,

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going to be offering

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a a full day of

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of, activities at the upcoming

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dissemination and implementation

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of science re conference in

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December, and so we encourage

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all of you to attend

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that as well.

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Doctor Lewis has a PhD

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in clinical psychology with a

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research focus on advancing pragmatic

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and rigorous measures and methods

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for implementation science and practice.

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She has pushed the field

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to focus on measurement quality

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to improve the field's research

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rigor and generalizability.

NOTE Confidence: 0.94333375

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Her work has led the

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field in considering nuances

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of health systems, organizations, and

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individual change

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in how evidence based interventions

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can be more effectively

NOTE Confidence: 0.9992437

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implemented and sustained

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to benefit patients and the

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general public.

NOTE Confidence: 0.9082481

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Doctor Lewis' expertise

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in implementation

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science is evidenced through national

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and international

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responsibilities.

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Ally, can you please keep

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an eye on having everyone

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be muted?

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Her national and international

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responsibilities,

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including

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serving as president of the

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Society for Implementation

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Research Collaboration, otherwise known as

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CERC, which is how I

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first met her when she

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invited me to give a

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talk at the SERC

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meeting maybe five or six

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years ago. She's also cofounding

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editor in chief of the

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00:02:04.390 --> 00:02:05.610
journal Implementation

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00:02:05.990 --> 00:02:07.130
Research and Practice.

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She's a lecturer for implementation

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science training institutes,

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a scientific adviser domestically and

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00:02:13.785 --> 00:02:16.205
abroad, and coeditor of Practical

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00:02:16.264 --> 00:02:16.764
Implementation

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Science.

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And in twenty twenty two,

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she was recognized

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by Clarivate as one of

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the most highly cited social

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scientists in the world.

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Doctor Lewis has been a

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driving force in elevating the

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importance

NOTE Confidence: 0.99977666

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of implementation

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mechanisms,

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emphasizing how studying mechanisms of

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change may improve tailoring, optimizing,

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00:02:37.955 --> 00:02:38.694
and scaling

NOTE Confidence: 0.9993145

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of effective implementation

NOTE Confidence: 0.9239716

00:02:40.675 --> 00:02:41.175
strategies,

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a topic that's of great

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interest to us here in

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our center, both, in terms

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of,

NOTE Confidence: 0.9973755

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advancing methodology

NOTE Confidence: 0.99948114

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for mediation analysis

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00:02:51.080 --> 00:02:52.280
and using this sort of

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information to improve

NOTE Confidence: 0.9995763

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the optimization

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of implementation studies as they

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00:02:57.240 --> 00:02:58.840
go through the design logo

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that we're working on. So

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I'm very pleased to turn

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00:03:02.440 --> 00:03:02.600
the,

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00:03:03.255 --> 00:03:05.175
meeting over today to doctor

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00:03:05.175 --> 00:03:06.794
Lewis who's gonna talk about

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a research agenda to advance

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00:03:09.095 --> 00:03:09.995
the study of the

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00:03:11.014 --> 00:03:11.514
mechanisms.

NOTE Confidence: 0.9528563

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And, well, doctor Lewis is

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00:03:14.375 --> 00:03:15.815
open to people,

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00:03:16.375 --> 00:03:17.995
speaking up if they have,

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00:03:19.030 --> 00:03:20.870
a clarifying question while she's

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00:03:20.870 --> 00:03:21.370
talking,

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00:03:21.669 --> 00:03:22.889
and then you can put

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sort of more opinion and,

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questions of a of a

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sort of far ranging

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00:03:29.669 --> 00:03:30.950
nature in the chat, and

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00:03:30.950 --> 00:03:32.445
then we'll go through them

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at the end of the

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talk along with any questions

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that any of you have

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at the end of the

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00:03:36.845 --> 00:03:38.525
talk. So with that, I'd

NOTE Confidence: 0.9841417

00:03:38.525 --> 00:03:39.645
like to turn things over

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to doctor Lewis.

NOTE Confidence: 0.9610727

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Thank you, doctor Spiegelman, for

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the kind invitation

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and introduction.

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And, absolutely, I'm hoping that,

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I can address any clarifying

NOTE Confidence: 0.98829955

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issues that might arise. It

NOTE Confidence: 0.98829955

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sounds like we have a

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really diverse,

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set of backgrounds in our

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00:03:56.720 --> 00:03:58.400
audience today. I see some

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old and new friends. So

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00:03:59.760 --> 00:04:01.525
thanks for joining us. I'm

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delighted. This is the first

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00:04:03.045 --> 00:04:03.545
time

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we'll have, a significant amount

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of minutes to actually unpack

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00:04:07.605 --> 00:04:08.965
the process that led to

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00:04:08.965 --> 00:04:10.345
and then the results of

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00:04:10.565 --> 00:04:12.325
developing a research agenda to

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00:04:12.325 --> 00:04:13.865
advance the study of implementation

NOTE Confidence: 0.9971918

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mechanisms.

NOTE Confidence: 0.93445665

00:04:15.680 --> 00:04:16.580
And so importantly,

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I don't have anything to

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00:04:18.960 --> 00:04:20.640
disclose and that the contents

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00:04:20.640 --> 00:04:22.000
of the presentation today are

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00:04:22.000 --> 00:04:23.520
not to be construed as

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00:04:23.520 --> 00:04:25.520
representing the official position of

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00:04:25.520 --> 00:04:26.720
NIH or the Department of

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Health and Human Services here

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00:04:28.000 --> 00:04:28.740
in the United

NOTE Confidence: 0.9877082

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States.

NOTE Confidence: 0.99957097

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I thought it was important

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to remind us all

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why we're here in terms

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of thinking about implementation science

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and,

NOTE Confidence: 0.9990109

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implementation

NOTE Confidence: 0.9509967

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mechanisms. And so,

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00:04:43.210 --> 00:04:44.570
folks might recall back in

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two thousand and one when

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the institutes of medicine in

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00:04:46.889 --> 00:04:48.250
the United States made this

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00:04:48.250 --> 00:04:50.650
urgent call for fundamental change

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to close the quality gap.

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00:04:52.250 --> 00:04:52.750
And,

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00:04:53.130 --> 00:04:54.169
the book featured on the

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00:04:54.169 --> 00:04:55.450
screen on the left here

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00:04:55.450 --> 00:04:57.370
recommended a sweeping redesign really

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00:04:57.370 --> 00:04:59.095
of the American health healthcare

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00:04:59.095 --> 00:04:59.595
system

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and provided four overarching principles

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for specific direction.

NOTE Confidence: 0.9822648

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One of those four principles

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were key steps to promote

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evidence based practice,

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00:05:09.014 --> 00:05:11.675
integration, and strengthening clinical information

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00:05:11.814 --> 00:05:12.314
systems.

NOTE Confidence: 0.994138

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And then in two thousand

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and eight, the Institute of

NOTE Confidence: 0.994138

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Medicine

NOTE Confidence: 0.931373

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put, together this, also this

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publication of To is Human,

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where they broke the silence

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00:05:21.890 --> 00:05:23.330
around medical errors and their

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consequence and set forth a

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national agenda to improve,

NOTE Confidence: 0.9495785

00:05:27.264 --> 00:05:28.884
patient safety through the design

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00:05:29.104 --> 00:05:30.544
of a safer health health

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00:05:30.544 --> 00:05:32.384
care system. So these are

NOTE Confidence: 0.9495785

00:05:32.384 --> 00:05:33.525
some of the inspirations

NOTE Confidence: 0.9653259

00:05:33.904 --> 00:05:35.664
for this formal field of

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00:05:35.664 --> 00:05:36.164
implementation

NOTE Confidence: 0.94247854

00:05:36.785 --> 00:05:39.104
science, coming to be. In

NOTE Confidence: 0.94247854

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addition to the publication that

NOTE Confidence: 0.94247854

00:05:40.950 --> 00:05:42.630
and colleagues put out in

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00:05:42.630 --> 00:05:44.070
two thousand and nine where

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00:05:44.070 --> 00:05:44.570
they,

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00:05:45.110 --> 00:05:47.029
feature this leaky pipeline of

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00:05:47.029 --> 00:05:49.210
research that helped to explain

NOTE Confidence: 0.9399925

00:05:49.430 --> 00:05:51.210
a very commonly cited,

NOTE Confidence: 0.94206005

00:05:51.670 --> 00:05:52.970
statistic that,

NOTE Confidence: 0.95325935

00:05:54.585 --> 00:05:56.104
a small percentage of our

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00:05:56.104 --> 00:05:57.245
research takes,

NOTE Confidence: 0.99351263

00:05:57.944 --> 00:05:59.944
up to seventeen years for

NOTE Confidence: 0.99351263

00:05:59.944 --> 00:06:02.125
effective interventions to become routinely

NOTE Confidence: 0.99351263

00:06:02.345 --> 00:06:03.865
available to patients. And you

NOTE Confidence: 0.99351263

00:06:03.865 --> 00:06:05.224
can see some of the

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00:06:05.224 --> 00:06:06.904
reasons for that time lag

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00:06:06.904 --> 00:06:08.104
and then the leak in

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00:06:08.104 --> 00:06:09.520
this pipeline on the image

NOTE Confidence: 0.99351263

00:06:09.520 --> 00:06:10.419
on your screen.

NOTE Confidence: 0.9996479

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I'm delighted to say that

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00:06:13.440 --> 00:06:15.199
we are approaching twenty years

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of implementation

NOTE Confidence: 0.99271333

00:06:16.240 --> 00:06:18.100
science at the National Institutes

NOTE Confidence: 0.99271333

00:06:18.160 --> 00:06:18.820
of Health.

NOTE Confidence: 0.98509425

00:06:19.520 --> 00:06:20.800
What you see on this

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slide is,

NOTE Confidence: 0.98439205

00:06:22.305 --> 00:06:23.665
what is fondly referred to

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00:06:23.665 --> 00:06:25.185
as the PAR twenty two

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00:06:25.185 --> 00:06:26.465
one zero five, which,

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00:06:27.105 --> 00:06:28.705
is a funding mechanism for

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00:06:28.705 --> 00:06:29.845
independent investigator

NOTE Confidence: 0.9928795

00:06:30.145 --> 00:06:31.445
initiated applications,

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00:06:32.545 --> 00:06:34.465
both in the United States

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00:06:34.465 --> 00:06:36.065
also with foreign components, but

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also for foreign investigators.

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00:06:37.800 --> 00:06:39.159
And you can see just

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how many of the institutes,

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centers, and offices at NIH

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00:06:42.680 --> 00:06:43.720
have signed on to this

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00:06:43.720 --> 00:06:45.240
program announcement. And later in

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00:06:45.240 --> 00:06:46.199
my talk, you'll see that

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this week, we've renewed this

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for another,

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another term, which I'm really

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00:06:50.440 --> 00:06:51.339
excited about.

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00:06:51.754 --> 00:06:52.154
But,

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just to make sure we're

NOTE Confidence: 0.9818751

00:06:53.914 --> 00:06:55.534
on the same page, implementation

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00:06:55.914 --> 00:06:57.935
science is the scientific study

NOTE Confidence: 0.9675497

00:06:58.154 --> 00:06:59.375
of the use of strategies

NOTE Confidence: 0.9675497

00:06:59.514 --> 00:07:00.815
to adopt and integrate,

NOTE Confidence: 0.9768763

00:07:02.074 --> 00:07:04.074
evidence based health interventions into

NOTE Confidence: 0.9768763

00:07:04.074 --> 00:07:05.675
clinical and community settings to

NOTE Confidence: 0.9768763

00:07:05.675 --> 00:07:08.410
improve individual outcomes and benefit

NOTE Confidence: 0.9768763

00:07:08.550 --> 00:07:09.530
population health.

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00:07:10.710 --> 00:07:11.990
Now I have permission from

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00:07:11.990 --> 00:07:13.030
the gentleman in the right

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00:07:13.030 --> 00:07:14.410
hand corner of my screen,

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00:07:15.190 --> 00:07:16.790
doctor David Chambers, who's the

NOTE Confidence: 0.9501004

00:07:16.790 --> 00:07:18.310
deputy director for implementation of

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00:07:18.310 --> 00:07:19.669
science at the National Cancer

NOTE Confidence: 0.9501004

00:07:19.669 --> 00:07:20.169
Institute,

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00:07:20.495 --> 00:07:22.035
to share how he characterized

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00:07:22.175 --> 00:07:23.295
our field when he and

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00:07:23.295 --> 00:07:24.655
I did a plenary session

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00:07:24.655 --> 00:07:25.395
at SERC,

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00:07:26.095 --> 00:07:28.015
several years ago now. And

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00:07:28.015 --> 00:07:30.175
so, briefly, in the two

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00:07:30.175 --> 00:07:30.675
thousands,

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00:07:31.135 --> 00:07:32.255
right on the heels of

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00:07:32.255 --> 00:07:34.035
that, funding opportunity,

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00:07:34.650 --> 00:07:36.570
we saw a great deal

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00:07:36.570 --> 00:07:38.490
of emphasis on trying to

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00:07:38.490 --> 00:07:40.750
explain and understand the gap

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00:07:40.890 --> 00:07:42.490
between what we know from

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00:07:42.490 --> 00:07:44.330
scientific evidence and then what

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00:07:44.330 --> 00:07:45.710
we see in practice.

NOTE Confidence: 0.9985415

00:07:46.410 --> 00:07:48.330
And, one of the seminal

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00:07:48.330 --> 00:07:50.335
articles that came out during

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00:07:50.335 --> 00:07:51.715
that decade of implementation

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00:07:52.175 --> 00:07:53.455
science is featured at the

NOTE Confidence: 0.95935863

00:07:53.455 --> 00:07:54.275
bottom here,

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00:07:54.575 --> 00:07:56.095
published by Laura Damschroeder and

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00:07:56.095 --> 00:07:56.595
colleagues.

NOTE Confidence: 0.9832149

00:07:56.975 --> 00:07:58.675
This is referred to oftentimes

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00:07:58.815 --> 00:08:00.514
as the CFIR, the consolidated

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00:08:00.735 --> 00:08:02.835
framework for implementation research.

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00:08:03.169 --> 00:08:04.290
And what they did was

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00:08:04.290 --> 00:08:06.230
they took together these determinant

NOTE Confidence: 0.98267657

00:08:06.290 --> 00:08:08.870
frameworks or frameworks that characterize

NOTE Confidence: 0.98267657

00:08:09.010 --> 00:08:11.270
barriers and facilitators to implementing

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00:08:11.330 --> 00:08:12.630
evidence based interventions,

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00:08:13.570 --> 00:08:15.010
and they organized them into

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00:08:15.010 --> 00:08:16.370
five domains. And I think

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00:08:16.370 --> 00:08:18.095
it was forty seven constructs

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00:08:18.095 --> 00:08:19.775
including sub constructs. And these

NOTE Confidence: 0.94353867

00:08:19.775 --> 00:08:20.755
are things like

NOTE Confidence: 0.9470796

00:08:21.055 --> 00:08:22.995
inner setting, culture, and climate

NOTE Confidence: 0.9470796

00:08:23.135 --> 00:08:24.335
of a health system or

NOTE Confidence: 0.9470796

00:08:24.335 --> 00:08:26.255
even an educational setting if

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00:08:26.255 --> 00:08:27.375
that's the target of an

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00:08:27.375 --> 00:08:29.315
evidence based in, intervention

NOTE Confidence: 0.91719687

00:08:29.855 --> 00:08:30.995
integration effort,

NOTE Confidence: 0.9677748

00:08:31.700 --> 00:08:33.780
to outer setting characteristics such

NOTE Confidence: 0.9677748

00:08:33.780 --> 00:08:35.140
as policies, but also, of

NOTE Confidence: 0.9677748

00:08:35.140 --> 00:08:36.920
course, characteristics of individuals,

NOTE Confidence: 0.98475933

00:08:37.540 --> 00:08:39.160
the process, and the intervention

NOTE Confidence: 0.98475933

00:08:39.300 --> 00:08:40.360
characteristics themselves.

NOTE Confidence: 0.9983538

00:08:41.140 --> 00:08:42.179
So we saw a lot

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00:08:42.179 --> 00:08:43.000
of these publications

NOTE Confidence: 0.9266123

00:08:43.460 --> 00:08:44.360
on characterizing,

NOTE Confidence: 0.9994094

00:08:45.535 --> 00:08:47.535
contextual factors that might help

NOTE Confidence: 0.9994094

00:08:47.535 --> 00:08:49.295
or hinder the integration of

NOTE Confidence: 0.9994094

00:08:49.295 --> 00:08:50.835
an evidence based intervention.

NOTE Confidence: 0.9868173

00:08:51.855 --> 00:08:53.455
Fast forward ten years or

NOTE Confidence: 0.9868173

00:08:53.455 --> 00:08:53.955
so,

NOTE Confidence: 0.9936545

00:08:54.415 --> 00:08:54.915
implementation

NOTE Confidence: 0.9796256

00:08:55.295 --> 00:08:56.975
scientists started grappling with, well,

NOTE Confidence: 0.9796256

00:08:56.975 --> 00:08:58.335
what works? We know what

NOTE Confidence: 0.9796256

00:08:58.335 --> 00:08:59.610
gets in the way. What

NOTE Confidence: 0.9796256

00:08:59.610 --> 00:09:01.070
are the methods or techniques

NOTE Confidence: 0.9796256

00:09:01.130 --> 00:09:02.730
that we need to deploy

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00:09:02.730 --> 00:09:04.730
in order to either resolve

NOTE Confidence: 0.9796256

00:09:04.730 --> 00:09:06.490
those barriers or leverage those

NOTE Confidence: 0.9796256

00:09:06.490 --> 00:09:06.990
facilitators

NOTE Confidence: 0.9922474

00:09:07.370 --> 00:09:09.450
and have success in terms

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00:09:09.450 --> 00:09:10.890
of fidelity to an evidence

NOTE Confidence: 0.9922474

00:09:10.890 --> 00:09:11.870
based intervention?

NOTE Confidence: 0.94685525

00:09:12.565 --> 00:09:14.085
And here, I saw that

NOTE Confidence: 0.94685525

00:09:14.085 --> 00:09:15.045
doctor Powell is with us

NOTE Confidence: 0.94685525

00:09:15.045 --> 00:09:15.765
today. So if you have

NOTE Confidence: 0.94685525

00:09:15.765 --> 00:09:17.765
any questions about implementation strategies,

NOTE Confidence: 0.94685525

00:09:17.765 --> 00:09:18.905
direct them to him.

NOTE Confidence: 0.95746595

00:09:19.285 --> 00:09:21.045
But he was important in

NOTE Confidence: 0.95746595

00:09:21.045 --> 00:09:22.885
leading the charge on a

NOTE Confidence: 0.95746595

00:09:22.885 --> 00:09:25.385
compilation of, strategies for implementing,

NOTE Confidence: 0.93524194

00:09:26.320 --> 00:09:28.480
clinical inner innovations in health

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00:09:28.480 --> 00:09:30.339
and mental health and subsequently

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00:09:30.480 --> 00:09:32.480
in twenty fifteen updated this

NOTE Confidence: 0.93524194

00:09:32.480 --> 00:09:33.920
compilation that folks might be

NOTE Confidence: 0.93524194

00:09:33.920 --> 00:09:35.839
familiar with, and referred to

NOTE Confidence: 0.93524194

00:09:35.839 --> 00:09:37.360
as ERIC, the experts for

NOTE Confidence: 0.93524194

00:09:37.360 --> 00:09:37.860
implementing,

NOTE Confidence: 0.9902203

00:09:39.705 --> 00:09:41.385
interventions recommending change. The mark

NOTE Confidence: 0.9902203

00:09:41.385 --> 00:09:42.345
of a good acronym is

NOTE Confidence: 0.9902203

00:09:42.345 --> 00:09:43.385
you can't remember what it

NOTE Confidence: 0.9902203

00:09:43.385 --> 00:09:45.245
stands for. But so ERIC

NOTE Confidence: 0.9902203

00:09:45.385 --> 00:09:46.425
is on the street, and

NOTE Confidence: 0.9902203

00:09:46.425 --> 00:09:47.385
a lot of people use

NOTE Confidence: 0.9902203

00:09:47.385 --> 00:09:49.465
this as a menu for,

NOTE Confidence: 0.9996177

00:09:49.865 --> 00:09:52.025
selecting strategies to overcome these

NOTE Confidence: 0.9996177

00:09:52.025 --> 00:09:53.325
obstacles for implementation.

NOTE Confidence: 0.95131177

00:09:54.570 --> 00:09:55.770
And now in the twenty

NOTE Confidence: 0.95131177

00:09:55.770 --> 00:09:57.450
twenties, we're starting to see

NOTE Confidence: 0.95131177

00:09:57.450 --> 00:09:58.490
more of and and we

NOTE Confidence: 0.95131177

00:09:58.490 --> 00:10:00.490
hope to inspire you today

NOTE Confidence: 0.95131177

00:10:00.490 --> 00:10:01.630
and in other spaces

NOTE Confidence: 0.99044204

00:10:02.090 --> 00:10:02.670
to be

NOTE Confidence: 0.999565

00:10:03.130 --> 00:10:04.350
critically evaluating

NOTE Confidence: 0.97313726

00:10:04.809 --> 00:10:07.150
why, how are these implementation

NOTE Confidence: 0.94095933

00:10:07.530 --> 00:10:09.309
strategies working or not.

NOTE Confidence: 0.9956163

00:10:10.245 --> 00:10:10.745
And

NOTE Confidence: 0.9810712

00:10:12.005 --> 00:10:13.365
answering this question of what

NOTE Confidence: 0.9810712

00:10:13.365 --> 00:10:15.045
works best for whom, when,

NOTE Confidence: 0.9810712

00:10:15.045 --> 00:10:16.805
and under what conditions. And

NOTE Confidence: 0.9810712

00:10:16.805 --> 00:10:17.684
I'll talk a little bit

NOTE Confidence: 0.9810712

00:10:17.684 --> 00:10:19.385
more about the systematic review,

NOTE Confidence: 0.9958264

00:10:19.845 --> 00:10:20.745
that we led

NOTE Confidence: 0.9465776

00:10:21.125 --> 00:10:22.245
a few years ago in

NOTE Confidence: 0.9465776

00:10:22.245 --> 00:10:23.065
just a moment.

NOTE Confidence: 0.99549395

00:10:24.110 --> 00:10:25.150
But before we get into

NOTE Confidence: 0.99549395

00:10:25.150 --> 00:10:26.910
that, I thought maybe another

NOTE Confidence: 0.99549395

00:10:26.910 --> 00:10:28.030
way to break this down.

NOTE Confidence: 0.99549395

00:10:28.030 --> 00:10:29.150
What are the factors that

NOTE Confidence: 0.99549395

00:10:29.150 --> 00:10:30.350
we've been exploring? What are

NOTE Confidence: 0.99549395

00:10:30.350 --> 00:10:31.630
we really interested in? What

NOTE Confidence: 0.99549395

00:10:31.630 --> 00:10:32.690
should we be studying?

NOTE Confidence: 0.9951777

00:10:33.310 --> 00:10:34.430
So in this table on

NOTE Confidence: 0.9951777

00:10:34.430 --> 00:10:35.950
the right hand side, we're

NOTE Confidence: 0.9951777

00:10:35.950 --> 00:10:37.964
featuring implementation outcomes. This is

NOTE Confidence: 0.9951777

00:10:37.964 --> 00:10:39.005
not the host of them.

NOTE Confidence: 0.9951777

00:10:39.005 --> 00:10:40.225
These are just some examples.

NOTE Confidence: 0.994534

00:10:40.684 --> 00:10:41.565
There are at least eight

NOTE Confidence: 0.994534

00:10:41.565 --> 00:10:42.684
of them that we seek

NOTE Confidence: 0.994534

00:10:42.684 --> 00:10:44.605
to achieve, but we're here

NOTE Confidence: 0.994534

00:10:44.605 --> 00:10:45.964
because we want adoption of

NOTE Confidence: 0.994534

00:10:45.964 --> 00:10:47.825
evidence and evidence based practices.

NOTE Confidence: 0.994534

00:10:47.885 --> 00:10:48.765
We want to see that

NOTE Confidence: 0.994534

00:10:48.765 --> 00:10:50.304
they're acceptable, appropriate,

NOTE Confidence: 0.9859277

00:10:51.085 --> 00:10:52.445
feasible to be done in

NOTE Confidence: 0.9859277

00:10:52.445 --> 00:10:53.025
the intended

NOTE Confidence: 0.85844606

00:10:53.779 --> 00:10:55.000
and that they're sustainable,

NOTE Confidence: 0.992918

00:10:55.699 --> 00:10:56.839
and that they're spread.

NOTE Confidence: 0.99194133

00:10:57.300 --> 00:10:58.339
So this is this is

NOTE Confidence: 0.99194133

00:10:58.339 --> 00:11:00.439
why we're here, implementation outcomes.

NOTE Confidence: 0.97156453

00:11:00.819 --> 00:11:02.420
But then, as you saw,

NOTE Confidence: 0.97156453

00:11:02.420 --> 00:11:03.779
that first decade, we really

NOTE Confidence: 0.97156453

00:11:03.779 --> 00:11:04.980
started to unpack what are

NOTE Confidence: 0.97156453

00:11:04.980 --> 00:11:06.255
the determinants, what are those

NOTE Confidence: 0.97156453

00:11:06.255 --> 00:11:07.795
barriers, what are those facilitators.

NOTE Confidence: 0.97156453

00:11:07.934 --> 00:11:09.215
And, again, these are just

NOTE Confidence: 0.97156453

00:11:09.215 --> 00:11:10.815
a a handful of examples,

NOTE Confidence: 0.97156453

00:11:10.815 --> 00:11:12.355
and they range from the

NOTE Confidence: 0.97156453

00:11:12.575 --> 00:11:13.075
intrapersonal,

NOTE Confidence: 0.99640113

00:11:13.535 --> 00:11:15.555
so in the individual provider,

NOTE Confidence: 0.99640113

00:11:15.615 --> 00:11:17.215
for example, all the way

NOTE Confidence: 0.99640113

00:11:17.215 --> 00:11:18.335
to system level,

NOTE Confidence: 0.99875003

00:11:18.815 --> 00:11:19.875
types of determinants.

NOTE Confidence: 0.9997702

00:11:21.570 --> 00:11:22.230
And then

NOTE Confidence: 0.9959001

00:11:22.610 --> 00:11:24.470
what are the implementation strategies?

NOTE Confidence: 0.9959001

00:11:24.530 --> 00:11:26.050
What are the activities we

NOTE Confidence: 0.9959001

00:11:26.050 --> 00:11:27.090
should be doing? What are

NOTE Confidence: 0.9959001

00:11:27.090 --> 00:11:27.570
the,

NOTE Confidence: 0.9911061

00:11:28.050 --> 00:11:29.170
methods that we should be

NOTE Confidence: 0.9911061

00:11:29.170 --> 00:11:30.530
deploying in order order to

NOTE Confidence: 0.9911061

00:11:30.530 --> 00:11:31.030
overcome

NOTE Confidence: 0.99953187

00:11:31.890 --> 00:11:32.630
those determinants

NOTE Confidence: 0.98776376

00:11:32.930 --> 00:11:33.590
of practice?

NOTE Confidence: 0.9884823

00:11:34.045 --> 00:11:35.245
And then what the focus

NOTE Confidence: 0.9884823

00:11:35.245 --> 00:11:36.525
of today is is on

NOTE Confidence: 0.9884823

00:11:36.525 --> 00:11:37.265
the mechanisms.

NOTE Confidence: 0.99142015

00:11:37.804 --> 00:11:38.945
How are those strategies,

NOTE Confidence: 0.9582264

00:11:40.045 --> 00:11:41.965
working through what process to

NOTE Confidence: 0.9582264

00:11:41.965 --> 00:11:43.725
overcome those determinants to help

NOTE Confidence: 0.9582264

00:11:43.725 --> 00:11:45.025
us achieve those outcomes?

NOTE Confidence: 0.95660126

00:11:46.140 --> 00:11:47.260
And I have permission from

NOTE Confidence: 0.95660126

00:11:47.260 --> 00:11:48.940
this gentleman here featured on

NOTE Confidence: 0.95660126

00:11:48.940 --> 00:11:50.620
your screen, doctor Alvin Gang,

NOTE Confidence: 0.95660126

00:11:50.940 --> 00:11:51.440
to

NOTE Confidence: 0.99211

00:11:51.820 --> 00:11:52.320
retell,

NOTE Confidence: 0.98791546

00:11:53.100 --> 00:11:53.580
a re

NOTE Confidence: 0.73617494

00:11:54.700 --> 00:11:55.440
a a a retelling

NOTE Confidence: 0.9678331

00:11:56.220 --> 00:11:57.500
of the story of vitamin

NOTE Confidence: 0.9678331

00:11:57.500 --> 00:11:58.780
c and how it surfaced

NOTE Confidence: 0.9678331

00:11:58.780 --> 00:12:00.080
as a cure for scurvy.

NOTE Confidence: 0.9678331

00:12:00.140 --> 00:12:00.460
So,

NOTE Confidence: 0.9820157

00:12:01.005 --> 00:12:02.445
thanks to Elvin. When I

NOTE Confidence: 0.9820157

00:12:02.445 --> 00:12:03.425
heard him describe,

NOTE Confidence: 0.99318475

00:12:04.285 --> 00:12:05.265
in this way,

NOTE Confidence: 0.9946979

00:12:06.125 --> 00:12:07.885
the the retelling of the

NOTE Confidence: 0.9946979

00:12:07.885 --> 00:12:09.184
vitamin c discoveries,

NOTE Confidence: 0.9779005

00:12:09.725 --> 00:12:11.745
I I, was so compelled

NOTE Confidence: 0.9601898

00:12:12.125 --> 00:12:13.165
that it helped us,

NOTE Confidence: 0.8985741

00:12:14.125 --> 00:12:15.745
motivate the study for mechanisms

NOTE Confidence: 0.8985741

00:12:15.804 --> 00:12:16.740
to advance implementation science.

NOTE Confidence: 0.86706907

00:12:17.700 --> 00:12:18.991
Implementation science, so I wanted

NOTE Confidence: 0.86706907

00:12:18.991 --> 00:12:19.770
to share it briefly with

NOTE Confidence: 0.86706907

00:12:19.770 --> 00:12:20.526
you. So as you all

NOTE Confidence: 0.86706907

00:12:20.526 --> 00:12:21.640
know, scurvy was this devastating,

NOTE Confidence: 0.97121

00:12:22.420 --> 00:12:24.020
disease that killed perhaps two

NOTE Confidence: 0.97121

00:12:24.020 --> 00:12:25.700
million sailors before the twentieth

NOTE Confidence: 0.97121

00:12:25.700 --> 00:12:27.459
century, often claiming half of

NOTE Confidence: 0.97121

00:12:27.459 --> 00:12:28.120
a crew.

NOTE Confidence: 0.97664547

00:12:28.820 --> 00:12:29.779
And as we now know,

NOTE Confidence: 0.97664547

00:12:29.779 --> 00:12:31.140
vitamin c contributes to the

NOTE Confidence: 0.97664547

00:12:31.140 --> 00:12:33.315
formation of the collagenous tissues,

NOTE Confidence: 0.97664547

00:12:33.315 --> 00:12:34.434
a material that keeps your

NOTE Confidence: 0.97664547

00:12:34.434 --> 00:12:35.875
blood vessels, joints, and gums

NOTE Confidence: 0.97664547

00:12:35.875 --> 00:12:37.714
intact, and its absence can

NOTE Confidence: 0.97664547

00:12:37.714 --> 00:12:39.795
be fatal. So in seventeen

NOTE Confidence: 0.97664547

00:12:39.795 --> 00:12:41.635
forty seven, James Linda Surgeon

NOTE Confidence: 0.97664547

00:12:41.635 --> 00:12:42.995
tried an experiment that then

NOTE Confidence: 0.97664547

00:12:42.995 --> 00:12:44.295
made history. Right?

NOTE Confidence: 0.9807701

00:12:46.089 --> 00:12:47.230
So his experiment,

NOTE Confidence: 0.99497473

00:12:47.610 --> 00:12:48.890
went something like this. He

NOTE Confidence: 0.99497473

00:12:48.890 --> 00:12:49.710
got twelve,

NOTE Confidence: 0.96143013

00:12:50.170 --> 00:12:51.690
sailors sick with scurvy and

NOTE Confidence: 0.96143013

00:12:51.690 --> 00:12:53.130
put them into six groups,

NOTE Confidence: 0.96143013

00:12:53.130 --> 00:12:54.250
two in each, and gave

NOTE Confidence: 0.96143013

00:12:54.250 --> 00:12:55.850
each group the candidate treatments

NOTE Confidence: 0.96143013

00:12:55.850 --> 00:12:57.290
that you see here. The

NOTE Confidence: 0.96143013

00:12:57.290 --> 00:12:58.730
two that got citrus recovered

NOTE Confidence: 0.96143013

00:12:58.730 --> 00:13:00.510
dramatically while the others languished.

NOTE Confidence: 0.96143013

00:13:00.804 --> 00:13:02.405
And this final finding is

NOTE Confidence: 0.96143013

00:13:02.405 --> 00:13:03.684
hailed as an early, if

NOTE Confidence: 0.96143013

00:13:03.684 --> 00:13:05.445
not the earliest successful clinical

NOTE Confidence: 0.96143013

00:13:05.445 --> 00:13:06.804
trial, and Lind has gone

NOTE Confidence: 0.96143013

00:13:06.804 --> 00:13:08.005
down in history as a

NOTE Confidence: 0.96143013

00:13:08.005 --> 00:13:09.065
scientific hero.

NOTE Confidence: 0.97162944

00:13:09.925 --> 00:13:11.285
However, the results were not

NOTE Confidence: 0.97162944

00:13:11.285 --> 00:13:13.230
successfully or consistently taken up

NOTE Confidence: 0.97162944

00:13:13.309 --> 00:13:14.429
for fifty to a hundred

NOTE Confidence: 0.97162944

00:13:14.429 --> 00:13:16.029
years, and admissions for scurvy

NOTE Confidence: 0.97162944

00:13:16.029 --> 00:13:17.309
at this typical hospital in

NOTE Confidence: 0.97162944

00:13:17.309 --> 00:13:18.750
Britain continued to be high

NOTE Confidence: 0.97162944

00:13:18.750 --> 00:13:19.790
for at least one hundred

NOTE Confidence: 0.97162944

00:13:19.790 --> 00:13:21.410
years after Lynn's experiment.

NOTE Confidence: 0.9728624

00:13:21.870 --> 00:13:22.829
So here we have a

NOTE Confidence: 0.9728624

00:13:22.829 --> 00:13:24.350
fabulous example of what we

NOTE Confidence: 0.9728624

00:13:24.350 --> 00:13:25.389
now refer to as this

NOTE Confidence: 0.9728624

00:13:25.389 --> 00:13:26.774
no do gap. So it's

NOTE Confidence: 0.9728624

00:13:26.774 --> 00:13:28.214
clear that the citrus theory

NOTE Confidence: 0.9728624

00:13:28.214 --> 00:13:29.175
had far less of an

NOTE Confidence: 0.9728624

00:13:29.175 --> 00:13:30.054
effect than it could have,

NOTE Confidence: 0.9728624

00:13:30.054 --> 00:13:31.274
and this is where implementation

NOTE Confidence: 0.99965686

00:13:31.575 --> 00:13:32.934
science can really come into

NOTE Confidence: 0.99965686

00:13:32.934 --> 00:13:33.434
play.

NOTE Confidence: 0.9944177

00:13:33.894 --> 00:13:35.095
And as with everything that

NOTE Confidence: 0.9944177

00:13:35.095 --> 00:13:36.475
we undertake in implementation

NOTE Confidence: 0.9797734

00:13:36.855 --> 00:13:38.375
science, the truth is far

NOTE Confidence: 0.9797734

00:13:38.375 --> 00:13:40.480
more complicated. So even though

NOTE Confidence: 0.9797734

00:13:40.480 --> 00:13:41.760
Lynn found that citrus led

NOTE Confidence: 0.9797734

00:13:41.760 --> 00:13:42.880
to recovery, no one knew

NOTE Confidence: 0.9797734

00:13:42.880 --> 00:13:43.620
what the mechanism,

NOTE Confidence: 0.95923805

00:13:44.400 --> 00:13:46.340
knew the mechanism, vitamin c.

NOTE Confidence: 0.9708279

00:13:46.880 --> 00:13:48.080
It's tragic in a way.

NOTE Confidence: 0.9556666

00:13:48.960 --> 00:13:49.920
As you can read, Lynn

NOTE Confidence: 0.9556666

00:13:49.920 --> 00:13:52.000
can, himself confesses in his

NOTE Confidence: 0.9556666

00:13:52.000 --> 00:13:53.280
final writings on the topic.

NOTE Confidence: 0.9556666

00:13:53.280 --> 00:13:54.640
He doesn't understand what he

NOTE Confidence: 0.9556666

00:13:54.640 --> 00:13:56.455
observed. And so some ships

NOTE Confidence: 0.9556666

00:13:56.455 --> 00:13:58.075
boiled lemon juice to concentrate

NOTE Confidence: 0.9556666

00:13:58.135 --> 00:13:59.815
it, but that inactivated vitamin

NOTE Confidence: 0.9556666

00:13:59.815 --> 00:14:01.415
c and sailors got scurvy

NOTE Confidence: 0.9556666

00:14:01.415 --> 00:14:01.915
and,

NOTE Confidence: 0.989894

00:14:02.455 --> 00:14:03.735
casting doubt on the theory.

NOTE Confidence: 0.989894

00:14:03.735 --> 00:14:05.255
And so in Elvin's words,

NOTE Confidence: 0.989894

00:14:05.255 --> 00:14:06.455
this is not the story

NOTE Confidence: 0.989894

00:14:06.455 --> 00:14:07.655
of a man with evidence,

NOTE Confidence: 0.989894

00:14:07.655 --> 00:14:09.029
but the failure failure of

NOTE Confidence: 0.989894

00:14:09.029 --> 00:14:10.570
a system to use it.

NOTE Confidence: 0.98309815

00:14:11.029 --> 00:14:12.070
And it's the story of

NOTE Confidence: 0.98309815

00:14:12.070 --> 00:14:13.510
a society that did not

NOTE Confidence: 0.98309815

00:14:13.510 --> 00:14:15.110
understand the mechanism of effect

NOTE Confidence: 0.98309815

00:14:15.110 --> 00:14:16.550
and therefore did not understand

NOTE Confidence: 0.98309815

00:14:16.550 --> 00:14:17.750
how to to use the

NOTE Confidence: 0.98309815

00:14:17.750 --> 00:14:18.890
intervention. So

NOTE Confidence: 0.994267

00:14:19.269 --> 00:14:20.310
if you're if you're thinking

NOTE Confidence: 0.994267

00:14:20.310 --> 00:14:21.130
about mechanisms,

NOTE Confidence: 0.98134005

00:14:21.670 --> 00:14:22.870
you won't be making these

NOTE Confidence: 0.98134005

00:14:22.870 --> 00:14:23.925
mistakes, and that's,

NOTE Confidence: 0.8966192

00:14:24.565 --> 00:14:25.285
hopefully what,

NOTE Confidence: 0.9962449

00:14:26.325 --> 00:14:27.685
will inspire more and more

NOTE Confidence: 0.9962449

00:14:27.685 --> 00:14:29.365
study of mechanisms in the

NOTE Confidence: 0.9962449

00:14:29.365 --> 00:14:31.625
implementation science space as we

NOTE Confidence: 0.9962449

00:14:31.685 --> 00:14:33.385
move forward in the field.

NOTE Confidence: 0.99382263

00:14:34.005 --> 00:14:35.765
Other things that inspire us

NOTE Confidence: 0.99382263

00:14:35.765 --> 00:14:37.205
to focus on mechanisms are

NOTE Confidence: 0.99382263

00:14:37.205 --> 00:14:38.910
these quotes that I hear

NOTE Confidence: 0.99382263

00:14:38.910 --> 00:14:40.030
and read about all the

NOTE Confidence: 0.99382263

00:14:40.030 --> 00:14:42.110
time. This strategy works here,

NOTE Confidence: 0.99382263

00:14:42.110 --> 00:14:43.090
but not here.

NOTE Confidence: 0.9971757

00:14:43.790 --> 00:14:44.850
There's no implementation

NOTE Confidence: 0.89522314

00:14:45.230 --> 00:14:46.210
without adaptation.

NOTE Confidence: 0.9915085

00:14:46.910 --> 00:14:48.190
And I think it's hard

NOTE Confidence: 0.9915085

00:14:48.190 --> 00:14:48.690
to,

NOTE Confidence: 0.99875325

00:14:49.310 --> 00:14:50.370
face these realities

NOTE Confidence: 0.99934834

00:14:50.670 --> 00:14:52.845
without centering mechanisms in the

NOTE Confidence: 0.99934834

00:14:52.845 --> 00:14:53.345
conversation.

NOTE Confidence: 0.964308

00:14:54.365 --> 00:14:56.125
So our our group was

NOTE Confidence: 0.964308

00:14:56.125 --> 00:14:56.625
so,

NOTE Confidence: 0.99943656

00:14:57.324 --> 00:14:57.824
motivated

NOTE Confidence: 0.7569612

00:14:58.204 --> 00:14:58.605
to,

NOTE Confidence: 0.9807699

00:14:59.725 --> 00:15:01.425
understand mechanisms of implementation

NOTE Confidence: 0.95962095

00:15:01.805 --> 00:15:03.584
strategies. We undertook the systematic

NOTE Confidence: 0.95962095

00:15:03.644 --> 00:15:04.144
review

NOTE Confidence: 0.9905752

00:15:04.620 --> 00:15:06.560
of empirical studies examining,

NOTE Confidence: 0.99932253

00:15:07.180 --> 00:15:07.920
just that.

NOTE Confidence: 0.96790934

00:15:08.220 --> 00:15:09.660
Now before I I share

NOTE Confidence: 0.96790934

00:15:09.660 --> 00:15:10.940
the methods and results of

NOTE Confidence: 0.96790934

00:15:10.940 --> 00:15:12.860
that review, I wanna ground

NOTE Confidence: 0.96790934

00:15:12.860 --> 00:15:13.820
us in in at least

NOTE Confidence: 0.96790934

00:15:13.820 --> 00:15:15.520
how our team was defining

NOTE Confidence: 0.9430255

00:15:16.380 --> 00:15:18.540
mechanisms for the systematic review

NOTE Confidence: 0.9430255

00:15:18.540 --> 00:15:19.245
and the other

NOTE Confidence: 0.981598

00:15:19.964 --> 00:15:21.505
aspects of the talk today.

NOTE Confidence: 0.981598

00:15:21.725 --> 00:15:23.245
So the reasons why change

NOTE Confidence: 0.981598

00:15:23.245 --> 00:15:24.845
occurred or how change came

NOTE Confidence: 0.981598

00:15:24.845 --> 00:15:26.285
about, so it being a

NOTE Confidence: 0.981598

00:15:26.285 --> 00:15:26.785
process,

NOTE Confidence: 0.94903785

00:15:27.725 --> 00:15:28.685
they can be,

NOTE Confidence: 0.9960826

00:15:29.885 --> 00:15:31.425
mechanisms can be

NOTE Confidence: 0.9995177

00:15:32.170 --> 00:15:34.110
found through examining mediators.

NOTE Confidence: 0.9744754

00:15:34.490 --> 00:15:36.750
Mediators are not necessarily inherently

NOTE Confidence: 0.9744754

00:15:36.890 --> 00:15:37.390
mechanisms,

NOTE Confidence: 0.9950343

00:15:37.770 --> 00:15:38.810
and, of course, it all

NOTE Confidence: 0.9950343

00:15:38.810 --> 00:15:40.570
depends on your definition and

NOTE Confidence: 0.9950343

00:15:40.570 --> 00:15:41.690
design and things of that

NOTE Confidence: 0.9950343

00:15:41.690 --> 00:15:42.190
nature.

NOTE Confidence: 0.9897788

00:15:42.810 --> 00:15:44.170
But you can read more

NOTE Confidence: 0.9897788

00:15:44.170 --> 00:15:44.670
about,

NOTE Confidence: 0.99306583

00:15:45.290 --> 00:15:45.790
the

NOTE Confidence: 0.9848582

00:15:46.465 --> 00:15:48.385
definitions of of mechanisms in

NOTE Confidence: 0.9848582

00:15:48.385 --> 00:15:49.425
the paper I've put on

NOTE Confidence: 0.9848582

00:15:49.425 --> 00:15:50.085
the screen.

NOTE Confidence: 0.984524

00:15:50.465 --> 00:15:51.685
I thought another way,

NOTE Confidence: 0.9936957

00:15:52.305 --> 00:15:53.745
based on what Donna was

NOTE Confidence: 0.9936957

00:15:53.745 --> 00:15:55.265
sharing with me about her

NOTE Confidence: 0.9936957

00:15:55.265 --> 00:15:56.565
group of just,

NOTE Confidence: 0.9995357

00:15:57.585 --> 00:15:58.085
depicting

NOTE Confidence: 0.9929484

00:15:58.625 --> 00:16:00.145
mechanisms in the causal chain

NOTE Confidence: 0.9929484

00:16:00.145 --> 00:16:01.290
was to put up this

NOTE Confidence: 0.9943233

00:16:01.930 --> 00:16:04.250
schematic of causal pathway diagramming,

NOTE Confidence: 0.9943233

00:16:04.250 --> 00:16:05.370
and it features all of

NOTE Confidence: 0.9943233

00:16:05.370 --> 00:16:06.910
the terms that I've mentioned

NOTE Confidence: 0.9939654

00:16:07.290 --> 00:16:09.130
to you already. So on

NOTE Confidence: 0.9939654

00:16:09.130 --> 00:16:10.589
the far right hand side,

NOTE Confidence: 0.9939654

00:16:10.730 --> 00:16:12.649
we're striving for some distal

NOTE Confidence: 0.9939654

00:16:12.649 --> 00:16:13.930
implementation outcome,

NOTE Confidence: 0.9906731

00:16:15.014 --> 00:16:16.295
when we bring a strategy

NOTE Confidence: 0.9906731

00:16:16.295 --> 00:16:17.194
into the field.

NOTE Confidence: 0.99920785

00:16:17.495 --> 00:16:18.694
And if we are to

NOTE Confidence: 0.99920785

00:16:18.694 --> 00:16:20.875
center the mechanism of action,

NOTE Confidence: 0.9952094

00:16:21.735 --> 00:16:23.274
we might be able to

NOTE Confidence: 0.9952094

00:16:23.495 --> 00:16:23.975
more,

NOTE Confidence: 0.95222574

00:16:24.454 --> 00:16:27.175
expertly, strongly, swiftly overcome and

NOTE Confidence: 0.95222574

00:16:27.175 --> 00:16:29.279
determinant to get to some

NOTE Confidence: 0.95222574

00:16:29.279 --> 00:16:29.779
proximal

NOTE Confidence: 0.9592088

00:16:30.560 --> 00:16:31.920
signal of success and ultimately

NOTE Confidence: 0.9592088

00:16:31.920 --> 00:16:34.000
to that implementation outcome. Of

NOTE Confidence: 0.9592088

00:16:34.000 --> 00:16:34.800
course, we need to be

NOTE Confidence: 0.9592088

00:16:34.800 --> 00:16:36.560
thinking about moderators, what is

NOTE Confidence: 0.9592088

00:16:36.560 --> 00:16:37.940
amplifying or dampening

NOTE Confidence: 0.9800306

00:16:38.320 --> 00:16:39.620
the impact of a strategy,

NOTE Confidence: 0.9800306

00:16:39.680 --> 00:16:41.200
and to make sure that

NOTE Confidence: 0.9800306

00:16:41.200 --> 00:16:43.060
there are the necessary preconditions

NOTE Confidence: 0.9800306

00:16:43.360 --> 00:16:45.055
in place in order to

NOTE Confidence: 0.9800306

00:16:45.055 --> 00:16:46.575
activate a mechanism. So just

NOTE Confidence: 0.9800306

00:16:46.575 --> 00:16:48.175
another way to think about

NOTE Confidence: 0.9800306

00:16:48.175 --> 00:16:48.675
and,

NOTE Confidence: 0.9458177

00:16:49.135 --> 00:16:50.815
stand up an evaluation of

NOTE Confidence: 0.9458177

00:16:50.815 --> 00:16:52.755
implementation strategy mechanisms.

NOTE Confidence: 0.9944479

00:16:54.255 --> 00:16:56.015
So for the systematic review

NOTE Confidence: 0.9944479

00:16:56.015 --> 00:16:57.060
that was published in twenty

NOTE Confidence: 0.9944479

00:16:57.060 --> 00:16:58.980
twenty, we identified thirty nine

NOTE Confidence: 0.9944479

00:16:58.980 --> 00:17:00.100
studies, and that was as

NOTE Confidence: 0.9944479

00:17:00.100 --> 00:17:01.460
of twenty eighteen. That's when

NOTE Confidence: 0.9944479

00:17:01.460 --> 00:17:03.720
our systematic review analysis ended.

NOTE Confidence: 0.98973554

00:17:04.420 --> 00:17:05.300
Fifty four of those were

NOTE Confidence: 0.98973554

00:17:05.300 --> 00:17:06.740
conducted in the US, so

NOTE Confidence: 0.98973554

00:17:06.740 --> 00:17:07.780
a lot of global work

NOTE Confidence: 0.98973554

00:17:07.780 --> 00:17:09.240
in this space to,

NOTE Confidence: 0.9996538

00:17:09.619 --> 00:17:10.520
study implementation

NOTE Confidence: 0.999727

00:17:10.820 --> 00:17:11.320
mechanisms.

NOTE Confidence: 0.98960483

00:17:11.984 --> 00:17:13.905
Interestingly, behavioral health settings were

NOTE Confidence: 0.98960483

00:17:13.905 --> 00:17:14.885
the most common,

NOTE Confidence: 0.88520175

00:17:15.265 --> 00:17:16.945
featured in this in this

NOTE Confidence: 0.88520175

00:17:16.945 --> 00:17:17.445
review,

NOTE Confidence: 0.99694973

00:17:17.744 --> 00:17:19.425
followed by hospitals and health

NOTE Confidence: 0.99694973

00:17:19.425 --> 00:17:19.925
systems.

NOTE Confidence: 0.9829946

00:17:20.385 --> 00:17:21.505
Seventy four percent of the

NOTE Confidence: 0.9829946

00:17:21.505 --> 00:17:23.184
empirical studies we included were

NOTE Confidence: 0.9829946

00:17:23.184 --> 00:17:25.105
quantitative in nature. There were

NOTE Confidence: 0.9829946

00:17:25.105 --> 00:17:26.385
a handful of mixed methods

NOTE Confidence: 0.9829946

00:17:26.385 --> 00:17:27.799
and qualitative only, of of

NOTE Confidence: 0.9829946

00:17:27.799 --> 00:17:28.299
course.

NOTE Confidence: 0.9751921

00:17:29.559 --> 00:17:30.919
It's interesting that not all

NOTE Confidence: 0.9751921

00:17:30.919 --> 00:17:32.520
of these studies actually used

NOTE Confidence: 0.9751921

00:17:32.520 --> 00:17:33.980
a theory model or framework

NOTE Confidence: 0.9751921

00:17:34.039 --> 00:17:34.539
to,

NOTE Confidence: 0.9711432

00:17:34.919 --> 00:17:35.419
articulate,

NOTE Confidence: 0.8253138

00:17:36.520 --> 00:17:37.580
and con contextualize

NOTE Confidence: 0.9425351

00:17:37.960 --> 00:17:39.820
their, mechanism evaluation.

NOTE Confidence: 0.9870732

00:17:40.600 --> 00:17:41.720
But of those who did,

NOTE Confidence: 0.9870732

00:17:41.720 --> 00:17:43.020
about seventy four percent,

NOTE Confidence: 0.9886164

00:17:43.515 --> 00:17:45.515
the diffusion of innovations theory

NOTE Confidence: 0.9886164

00:17:45.515 --> 00:17:47.115
featured most with twenty percent

NOTE Confidence: 0.9886164

00:17:47.115 --> 00:17:47.855
of researchers.

NOTE Confidence: 0.9731753

00:17:49.435 --> 00:17:49.935
So,

NOTE Confidence: 0.9995453

00:17:50.635 --> 00:17:51.915
this is a legend that

NOTE Confidence: 0.9995453

00:17:51.915 --> 00:17:53.035
you see on your screen

NOTE Confidence: 0.9995453

00:17:53.035 --> 00:17:53.515
now.

NOTE Confidence: 0.9695179

00:17:53.915 --> 00:17:55.195
You've seen all these terms

NOTE Confidence: 0.9695179

00:17:55.195 --> 00:17:56.095
before implementation

NOTE Confidence: 0.9898897

00:17:56.475 --> 00:17:57.615
strategy, determinant

NOTE Confidence: 0.98635876

00:17:58.440 --> 00:17:59.799
implementation outcome, which, of course,

NOTE Confidence: 0.98635876

00:17:59.799 --> 00:18:01.480
is different than the clinical

NOTE Confidence: 0.98635876

00:18:01.480 --> 00:18:02.520
outcome. And so in some

NOTE Confidence: 0.98635876

00:18:02.520 --> 00:18:03.799
ways, we have two levels

NOTE Confidence: 0.98635876

00:18:03.799 --> 00:18:05.320
of intervention and two levels

NOTE Confidence: 0.98635876

00:18:05.320 --> 00:18:06.059
of outcomes.

NOTE Confidence: 0.9977119

00:18:06.600 --> 00:18:07.159
And then,

NOTE Confidence: 0.9919833

00:18:07.640 --> 00:18:09.559
we're characterizing the mechanism as

NOTE Confidence: 0.9919833

00:18:09.559 --> 00:18:11.159
a mediator in these models

NOTE Confidence: 0.9919833

00:18:11.159 --> 00:18:12.465
you'll see. So what we

NOTE Confidence: 0.9919833

00:18:12.465 --> 00:18:14.325
tried to do is actually,

NOTE Confidence: 0.9945773

00:18:15.505 --> 00:18:16.804
in a in a figure

NOTE Confidence: 0.9945773

00:18:16.865 --> 00:18:18.804
using these shapes and icons

NOTE Confidence: 0.96585244

00:18:19.184 --> 00:18:21.905
is characterize the range of

NOTE Confidence: 0.96585244

00:18:21.905 --> 00:18:23.984
types of mechanism evaluations that

NOTE Confidence: 0.96585244

00:18:23.984 --> 00:18:25.205
the field had contributed,

NOTE Confidence: 0.999788

00:18:25.744 --> 00:18:26.645
to this point.

NOTE Confidence: 0.9668599

00:18:27.359 --> 00:18:28.960
So in the upper left

NOTE Confidence: 0.9668599

00:18:28.960 --> 00:18:29.460
corner,

NOTE Confidence: 0.9955127

00:18:29.840 --> 00:18:31.359
model one, we saw this

NOTE Confidence: 0.9955127

00:18:31.359 --> 00:18:32.800
in one study where,

NOTE Confidence: 0.99671364

00:18:33.119 --> 00:18:34.020
folks were

NOTE Confidence: 0.99364376

00:18:34.559 --> 00:18:35.059
actually

NOTE Confidence: 0.98358

00:18:35.600 --> 00:18:36.480
looking at,

NOTE Confidence: 0.99796593

00:18:36.960 --> 00:18:37.460
determinants

NOTE Confidence: 0.8754183

00:18:37.760 --> 00:18:39.840
and then, the change in

NOTE Confidence: 0.8754183

00:18:39.840 --> 00:18:41.440
strategies, which was a little

NOTE Confidence: 0.8754183

00:18:41.440 --> 00:18:41.680
bit interesting and unexpected for

NOTE Confidence: 0.8754183

00:18:41.680 --> 00:18:41.920
me at least,

NOTE Confidence: 0.99023443

00:18:44.855 --> 00:18:46.215
to then change in in

NOTE Confidence: 0.99023443

00:18:46.215 --> 00:18:47.515
determinants of practice.

NOTE Confidence: 0.9701147

00:18:48.135 --> 00:18:49.815
This model two appeared in

NOTE Confidence: 0.9701147

00:18:49.815 --> 00:18:51.595
two different studies, strategy

NOTE Confidence: 0.975844

00:18:52.294 --> 00:18:52.794
to,

NOTE Confidence: 0.98695844

00:18:54.215 --> 00:18:55.835
outcome to another outcome.

NOTE Confidence: 0.98530614

00:18:56.290 --> 00:18:57.490
And this was the primary

NOTE Confidence: 0.98530614

00:18:57.490 --> 00:18:58.930
model we were interested in

NOTE Confidence: 0.98530614

00:18:58.930 --> 00:19:00.070
seeing where strategies

NOTE Confidence: 0.9743491

00:19:00.369 --> 00:19:02.530
are changing determinants in practice

NOTE Confidence: 0.9743491

00:19:02.530 --> 00:19:04.150
and then yielding the implementation

NOTE Confidence: 0.9743491

00:19:04.450 --> 00:19:06.130
outcomes of interest. We saw

NOTE Confidence: 0.9743491

00:19:06.130 --> 00:19:07.650
this I'm sorry. This is

NOTE Confidence: 0.9743491

00:19:07.650 --> 00:19:09.330
Donna. Just because even I

NOTE Confidence: 0.9743491

00:19:09.330 --> 00:19:10.930
am a I understand all

NOTE Confidence: 0.9743491

00:19:10.930 --> 00:19:12.105
the terms, but I'm not

NOTE Confidence: 0.9743491

00:19:12.105 --> 00:19:13.625
quite sure what determinant of

NOTE Confidence: 0.9743491

00:19:13.625 --> 00:19:14.605
practice means.

NOTE Confidence: 0.995165

00:19:15.065 --> 00:19:17.085
Sure. Yes. Thanks for clarifying.

NOTE Confidence: 0.995165

00:19:17.304 --> 00:19:18.205
So determinant,

NOTE Confidence: 0.9808107

00:19:18.744 --> 00:19:19.785
I'm using that as the

NOTE Confidence: 0.9808107

00:19:19.785 --> 00:19:21.544
jargony term for barriers or

NOTE Confidence: 0.9808107

00:19:21.544 --> 00:19:23.145
facilitators. So these are Okay.

NOTE Confidence: 0.9808107

00:19:23.225 --> 00:19:24.684
Those contextual factors

NOTE Confidence: 0.9538814

00:19:25.385 --> 00:19:25.625
that,

NOTE Confidence: 0.9991024

00:19:26.269 --> 00:19:28.429
would otherwise undermine a successful

NOTE Confidence: 0.9991024

00:19:28.429 --> 00:19:28.929
implementation

NOTE Confidence: 0.95162857

00:19:29.389 --> 00:19:30.769
with an example being,

NOTE Confidence: 0.99441355

00:19:31.549 --> 00:19:32.690
something like turnover

NOTE Confidence: 0.99810123

00:19:33.070 --> 00:19:33.730
or implementation

NOTE Confidence: 0.98770016

00:19:34.109 --> 00:19:36.529
climate. Right? Mhmm. Mhmm. Yes.

NOTE Confidence: 0.98770016

00:19:36.669 --> 00:19:38.669
So the idea being that

NOTE Confidence: 0.98770016

00:19:38.669 --> 00:19:41.019
we're often choosing a strategy

NOTE Confidence: 0.9985793

00:19:41.725 --> 00:19:43.585
to address a determinant

NOTE Confidence: 0.96482414

00:19:43.965 --> 00:19:45.725
to then yield that outcome

NOTE Confidence: 0.96482414

00:19:45.725 --> 00:19:47.484
of interest. And it was

NOTE Confidence: 0.96482414

00:19:47.484 --> 00:19:49.085
interesting. We only saw of

NOTE Confidence: 0.96482414

00:19:49.085 --> 00:19:50.524
the thirty nine studies, this

NOTE Confidence: 0.96482414

00:19:50.524 --> 00:19:52.125
particular model showing up in

NOTE Confidence: 0.96482414

00:19:52.125 --> 00:19:53.585
seven of the studies.

NOTE Confidence: 0.9973795

00:19:54.100 --> 00:19:55.619
Otherwise, we're seeing a whole

NOTE Confidence: 0.9973795

00:19:55.619 --> 00:19:57.460
different range of constellations, and

NOTE Confidence: 0.9973795

00:19:57.460 --> 00:19:58.679
I'll just let the screen

NOTE Confidence: 0.9768619

00:19:59.059 --> 00:20:00.419
continue to populate here so

NOTE Confidence: 0.9768619

00:20:00.419 --> 00:20:01.460
you can see the different

NOTE Confidence: 0.9768619

00:20:01.460 --> 00:20:02.200
range of

NOTE Confidence: 0.9973466

00:20:02.580 --> 00:20:03.799
mechanism evaluations

NOTE Confidence: 0.9993266

00:20:04.179 --> 00:20:05.880
among those thirty nine studies

NOTE Confidence: 0.73172027

00:20:07.299 --> 00:20:07.799
here.

NOTE Confidence: 0.92626226

00:20:09.375 --> 00:20:10.815
So then also the last

NOTE Confidence: 0.92626226

00:20:10.815 --> 00:20:12.095
thing I'll say about the

NOTE Confidence: 0.92626226

00:20:12.095 --> 00:20:14.275
systematic review findings is that,

NOTE Confidence: 0.9694927

00:20:15.055 --> 00:20:16.895
if you if you look

NOTE Confidence: 0.9694927

00:20:16.895 --> 00:20:18.575
at the, you know, Seminole

NOTE Confidence: 0.9694927

00:20:18.575 --> 00:20:19.795
Bradford Hill

NOTE Confidence: 0.9939184

00:20:21.200 --> 00:20:22.580
criteria for establishing

NOTE Confidence: 0.9335535

00:20:22.880 --> 00:20:25.300
mechanisms then elaborated on in

NOTE Confidence: 0.9335535

00:20:25.359 --> 00:20:26.880
in later years by Al

NOTE Confidence: 0.9335535

00:20:26.880 --> 00:20:27.380
Kasdan,

NOTE Confidence: 0.99849623

00:20:28.400 --> 00:20:30.100
there are these criteria

NOTE Confidence: 0.9333599

00:20:30.400 --> 00:20:32.240
that's not just single studies,

NOTE Confidence: 0.9333599

00:20:32.240 --> 00:20:32.715
but,

NOTE Confidence: 0.98648053

00:20:33.355 --> 00:20:35.534
subsequent studies of similar mechanisms

NOTE Confidence: 0.98648053

00:20:35.755 --> 00:20:37.355
really need to address in

NOTE Confidence: 0.98648053

00:20:37.355 --> 00:20:38.635
order to have confidence that

NOTE Confidence: 0.98648053

00:20:38.635 --> 00:20:40.734
you've established a mechanism. So

NOTE Confidence: 0.98648053

00:20:40.955 --> 00:20:42.015
things like plausibility.

NOTE Confidence: 0.97084594

00:20:42.395 --> 00:20:44.075
There's a timeline issue. Right?

NOTE Confidence: 0.97084594

00:20:44.075 --> 00:20:44.875
And that's why we think

NOTE Confidence: 0.97084594

00:20:44.875 --> 00:20:46.315
about mediators when we talk

NOTE Confidence: 0.97084594

00:20:46.315 --> 00:20:47.135
about mechanisms.

NOTE Confidence: 0.99238265

00:20:47.600 --> 00:20:48.980
There needs to be association.

NOTE Confidence: 0.9974101

00:20:49.440 --> 00:20:50.660
Ideally, there's manipulation

NOTE Confidence: 0.93254685

00:20:51.200 --> 00:20:51.700
happening,

NOTE Confidence: 0.9996939

00:20:52.480 --> 00:20:52.980
consistency

NOTE Confidence: 0.9913939

00:20:53.280 --> 00:20:54.260
across studies,

NOTE Confidence: 0.9927232

00:20:54.720 --> 00:20:55.220
specificity,

NOTE Confidence: 0.9807299

00:20:56.080 --> 00:20:57.520
that you're able to that

NOTE Confidence: 0.9807299

00:20:57.520 --> 00:20:58.960
you're able to shed light

NOTE Confidence: 0.9807299

00:20:58.960 --> 00:21:00.900
on evidence for a specific

NOTE Confidence: 0.9869285

00:21:01.359 --> 00:21:03.060
mechanism and not others,

NOTE Confidence: 0.8880874

00:21:03.734 --> 00:21:04.395
and then,

NOTE Confidence: 0.97403425

00:21:05.095 --> 00:21:06.775
evidence of a gradient of

NOTE Confidence: 0.97403425

00:21:06.775 --> 00:21:08.455
change. And so you can

NOTE Confidence: 0.97403425

00:21:08.455 --> 00:21:09.335
see that,

NOTE Confidence: 0.9771318

00:21:09.895 --> 00:21:11.575
very few studies were able

NOTE Confidence: 0.9771318

00:21:11.575 --> 00:21:13.015
to address all of these

NOTE Confidence: 0.9771318

00:21:13.015 --> 00:21:14.795
or any of these criteria.

NOTE Confidence: 0.9771318

00:21:14.934 --> 00:21:15.830
So there's work to be

NOTE Confidence: 0.9771318

00:21:15.830 --> 00:21:16.330
done.

NOTE Confidence: 0.9984415

00:21:16.630 --> 00:21:18.070
This is all inspiration for

NOTE Confidence: 0.9984415

00:21:18.070 --> 00:21:18.730
what led

NOTE Confidence: 0.97329533

00:21:19.109 --> 00:21:20.869
us to wanna unpack this

NOTE Confidence: 0.97329533

00:21:20.869 --> 00:21:22.310
line from a to b,

NOTE Confidence: 0.97329533

00:21:22.310 --> 00:21:23.450
strategy to outcome,

NOTE Confidence: 0.97954476

00:21:23.830 --> 00:21:25.830
and, borrowed this comic from

NOTE Confidence: 0.97954476

00:21:25.830 --> 00:21:27.190
Byron Powell and others that

NOTE Confidence: 0.97954476

00:21:27.190 --> 00:21:28.070
I think you should be

NOTE Confidence: 0.97954476

00:21:28.070 --> 00:21:29.510
more explicit here in step

NOTE Confidence: 0.97954476

00:21:29.510 --> 00:21:30.490
two. And so

NOTE Confidence: 0.98512346

00:21:30.994 --> 00:21:32.355
here we go. A little

NOTE Confidence: 0.98512346

00:21:32.355 --> 00:21:33.575
bit more on the motivation.

NOTE Confidence: 0.98512346

00:21:33.635 --> 00:21:34.755
What are the problems we're

NOTE Confidence: 0.98512346

00:21:34.755 --> 00:21:35.795
trying to solve when we

NOTE Confidence: 0.98512346

00:21:35.795 --> 00:21:36.935
think about mechanisms?

NOTE Confidence: 0.9925452

00:21:38.115 --> 00:21:39.255
You know, unfortunately,

NOTE Confidence: 0.9988953

00:21:39.635 --> 00:21:41.315
despite the progress, the twenty

NOTE Confidence: 0.9988953

00:21:41.315 --> 00:21:42.675
years or more of science

NOTE Confidence: 0.9988953

00:21:42.675 --> 00:21:43.494
in this area,

NOTE Confidence: 0.9921658

00:21:44.355 --> 00:21:46.540
we see that, there is

NOTE Confidence: 0.9921658

00:21:46.540 --> 00:21:47.680
still some suboptimal,

NOTE Confidence: 0.99932027

00:21:48.940 --> 00:21:50.859
outcomes in terms of the

NOTE Confidence: 0.99932027

00:21:50.859 --> 00:21:51.359
implementation

NOTE Confidence: 0.9943341

00:21:51.660 --> 00:21:53.740
clinical trials that demand a

NOTE Confidence: 0.9943341

00:21:53.740 --> 00:21:54.560
huge investment,

NOTE Confidence: 0.9968292

00:21:55.500 --> 00:21:56.960
both domestically and abroad.

NOTE Confidence: 0.973543

00:21:58.060 --> 00:21:59.340
And there's one,

NOTE Confidence: 0.9754553

00:21:59.740 --> 00:22:00.940
example that I like to

NOTE Confidence: 0.9754553

00:22:00.940 --> 00:22:02.994
bring up, the tailored implementation

NOTE Confidence: 0.9754553

00:22:03.215 --> 00:22:04.355
in chronic diseases.

NOTE Confidence: 0.9987399

00:22:04.975 --> 00:22:06.034
This is a multinational

NOTE Confidence: 0.9915438

00:22:06.575 --> 00:22:08.755
study in Europe that took

NOTE Confidence: 0.9915438

00:22:08.894 --> 00:22:09.635
seven years,

NOTE Confidence: 0.9897299

00:22:10.815 --> 00:22:12.434
to come to fruition.

NOTE Confidence: 0.9984244

00:22:12.734 --> 00:22:13.234
And

NOTE Confidence: 0.99878985

00:22:13.630 --> 00:22:14.450
in the introductory

NOTE Confidence: 0.96955305

00:22:14.830 --> 00:22:16.450
article to the special collection

NOTE Confidence: 0.96955305

00:22:16.510 --> 00:22:18.190
that gave us so many

NOTE Confidence: 0.96955305

00:22:18.190 --> 00:22:20.190
learnings in the implementation science

NOTE Confidence: 0.96955305

00:22:20.190 --> 00:22:22.350
space, unfold or, unfortunately, the

NOTE Confidence: 0.96955305

00:22:22.350 --> 00:22:23.950
effects were null in terms

NOTE Confidence: 0.96955305

00:22:23.950 --> 00:22:25.409
of the tailoring,

NOTE Confidence: 0.9553223

00:22:26.030 --> 00:22:27.710
influencing the outcomes they cared

NOTE Confidence: 0.9553223

00:22:27.710 --> 00:22:29.715
about. And Michelle Vinseng, the

NOTE Confidence: 0.9553223

00:22:29.715 --> 00:22:31.255
former editor of implementation

NOTE Confidence: 0.9675993

00:22:31.555 --> 00:22:33.575
science, states that the chosen

NOTE Confidence: 0.9675993

00:22:33.635 --> 00:22:35.795
strategies were not sufficiently matched

NOTE Confidence: 0.9675993

00:22:35.795 --> 00:22:37.875
with targeted determinants or not

NOTE Confidence: 0.9675993

00:22:37.875 --> 00:22:38.375
effective

NOTE Confidence: 0.9929532

00:22:38.835 --> 00:22:40.035
in the targeted groups and

NOTE Confidence: 0.9929532

00:22:40.035 --> 00:22:41.635
settings. So insight into the

NOTE Confidence: 0.9929532

00:22:41.635 --> 00:22:43.820
linkages of interventions and determinants

NOTE Confidence: 0.9929532

00:22:43.880 --> 00:22:44.780
is very limited.

NOTE Confidence: 0.9969914

00:22:45.559 --> 00:22:47.000
So that that's,

NOTE Confidence: 0.8176768

00:22:47.720 --> 00:22:48.619
a more recent,

NOTE Confidence: 0.9996923

00:22:49.240 --> 00:22:49.740
observation

NOTE Confidence: 0.9885791

00:22:50.040 --> 00:22:51.640
that motivates this, and I'll

NOTE Confidence: 0.9885791

00:22:51.640 --> 00:22:52.760
stay back on that slide

NOTE Confidence: 0.9885791

00:22:52.760 --> 00:22:54.299
just for another moment to

NOTE Confidence: 0.9885791

00:22:54.440 --> 00:22:55.980
acknowledge also that,

NOTE Confidence: 0.99662066

00:22:57.255 --> 00:22:58.875
the higher cost and complexity

NOTE Confidence: 0.99662066

00:22:59.015 --> 00:22:59.675
of implementation

NOTE Confidence: 0.9708474

00:23:00.055 --> 00:23:02.135
strategies is sometimes perturbing to

NOTE Confidence: 0.9708474

00:23:02.135 --> 00:23:03.815
me. You know, we've got,

NOTE Confidence: 0.9943359

00:23:04.375 --> 00:23:06.535
we've got such inequities in

NOTE Confidence: 0.9943359

00:23:06.535 --> 00:23:08.135
terms of access to evidence

NOTE Confidence: 0.9943359

00:23:08.135 --> 00:23:09.035
based interventions.

NOTE Confidence: 0.95417327

00:23:09.655 --> 00:23:10.695
And if here we are,

NOTE Confidence: 0.99476606

00:23:11.760 --> 00:23:13.460
designing and testing implementation

NOTE Confidence: 0.9652237

00:23:13.840 --> 00:23:15.680
strategies that cannot be accessed

NOTE Confidence: 0.9652237

00:23:15.680 --> 00:23:17.380
by low resource settings that

NOTE Confidence: 0.9652237

00:23:17.520 --> 00:23:18.960
cannot be scaled because of

NOTE Confidence: 0.9652237

00:23:18.960 --> 00:23:20.720
their cost, I I think

NOTE Confidence: 0.9652237

00:23:20.720 --> 00:23:22.580
we're doing ourselves a disservice

NOTE Confidence: 0.9652237

00:23:22.640 --> 00:23:23.540
and might unfortunately

NOTE Confidence: 0.99710196

00:23:24.355 --> 00:23:26.054
land ourselves with this ironic

NOTE Confidence: 0.99710196

00:23:26.195 --> 00:23:27.634
situation where we've created our

NOTE Confidence: 0.99710196

00:23:27.634 --> 00:23:29.654
own gap between implementation

NOTE Confidence: 0.9265073

00:23:30.034 --> 00:23:31.975
strategy evidence and then implementation

NOTE Confidence: 0.95105875

00:23:32.355 --> 00:23:33.815
practice and what is possible.

NOTE Confidence: 0.98083633

00:23:34.434 --> 00:23:35.794
And then finally, and this

NOTE Confidence: 0.98083633

00:23:35.794 --> 00:23:36.914
is actually more along the

NOTE Confidence: 0.98083633

00:23:36.914 --> 00:23:37.794
lines of what I was

NOTE Confidence: 0.98083633

00:23:37.794 --> 00:23:38.534
just saying,

NOTE Confidence: 0.8993616

00:23:39.210 --> 00:23:40.429
that, inequities

NOTE Confidence: 0.9990415

00:23:40.730 --> 00:23:42.590
could could really be exacerbated

NOTE Confidence: 0.9990415

00:23:42.809 --> 00:23:44.270
when we're really trying to

NOTE Confidence: 0.9990415

00:23:44.330 --> 00:23:45.770
address them and achieve health

NOTE Confidence: 0.9990415

00:23:45.770 --> 00:23:46.270
equity.

NOTE Confidence: 0.95349956

00:23:47.850 --> 00:23:49.770
So practically speaking, we and

NOTE Confidence: 0.95349956

00:23:49.770 --> 00:23:50.835
I always feel like I

NOTE Confidence: 0.95349956

00:23:50.835 --> 00:23:51.654
should say,

NOTE Confidence: 0.98726654

00:23:52.115 --> 00:23:53.395
at least a few things

NOTE Confidence: 0.98726654

00:23:53.395 --> 00:23:54.755
along the lines of why

NOTE Confidence: 0.98726654

00:23:54.755 --> 00:23:56.695
are why is studying implementation

NOTE Confidence: 0.98726654

00:23:56.914 --> 00:23:58.534
mechanisms useful practically,

NOTE Confidence: 0.9819497

00:23:59.395 --> 00:24:00.835
because it does seem like

NOTE Confidence: 0.9819497

00:24:00.835 --> 00:24:02.695
such a scientific sort of,

NOTE Confidence: 0.90179527

00:24:03.635 --> 00:24:04.135
specific,

NOTE Confidence: 0.9941314

00:24:04.674 --> 00:24:05.654
type of evaluation.

NOTE Confidence: 0.99617606

00:24:06.380 --> 00:24:07.340
Well, you've heard me talk

NOTE Confidence: 0.99617606

00:24:07.340 --> 00:24:08.880
about selecting strategies.

NOTE Confidence: 0.97767705

00:24:09.900 --> 00:24:11.100
This is not an easy

NOTE Confidence: 0.97767705

00:24:11.100 --> 00:24:12.800
task. When we do,

NOTE Confidence: 0.9524822

00:24:14.140 --> 00:24:15.900
try to characterize the literature

NOTE Confidence: 0.9524822

00:24:15.900 --> 00:24:16.780
on what are the most

NOTE Confidence: 0.9524822

00:24:16.780 --> 00:24:17.280
common

NOTE Confidence: 0.9931579

00:24:17.580 --> 00:24:18.080
implementation

NOTE Confidence: 0.99178416

00:24:18.460 --> 00:24:19.760
strategies being tested,

NOTE Confidence: 0.97101057

00:24:20.185 --> 00:24:21.225
we see so much of

NOTE Confidence: 0.97101057

00:24:21.225 --> 00:24:22.665
it being perhaps driven by

NOTE Confidence: 0.97101057

00:24:22.665 --> 00:24:23.165
familiarity,

NOTE Confidence: 0.9971954

00:24:23.785 --> 00:24:25.065
you know, groups being or

NOTE Confidence: 0.9971954

00:24:25.065 --> 00:24:27.005
hospital systems being familiar with

NOTE Confidence: 0.9971954

00:24:27.225 --> 00:24:28.585
CMEs. And so what do

NOTE Confidence: 0.9971954

00:24:28.585 --> 00:24:29.465
they do when they need

NOTE Confidence: 0.9971954

00:24:29.465 --> 00:24:30.265
to bring in a new

NOTE Confidence: 0.9971954

00:24:30.265 --> 00:24:31.244
clinical intervention?

NOTE Confidence: 0.99606913

00:24:31.945 --> 00:24:33.244
They offer a CME.

NOTE Confidence: 0.9874559

00:24:34.480 --> 00:24:35.520
But there should be other

NOTE Confidence: 0.9874559

00:24:35.520 --> 00:24:37.600
ways to inform selection of

NOTE Confidence: 0.9874559

00:24:37.600 --> 00:24:38.100
strategies.

NOTE Confidence: 0.8229426

00:24:39.359 --> 00:24:39.859
Unfortunately,

NOTE Confidence: 0.9884404

00:24:40.400 --> 00:24:41.780
and there are other examples,

NOTE Confidence: 0.9884404

00:24:41.919 --> 00:24:42.820
not just familiarity,

NOTE Confidence: 0.8961452

00:24:44.799 --> 00:24:45.679
which is sort of the

NOTE Confidence: 0.8961452

00:24:45.679 --> 00:24:47.039
first that the train and

NOTE Confidence: 0.8961452

00:24:47.039 --> 00:24:47.539
pray,

NOTE Confidence: 0.9196117

00:24:48.125 --> 00:24:49.965
But there's the kitchen sink

NOTE Confidence: 0.9196117

00:24:49.965 --> 00:24:50.465
approach,

NOTE Confidence: 0.9621914

00:24:50.845 --> 00:24:52.205
that relates to the increasing

NOTE Confidence: 0.9621914

00:24:52.205 --> 00:24:54.205
cost and complexity. Let's throw

NOTE Confidence: 0.9621914

00:24:54.205 --> 00:24:55.725
all the strategies we can

NOTE Confidence: 0.9621914

00:24:55.725 --> 00:24:56.465
at the,

NOTE Confidence: 0.99906605

00:24:57.244 --> 00:24:57.744
implementation

NOTE Confidence: 0.9538978

00:24:58.125 --> 00:24:59.345
problems we're facing.

NOTE Confidence: 0.97236156

00:25:00.230 --> 00:25:01.850
We I talked about tailoring.

NOTE Confidence: 0.98992586

00:25:02.230 --> 00:25:03.910
There's and the the opposite

NOTE Confidence: 0.98992586

00:25:03.910 --> 00:25:04.790
of that is a one

NOTE Confidence: 0.98992586

00:25:04.790 --> 00:25:06.310
size fits all approach. And

NOTE Confidence: 0.98992586

00:25:06.310 --> 00:25:07.830
so if we're selecting a

NOTE Confidence: 0.98992586

00:25:07.830 --> 00:25:08.890
bundle of strategies,

NOTE Confidence: 0.8423765

00:25:09.750 --> 00:25:11.109
and using them the the

NOTE Confidence: 0.8423765

00:25:11.109 --> 00:25:12.790
same across context, then,

NOTE Confidence: 0.9329441

00:25:13.965 --> 00:25:14.925
that might not be the

NOTE Confidence: 0.9329441

00:25:14.925 --> 00:25:16.125
best way to to make

NOTE Confidence: 0.9329441

00:25:16.125 --> 00:25:18.385
selections. And then Martin Echols

NOTE Confidence: 0.9329441

00:25:18.445 --> 00:25:20.605
coined the is logiat, which

NOTE Confidence: 0.9329441

00:25:20.605 --> 00:25:21.565
was it seemed like a

NOTE Confidence: 0.9329441

00:25:21.565 --> 00:25:22.945
good idea at the time.

NOTE Confidence: 0.98813856

00:25:23.325 --> 00:25:24.285
And so we can do

NOTE Confidence: 0.98813856

00:25:24.285 --> 00:25:25.825
better, and I think studying

NOTE Confidence: 0.98813856

00:25:25.885 --> 00:25:27.565
mechanisms and centering them in

NOTE Confidence: 0.98813856

00:25:27.565 --> 00:25:28.845
selection is one way to

NOTE Confidence: 0.98813856

00:25:28.845 --> 00:25:28.980
do

NOTE Confidence: 0.9827528

00:25:31.220 --> 00:25:33.059
better. Practically speaking then,

NOTE Confidence: 0.99513066

00:25:33.780 --> 00:25:35.400
part of selecting is matching

NOTE Confidence: 0.99513066

00:25:35.700 --> 00:25:37.640
to the strategies to barriers.

NOTE Confidence: 0.99791384

00:25:38.340 --> 00:25:39.299
So you've heard me talk

NOTE Confidence: 0.99791384

00:25:39.299 --> 00:25:41.725
about determinants multiple times. This

NOTE Confidence: 0.99791384

00:25:41.725 --> 00:25:42.845
is one of the really

NOTE Confidence: 0.99791384

00:25:42.845 --> 00:25:43.345
interesting,

NOTE Confidence: 0.99624777

00:25:43.885 --> 00:25:45.664
outputs from that tailored implementation

NOTE Confidence: 0.99624777

00:25:45.725 --> 00:25:46.784
of chronic disease,

NOTE Confidence: 0.9620139

00:25:47.404 --> 00:25:49.085
multinational study where Kraus and

NOTE Confidence: 0.9620139

00:25:49.085 --> 00:25:50.284
colleagues and forgive me for

NOTE Confidence: 0.9620139

00:25:50.284 --> 00:25:51.804
not having the citation here

NOTE Confidence: 0.9620139

00:25:51.804 --> 00:25:52.465
for you.

NOTE Confidence: 0.92519134

00:25:52.845 --> 00:25:54.924
They discovered six hundred and

NOTE Confidence: 0.92519134

00:25:54.924 --> 00:25:55.424
one,

NOTE Confidence: 0.8732031

00:25:56.530 --> 00:25:58.950
discrete plausible determinants of practice,

NOTE Confidence: 0.989098

00:25:59.330 --> 00:26:00.690
and they did shake loose

NOTE Confidence: 0.989098

00:26:00.690 --> 00:26:02.210
across a variety of levels,

NOTE Confidence: 0.989098

00:26:02.210 --> 00:26:03.830
patient, provider, organization,

NOTE Confidence: 0.9952492

00:26:04.369 --> 00:26:06.070
community, and policy levels.

NOTE Confidence: 0.97776145

00:26:06.609 --> 00:26:08.115
So when you're faced with,

NOTE Confidence: 0.97776145

00:26:08.195 --> 00:26:09.395
you know, I think we

NOTE Confidence: 0.97776145

00:26:09.395 --> 00:26:10.915
see more often fifty or

NOTE Confidence: 0.97776145

00:26:10.915 --> 00:26:12.434
so determinants in a given

NOTE Confidence: 0.97776145

00:26:12.434 --> 00:26:14.135
project. This was across many.

NOTE Confidence: 0.97776145

00:26:14.275 --> 00:26:15.315
But when you're faced with

NOTE Confidence: 0.97776145

00:26:15.315 --> 00:26:16.515
so many determinants, how do

NOTE Confidence: 0.97776145

00:26:16.515 --> 00:26:18.054
you select and match strategies?

NOTE Confidence: 0.9622292

00:26:18.595 --> 00:26:20.115
Especially when then you're faced

NOTE Confidence: 0.9622292

00:26:20.115 --> 00:26:21.635
with seventy or more. I

NOTE Confidence: 0.9622292

00:26:21.635 --> 00:26:23.190
think more recently, we see

NOTE Confidence: 0.9622292

00:26:23.269 --> 00:26:24.789
at least one hundred discrete

NOTE Confidence: 0.9622292

00:26:24.789 --> 00:26:26.389
strategies are available to us

NOTE Confidence: 0.9622292

00:26:26.389 --> 00:26:27.830
for use. And I'm giving

NOTE Confidence: 0.9622292

00:26:27.830 --> 00:26:29.669
you some some examples across

NOTE Confidence: 0.9622292

00:26:29.669 --> 00:26:32.250
plan, educate, finance, restructure,

NOTE Confidence: 0.95480174

00:26:32.789 --> 00:26:34.389
quality management, and the policy

NOTE Confidence: 0.95480174

00:26:34.389 --> 00:26:34.889
context.

NOTE Confidence: 0.9910453

00:26:36.865 --> 00:26:39.105
So then, tailoring is another,

NOTE Confidence: 0.99788505

00:26:39.505 --> 00:26:40.965
approach to implementation,

NOTE Confidence: 0.9566527

00:26:41.825 --> 00:26:43.345
that I've been talking about,

NOTE Confidence: 0.9566527

00:26:43.345 --> 00:26:43.845
and,

NOTE Confidence: 0.99220324

00:26:44.625 --> 00:26:46.465
I'm excited about the work

NOTE Confidence: 0.99220324

00:26:46.465 --> 00:26:48.545
forthcoming from Sheena McHugh and

NOTE Confidence: 0.99220324

00:26:48.545 --> 00:26:50.930
her team. They're characterizing processes

NOTE Confidence: 0.99220324

00:26:50.930 --> 00:26:52.790
and outcomes of tailoring implementation

NOTE Confidence: 0.9465244

00:26:53.090 --> 00:26:53.590
strategies,

NOTE Confidence: 0.9588214

00:26:54.369 --> 00:26:55.730
because, really, there's so much

NOTE Confidence: 0.9588214

00:26:55.730 --> 00:26:56.369
to be,

NOTE Confidence: 0.9899553

00:26:57.330 --> 00:26:59.170
learned and specified in this

NOTE Confidence: 0.9899553

00:26:59.170 --> 00:27:00.770
space. Even the definition of

NOTE Confidence: 0.9899553

00:27:00.770 --> 00:27:01.270
tailoring,

NOTE Confidence: 0.986787

00:27:02.065 --> 00:27:03.825
has some tension associated with

NOTE Confidence: 0.986787

00:27:03.825 --> 00:27:04.325
it,

NOTE Confidence: 0.9961158

00:27:04.705 --> 00:27:06.305
and the methods are unclear

NOTE Confidence: 0.9961158

00:27:06.305 --> 00:27:07.365
about how best,

NOTE Confidence: 0.99369824

00:27:07.744 --> 00:27:09.765
to tailor to optimize outcomes.

NOTE Confidence: 0.99960136

00:27:10.225 --> 00:27:11.605
And speaking of optimization,

NOTE Confidence: 0.9865846

00:27:12.065 --> 00:27:13.025
there are a couple of

NOTE Confidence: 0.9865846

00:27:13.025 --> 00:27:14.785
groups, including yours, Donna, who

NOTE Confidence: 0.9865846

00:27:14.785 --> 00:27:16.140
are helping us think about

NOTE Confidence: 0.9865846

00:27:16.300 --> 00:27:17.200
how do we optimize

NOTE Confidence: 0.99930835

00:27:17.580 --> 00:27:18.080
implementation

NOTE Confidence: 0.9981337

00:27:18.460 --> 00:27:18.960
strategies

NOTE Confidence: 0.93423903

00:27:19.420 --> 00:27:21.500
when we're centering criteria like

NOTE Confidence: 0.93423903

00:27:21.500 --> 00:27:22.560
equity or

NOTE Confidence: 0.929931

00:27:23.020 --> 00:27:24.480
cost or efficiency.

NOTE Confidence: 0.98553056

00:27:25.100 --> 00:27:26.619
How do we streamline? How

NOTE Confidence: 0.98553056

00:27:26.619 --> 00:27:28.160
do we scale implementation,

NOTE Confidence: 0.9801897

00:27:29.660 --> 00:27:30.160
accordingly?

NOTE Confidence: 0.97603595

00:27:31.325 --> 00:27:32.865
So that all of that

NOTE Confidence: 0.97603595

00:27:33.005 --> 00:27:34.445
led us to apply to

NOTE Confidence: 0.97603595

00:27:34.445 --> 00:27:36.125
the Agency for Healthcare Research

NOTE Confidence: 0.97603595

00:27:36.125 --> 00:27:37.725
in the United States, for

NOTE Confidence: 0.97603595

00:27:37.725 --> 00:27:39.484
an r thirteen award. This

NOTE Confidence: 0.97603595

00:27:39.484 --> 00:27:41.105
is a conference grant mechanism,

NOTE Confidence: 0.9553218

00:27:41.965 --> 00:27:43.725
that we fortunately received after

NOTE Confidence: 0.9553218

00:27:43.725 --> 00:27:44.625
our third application.

NOTE Confidence: 0.9883645

00:27:44.925 --> 00:27:45.805
I like to be a

NOTE Confidence: 0.9883645

00:27:45.805 --> 00:27:47.460
humble human and let folks

NOTE Confidence: 0.9883645

00:27:47.460 --> 00:27:48.900
know it takes a lot

NOTE Confidence: 0.9883645

00:27:48.900 --> 00:27:50.340
of tries, right, to get

NOTE Confidence: 0.9883645

00:27:50.340 --> 00:27:50.840
your,

NOTE Confidence: 0.9978857

00:27:51.380 --> 00:27:52.840
grant ideas funded.

NOTE Confidence: 0.9793774

00:27:53.700 --> 00:27:54.740
This was not my record.

NOTE Confidence: 0.9793774

00:27:54.740 --> 00:27:55.940
I think I submitted an

NOTE Confidence: 0.9793774

00:27:55.940 --> 00:27:57.140
r o one four times

NOTE Confidence: 0.9793774

00:27:57.140 --> 00:27:59.000
once before I was successful.

NOTE Confidence: 0.98283017

00:27:59.925 --> 00:28:00.885
But the goals of this

NOTE Confidence: 0.98283017

00:28:00.885 --> 00:28:02.425
r thirteen were to establish

NOTE Confidence: 0.98283017

00:28:02.485 --> 00:28:03.845
the priorities to guide a

NOTE Confidence: 0.98283017

00:28:03.845 --> 00:28:05.385
research agenda on implementation

NOTE Confidence: 0.98960775

00:28:05.685 --> 00:28:06.965
mechanisms and then to share

NOTE Confidence: 0.98960775

00:28:06.965 --> 00:28:07.625
it broadly.

NOTE Confidence: 0.9380634

00:28:08.565 --> 00:28:09.925
The methods we use were

NOTE Confidence: 0.9380634

00:28:09.925 --> 00:28:10.425
multifold.

NOTE Confidence: 0.9719949

00:28:10.885 --> 00:28:12.265
They featured partnership,

NOTE Confidence: 0.88413215

00:28:12.885 --> 00:28:13.929
with SERC,

NOTE Confidence: 0.943007

00:28:14.390 --> 00:28:15.669
that society that has been

NOTE Confidence: 0.943007

00:28:15.669 --> 00:28:17.049
mentioned a couple of times,

NOTE Confidence: 0.9864847

00:28:17.590 --> 00:28:18.490
network recruitment,

NOTE Confidence: 0.959879

00:28:19.030 --> 00:28:20.650
to folks who had mechanism

NOTE Confidence: 0.959879

00:28:20.789 --> 00:28:21.690
like expertise,

NOTE Confidence: 0.9652324

00:28:22.630 --> 00:28:24.090
and we formed this mechanisms

NOTE Confidence: 0.9652324

00:28:24.150 --> 00:28:26.115
network of expertise in SERC.

NOTE Confidence: 0.9392979

00:28:26.915 --> 00:28:28.775
We then identified challenges,

NOTE Confidence: 0.9977017

00:28:30.035 --> 00:28:31.155
to doing this type of

NOTE Confidence: 0.9977017

00:28:31.155 --> 00:28:31.655
research,

NOTE Confidence: 0.993554

00:28:32.035 --> 00:28:34.215
did some synthesis work, articulated

NOTE Confidence: 0.993554

00:28:34.355 --> 00:28:35.575
priorities and possibilities,

NOTE Confidence: 0.979091

00:28:36.595 --> 00:28:37.895
and are in the dissemination,

NOTE Confidence: 0.99933577

00:28:38.675 --> 00:28:39.655
stage of things.

NOTE Confidence: 0.98076826

00:28:40.370 --> 00:28:41.490
So just wanted to give

NOTE Confidence: 0.98076826

00:28:41.490 --> 00:28:42.610
a nod to the many

NOTE Confidence: 0.98076826

00:28:42.610 --> 00:28:44.770
humans who participated in this

NOTE Confidence: 0.98076826

00:28:44.770 --> 00:28:46.290
effort. I have to acknowledge

NOTE Confidence: 0.98076826

00:28:46.290 --> 00:28:47.970
that they're predominantly in the

NOTE Confidence: 0.98076826

00:28:47.970 --> 00:28:49.910
United States. We had funding

NOTE Confidence: 0.98076826

00:28:49.970 --> 00:28:52.070
limitations to travel people broadly.

NOTE Confidence: 0.97518194

00:28:52.765 --> 00:28:53.965
And, also, as you might

NOTE Confidence: 0.97518194

00:28:53.965 --> 00:28:55.245
have noted with the timeline,

NOTE Confidence: 0.97518194

00:28:55.245 --> 00:28:57.425
this overlapped with COVID, which

NOTE Confidence: 0.97518194

00:28:57.565 --> 00:28:59.325
prevented some of the conference

NOTE Confidence: 0.97518194

00:28:59.325 --> 00:29:00.845
like activities that we had

NOTE Confidence: 0.97518194

00:29:00.845 --> 00:29:01.345
planned.

NOTE Confidence: 0.96758723

00:29:02.045 --> 00:29:03.405
But we kicked things off

NOTE Confidence: 0.96758723

00:29:03.405 --> 00:29:05.485
with a, plenary session at

NOTE Confidence: 0.96758723

00:29:05.485 --> 00:29:06.465
SERC in twenty

NOTE Confidence: 0.9421935

00:29:08.100 --> 00:29:09.860
seven nineteen, it looks like

NOTE Confidence: 0.9421935

00:29:09.860 --> 00:29:10.520
it was,

NOTE Confidence: 0.97629684

00:29:10.900 --> 00:29:12.260
with David Chambers and doctor

NOTE Confidence: 0.97629684

00:29:12.260 --> 00:29:13.380
Nate Williams where we were

NOTE Confidence: 0.97629684

00:29:13.380 --> 00:29:14.840
setting the stage for understanding,

NOTE Confidence: 0.97629684

00:29:14.900 --> 00:29:15.620
sort of trying to get

NOTE Confidence: 0.97629684

00:29:15.620 --> 00:29:16.820
on the same page about

NOTE Confidence: 0.97629684

00:29:16.820 --> 00:29:17.320
implementation

NOTE Confidence: 0.9876088

00:29:17.700 --> 00:29:18.200
mechanisms

NOTE Confidence: 0.9792913

00:29:18.740 --> 00:29:20.020
and what we knew about

NOTE Confidence: 0.9792913

00:29:20.020 --> 00:29:20.980
them and what we might

NOTE Confidence: 0.9792913

00:29:20.980 --> 00:29:21.480
not.

NOTE Confidence: 0.97748816

00:29:22.415 --> 00:29:24.495
And then we had several

NOTE Confidence: 0.97748816

00:29:24.495 --> 00:29:26.355
inputs for this research agenda.

NOTE Confidence: 0.97748816

00:29:26.415 --> 00:29:28.174
So the systematic reviews that

NOTE Confidence: 0.97748816

00:29:28.174 --> 00:29:29.794
existed in this space were

NOTE Confidence: 0.97748816

00:29:30.015 --> 00:29:31.615
among the inputs. We did

NOTE Confidence: 0.97748816

00:29:31.615 --> 00:29:33.294
an exercise we we called

NOTE Confidence: 0.97748816

00:29:33.294 --> 00:29:35.020
matrix mapping. So all of

NOTE Confidence: 0.97748816

00:29:35.020 --> 00:29:36.720
those, folks on the mechanism

NOTE Confidence: 0.97748816

00:29:36.780 --> 00:29:38.300
of expertise in the early

NOTE Confidence: 0.97748816

00:29:38.300 --> 00:29:38.800
days

NOTE Confidence: 0.9322432

00:29:39.260 --> 00:29:40.240
helped share,

NOTE Confidence: 0.99354666

00:29:41.100 --> 00:29:42.640
where they were studying mechanisms,

NOTE Confidence: 0.99354666

00:29:42.700 --> 00:29:44.140
what they knew about them

NOTE Confidence: 0.99354666

00:29:44.140 --> 00:29:46.000
in a really systematic approach.

NOTE Confidence: 0.9592264

00:29:46.905 --> 00:29:48.985
We also listened in on,

NOTE Confidence: 0.9592264

00:29:49.385 --> 00:29:51.145
studies being proposed that were

NOTE Confidence: 0.9592264

00:29:51.145 --> 00:29:52.445
being discussed in these,

NOTE Confidence: 0.98360884

00:29:52.985 --> 00:29:54.445
workshops, and we qualitatively

NOTE Confidence: 0.9873519

00:29:54.825 --> 00:29:56.765
extracted challenges to,

NOTE Confidence: 0.9994027

00:29:57.225 --> 00:29:58.685
doing mechanism evaluations.

NOTE Confidence: 0.9863844

00:29:59.330 --> 00:30:01.250
We hosted breakout sessions at

NOTE Confidence: 0.9863844

00:30:01.250 --> 00:30:02.290
SERC. So some of you

NOTE Confidence: 0.9863844

00:30:02.290 --> 00:30:03.410
might even been in those

NOTE Confidence: 0.9863844

00:30:03.410 --> 00:30:05.590
rooms where we had facilitated

NOTE Confidence: 0.9863844

00:30:05.730 --> 00:30:07.010
conversations, and I know some

NOTE Confidence: 0.9863844

00:30:07.010 --> 00:30:08.210
of our facilitators are on

NOTE Confidence: 0.9863844

00:30:08.210 --> 00:30:09.970
the call today. So grateful

NOTE Confidence: 0.9863844

00:30:09.970 --> 00:30:11.650
for all you did, to

NOTE Confidence: 0.9863844

00:30:11.650 --> 00:30:13.330
solicit information as one of

NOTE Confidence: 0.9863844

00:30:13.330 --> 00:30:14.684
these inputs. And then we

NOTE Confidence: 0.9863844

00:30:14.684 --> 00:30:16.924
actually coded abstracts at that

NOTE Confidence: 0.9863844

00:30:16.924 --> 00:30:18.065
particular conference.

NOTE Confidence: 0.9770582

00:30:20.125 --> 00:30:21.804
And this this was the

NOTE Confidence: 0.9770582

00:30:21.804 --> 00:30:23.585
theme of the CERC conference

NOTE Confidence: 0.9770582

00:30:23.725 --> 00:30:26.065
back in twenty seventeen, actually.

NOTE Confidence: 0.997603

00:30:27.164 --> 00:30:28.065
Excuse me.

NOTE Confidence: 0.98209095

00:30:28.445 --> 00:30:28.684
And,

NOTE Confidence: 0.92571026

00:30:29.620 --> 00:30:30.679
I should make

NOTE Confidence: 0.91936255

00:30:31.220 --> 00:30:32.260
come off mute to share

NOTE Confidence: 0.91936255

00:30:32.260 --> 00:30:34.200
the methods behind concept mapping.

NOTE Confidence: 0.9954577

00:30:34.659 --> 00:30:36.100
It's a great way to

NOTE Confidence: 0.9954577

00:30:36.100 --> 00:30:37.000
bring together,

NOTE Confidence: 0.9698995

00:30:38.020 --> 00:30:39.559
experts to consider,

NOTE Confidence: 0.7385314

00:30:40.659 --> 00:30:41.159
discrete,

NOTE Confidence: 0.98643166

00:30:41.700 --> 00:30:43.545
pieces of information. In this

NOTE Confidence: 0.98643166

00:30:43.545 --> 00:30:45.305
case, they were considering one

NOTE Confidence: 0.98643166

00:30:45.305 --> 00:30:47.805
hundred and five unique challenges

NOTE Confidence: 0.9994965

00:30:48.105 --> 00:30:49.245
to studying implementation

NOTE Confidence: 0.7926846

00:30:49.625 --> 00:30:50.125
mechanisms,

NOTE Confidence: 0.9829151

00:30:50.585 --> 00:30:52.425
and they were asked to,

NOTE Confidence: 0.950851

00:30:52.825 --> 00:30:55.485
group them to conceptually distinct

NOTE Confidence: 0.950851

00:30:55.545 --> 00:30:57.885
piles and help us characterize

NOTE Confidence: 0.950851

00:30:58.105 --> 00:30:58.605
those,

NOTE Confidence: 0.97752

00:30:59.490 --> 00:31:01.090
discrete challenges. And this is

NOTE Confidence: 0.97752

00:31:01.090 --> 00:31:02.370
where we landed in terms

NOTE Confidence: 0.97752

00:31:02.370 --> 00:31:03.750
of a concept map.

NOTE Confidence: 0.99470097

00:31:04.370 --> 00:31:05.650
And so you can see

NOTE Confidence: 0.99470097

00:31:05.650 --> 00:31:07.090
the challenges to doing this

NOTE Confidence: 0.99470097

00:31:07.090 --> 00:31:09.490
work range from theoretical and

NOTE Confidence: 0.99470097

00:31:09.490 --> 00:31:10.630
causal in nature

NOTE Confidence: 0.99562204

00:31:11.365 --> 00:31:12.645
to the types of methods

NOTE Confidence: 0.99562204

00:31:12.645 --> 00:31:14.184
and designs that are needed,

NOTE Confidence: 0.9547689

00:31:15.365 --> 00:31:16.825
and and and more.

NOTE Confidence: 0.9923838

00:31:17.445 --> 00:31:18.885
So these one hundred and

NOTE Confidence: 0.9923838

00:31:18.885 --> 00:31:19.385
five,

NOTE Confidence: 0.95546466

00:31:19.924 --> 00:31:21.145
challenges were,

NOTE Confidence: 0.9937599

00:31:22.085 --> 00:31:22.825
the springboard

NOTE Confidence: 0.962203

00:31:23.284 --> 00:31:24.184
for then,

NOTE Confidence: 0.9954919

00:31:24.485 --> 00:31:24.985
our

NOTE Confidence: 0.926891

00:31:25.920 --> 00:31:27.380
mechanisms research agenda.

NOTE Confidence: 0.97203285

00:31:27.760 --> 00:31:29.520
Just acknowledging that during COVID,

NOTE Confidence: 0.97203285

00:31:29.520 --> 00:31:30.720
we got creative and we

NOTE Confidence: 0.97203285

00:31:30.720 --> 00:31:32.160
met on rocks and stumps

NOTE Confidence: 0.97203285

00:31:32.160 --> 00:31:32.900
in the woods

NOTE Confidence: 0.9946338

00:31:33.680 --> 00:31:34.420
to articulate

NOTE Confidence: 0.9996214

00:31:34.720 --> 00:31:35.780
our research agenda

NOTE Confidence: 0.98101056

00:31:36.240 --> 00:31:37.440
and used a lot of

NOTE Confidence: 0.98101056

00:31:37.440 --> 00:31:39.540
sticky notes to, help

NOTE Confidence: 0.99966764

00:31:39.915 --> 00:31:41.855
clarify priorities and possibilities.

NOTE Confidence: 0.9936506

00:31:42.715 --> 00:31:44.415
So this paper was published,

NOTE Confidence: 0.99831134

00:31:44.955 --> 00:31:46.555
just in September of this

NOTE Confidence: 0.99831134

00:31:46.555 --> 00:31:47.055
year.

NOTE Confidence: 0.9880454

00:31:47.355 --> 00:31:49.035
Another artifact of COVID is

NOTE Confidence: 0.9880454

00:31:49.035 --> 00:31:50.475
that some papers took a

NOTE Confidence: 0.9880454

00:31:50.475 --> 00:31:51.755
little bit longer to get

NOTE Confidence: 0.9880454

00:31:51.755 --> 00:31:52.575
out the door,

NOTE Confidence: 0.99807805

00:31:53.070 --> 00:31:54.669
but I'm delighted to have

NOTE Confidence: 0.99807805

00:31:54.669 --> 00:31:56.029
that out there in an

NOTE Confidence: 0.99807805

00:31:56.029 --> 00:31:57.630
open access journal for folks

NOTE Confidence: 0.99807805

00:31:57.630 --> 00:31:58.850
to consider,

NOTE Confidence: 0.9988308

00:31:59.630 --> 00:32:01.570
as you're thinking about implementation

NOTE Confidence: 0.9875964

00:32:01.870 --> 00:32:02.370
evaluations

NOTE Confidence: 0.99888796

00:32:02.750 --> 00:32:03.570
going forward.

NOTE Confidence: 0.998921

00:32:03.950 --> 00:32:04.990
I'll spend just a few

NOTE Confidence: 0.998921

00:32:04.990 --> 00:32:06.669
minutes then on what we

NOTE Confidence: 0.998921

00:32:06.669 --> 00:32:08.049
featured in that paper.

NOTE Confidence: 0.96796894

00:32:08.804 --> 00:32:10.404
And so how we organize

NOTE Confidence: 0.96796894

00:32:10.404 --> 00:32:11.384
things was,

NOTE Confidence: 0.97583133

00:32:11.924 --> 00:32:13.605
grouping them into what we

NOTE Confidence: 0.97583133

00:32:13.605 --> 00:32:14.585
felt like were,

NOTE Confidence: 0.9919214

00:32:15.125 --> 00:32:17.284
conceptually sort of distinct areas

NOTE Confidence: 0.9919214

00:32:17.284 --> 00:32:17.945
of priority.

NOTE Confidence: 0.9826239

00:32:18.404 --> 00:32:19.684
And then within each of

NOTE Confidence: 0.9826239

00:32:19.684 --> 00:32:21.125
those areas of priority, we

NOTE Confidence: 0.9826239

00:32:21.125 --> 00:32:22.504
had at least two goals,

NOTE Confidence: 0.99922895

00:32:23.284 --> 00:32:24.024
and then

NOTE Confidence: 0.96815646

00:32:24.409 --> 00:32:25.870
we tried to make things

NOTE Confidence: 0.96815646

00:32:25.929 --> 00:32:27.929
concrete and actionable. So we

NOTE Confidence: 0.96815646

00:32:27.929 --> 00:32:29.070
called these possibilities,

NOTE Confidence: 0.99211

00:32:29.370 --> 00:32:30.909
sort of action possibilities.

NOTE Confidence: 0.99165994

00:32:31.610 --> 00:32:32.890
And so there's a hundred

NOTE Confidence: 0.99165994

00:32:32.890 --> 00:32:34.750
and fifty one action possibilities,

NOTE Confidence: 0.98167247

00:32:35.370 --> 00:32:36.750
for studying implementation

NOTE Confidence: 0.9848181

00:32:37.795 --> 00:32:39.955
mechanisms moving forward, and I'll

NOTE Confidence: 0.9848181

00:32:39.955 --> 00:32:41.235
give you some examples of

NOTE Confidence: 0.9848181

00:32:41.235 --> 00:32:41.735
those.

NOTE Confidence: 0.99939257

00:32:42.435 --> 00:32:43.715
So one of the priority

NOTE Confidence: 0.99939257

00:32:43.715 --> 00:32:44.215
areas

NOTE Confidence: 0.9879871

00:32:44.595 --> 00:32:46.195
is accumulating knowledge within and

NOTE Confidence: 0.9879871

00:32:46.195 --> 00:32:47.975
across disciplines. So,

NOTE Confidence: 0.9417976

00:32:48.915 --> 00:32:50.535
there you know, this included

NOTE Confidence: 0.9417976

00:32:50.835 --> 00:32:52.799
nineteen actions actions that featured

NOTE Confidence: 0.9417976

00:32:52.799 --> 00:32:53.299
specific

NOTE Confidence: 0.9314054

00:32:53.679 --> 00:32:55.460
systematic reviews and meta analyses.

NOTE Confidence: 0.9314054

00:32:55.520 --> 00:32:56.900
When we think about mechanisms,

NOTE Confidence: 0.9790792

00:32:57.600 --> 00:32:59.200
the questions we hope scholars

NOTE Confidence: 0.9790792

00:32:59.200 --> 00:33:00.740
will answer are things like,

NOTE Confidence: 0.9790792

00:33:01.039 --> 00:33:01.780
do mechanisms

NOTE Confidence: 0.9327524

00:33:02.320 --> 00:33:03.299
operate universally,

NOTE Confidence: 0.9450584

00:33:03.600 --> 00:33:05.220
or is there variation across

NOTE Confidence: 0.9450584

00:33:05.440 --> 00:33:05.865
context,

NOTE Confidence: 0.9975533

00:33:06.585 --> 00:33:07.625
that we need to be

NOTE Confidence: 0.9975533

00:33:07.625 --> 00:33:08.184
aware of?

NOTE Confidence: 0.943027

00:33:09.545 --> 00:33:11.145
Another priority area is,

NOTE Confidence: 0.97788656

00:33:11.625 --> 00:33:14.205
prioritizing mechanism research incorporating other

NOTE Confidence: 0.97788656

00:33:14.265 --> 00:33:15.965
knowledge. So this had eleven

NOTE Confidence: 0.9546372

00:33:16.265 --> 00:33:18.445
possible actions to bring transdisciplinary

NOTE Confidence: 0.82624835

00:33:29.679 --> 00:33:30.179
epidemiology,

NOTE Confidence: 0.99156094

00:33:30.480 --> 00:33:33.054
psychology, and various other disciplines.

NOTE Confidence: 0.99156094

00:33:33.054 --> 00:33:34.514
And so there are named

NOTE Confidence: 0.99156094

00:33:34.575 --> 00:33:36.095
possible actions for how to

NOTE Confidence: 0.99156094

00:33:36.095 --> 00:33:37.315
do that type of work

NOTE Confidence: 0.99958664

00:33:37.615 --> 00:33:38.735
in the table featured in

NOTE Confidence: 0.99958664

00:33:38.735 --> 00:33:39.475
that paper.

NOTE Confidence: 0.9710493

00:33:40.335 --> 00:33:42.014
We another priority area was

NOTE Confidence: 0.9710493

00:33:42.014 --> 00:33:44.115
overcome design challenges and innovate

NOTE Confidence: 0.9710493

00:33:44.174 --> 00:33:45.870
methods. There were eighteen actions

NOTE Confidence: 0.9710493

00:33:45.870 --> 00:33:47.310
here where there's really new

NOTE Confidence: 0.9710493

00:33:47.310 --> 00:33:48.670
methods needed or we need

NOTE Confidence: 0.9710493

00:33:48.670 --> 00:33:50.030
to borrow methods from other

NOTE Confidence: 0.9710493

00:33:50.030 --> 00:33:51.090
disciplines. So

NOTE Confidence: 0.970365

00:33:51.470 --> 00:33:53.890
modeling time and quantitative assessment

NOTE Confidence: 0.970365

00:33:54.030 --> 00:33:55.810
for isolating specific mechanisms,

NOTE Confidence: 0.9953662

00:33:56.830 --> 00:33:57.890
identifying underutilized

NOTE Confidence: 0.95673996

00:33:58.190 --> 00:34:00.030
methods that offer specific value,

NOTE Confidence: 0.95673996

00:34:00.030 --> 00:34:01.695
like like comparative case studies

NOTE Confidence: 0.95673996

00:34:01.695 --> 00:34:03.855
that could generate hypotheses about

NOTE Confidence: 0.95673996

00:34:03.855 --> 00:34:05.555
complex mechanistic pathways.

NOTE Confidence: 0.95456153

00:34:08.655 --> 00:34:10.835
Priority area around improving measurements.

NOTE Confidence: 0.95456153

00:34:10.895 --> 00:34:12.275
So measurement of mechanisms,

NOTE Confidence: 0.9362599

00:34:12.895 --> 00:34:14.415
particularly in the context where

NOTE Confidence: 0.9362599

00:34:14.415 --> 00:34:16.859
implementation scientists work is pretty

NOTE Confidence: 0.99834365

00:34:17.400 --> 00:34:17.880
challenging.

NOTE Confidence: 0.9401908

00:34:18.599 --> 00:34:20.780
This included thirteen different actions

NOTE Confidence: 0.9401908

00:34:20.839 --> 00:34:21.500
such as

NOTE Confidence: 0.9908667

00:34:21.800 --> 00:34:24.119
pragmatic approaches for objective data

NOTE Confidence: 0.9908667

00:34:24.119 --> 00:34:24.619
collection,

NOTE Confidence: 0.9945726

00:34:24.920 --> 00:34:27.000
those capturing lived experiences of

NOTE Confidence: 0.9945726

00:34:27.000 --> 00:34:27.500
individuals.

NOTE Confidence: 0.98384196

00:34:29.295 --> 00:34:31.055
Then we have another priority

NOTE Confidence: 0.98384196

00:34:31.055 --> 00:34:32.895
area for providing guidance for

NOTE Confidence: 0.98384196

00:34:32.895 --> 00:34:35.614
specifying mechanisms. There were fifteen

NOTE Confidence: 0.98384196

00:34:35.614 --> 00:34:37.775
actions here reflecting mostly tools

NOTE Confidence: 0.98384196

00:34:37.775 --> 00:34:38.275
and

NOTE Confidence: 0.9879905

00:34:38.575 --> 00:34:40.594
aids to improve researchers' approach

NOTE Confidence: 0.9879905

00:34:40.655 --> 00:34:41.954
to examining mechanisms.

NOTE Confidence: 0.9936869

00:34:42.600 --> 00:34:44.360
I, didn't share this when

NOTE Confidence: 0.9936869

00:34:44.360 --> 00:34:45.320
I was reporting out on

NOTE Confidence: 0.9936869

00:34:45.320 --> 00:34:47.100
the systematic review of mechanisms,

NOTE Confidence: 0.9936869

00:34:47.160 --> 00:34:49.500
but it was really challenging

NOTE Confidence: 0.9936869

00:34:49.720 --> 00:34:51.340
for us as a research

NOTE Confidence: 0.9936869

00:34:51.400 --> 00:34:52.460
team to,

NOTE Confidence: 0.9983824

00:34:53.239 --> 00:34:53.739
synthesize

NOTE Confidence: 0.967778

00:34:54.040 --> 00:34:55.800
across those thirty nine studies

NOTE Confidence: 0.967778

00:34:55.800 --> 00:34:56.120
because,

NOTE Confidence: 0.99971247

00:34:57.575 --> 00:34:59.035
most of the

NOTE Confidence: 0.9835443

00:34:59.734 --> 00:35:01.114
studies and their

NOTE Confidence: 0.99154204

00:35:01.575 --> 00:35:03.654
authors conceptualize mechanisms in different

NOTE Confidence: 0.99154204

00:35:03.654 --> 00:35:05.494
ways and conceptualize the causal

NOTE Confidence: 0.99154204

00:35:05.494 --> 00:35:06.875
pathway in different ways.

NOTE Confidence: 0.9919957

00:35:07.494 --> 00:35:08.315
And so,

NOTE Confidence: 0.98571706

00:35:08.775 --> 00:35:10.214
that's just one piece of

NOTE Confidence: 0.98571706

00:35:10.214 --> 00:35:11.835
evidence or example that,

NOTE Confidence: 0.99916965

00:35:12.279 --> 00:35:14.279
having some alignment or harmony

NOTE Confidence: 0.99916965

00:35:14.279 --> 00:35:15.400
around how we're thinking about

NOTE Confidence: 0.99916965

00:35:15.400 --> 00:35:16.859
this could be really helpful

NOTE Confidence: 0.99916965

00:35:16.920 --> 00:35:17.739
moving forward.

NOTE Confidence: 0.9932388

00:35:18.759 --> 00:35:20.839
Another priority area on increasing

NOTE Confidence: 0.9932388

00:35:20.839 --> 00:35:22.599
the focus on theorizing. So

NOTE Confidence: 0.9932388

00:35:22.599 --> 00:35:24.359
there were twelve possible actions

NOTE Confidence: 0.9932388

00:35:24.359 --> 00:35:26.779
here for developing, incorporating, refining

NOTE Confidence: 0.9585224

00:35:27.414 --> 00:35:29.255
theory and mechanistic research to

NOTE Confidence: 0.9585224

00:35:29.255 --> 00:35:31.575
better characterize mechanisms, so making

NOTE Confidence: 0.9585224

00:35:31.575 --> 00:35:32.934
theory explicit even in the

NOTE Confidence: 0.9585224

00:35:32.934 --> 00:35:34.394
strategy design phase.

NOTE Confidence: 0.9624186

00:35:35.255 --> 00:35:36.535
And this is the last

NOTE Confidence: 0.9624186

00:35:36.535 --> 00:35:38.535
group. These were emergent actions,

NOTE Confidence: 0.9624186

00:35:38.535 --> 00:35:38.934
so they,

NOTE Confidence: 0.9837533

00:35:39.869 --> 00:35:40.609
were not

NOTE Confidence: 0.99968946

00:35:40.910 --> 00:35:42.529
similar to the challenges

NOTE Confidence: 0.97724044

00:35:42.829 --> 00:35:43.230
that,

NOTE Confidence: 0.97709346

00:35:43.789 --> 00:35:45.650
fed into the concept mapping.

NOTE Confidence: 0.97709346

00:35:45.869 --> 00:35:46.670
But the group,

NOTE Confidence: 0.9992882

00:35:47.069 --> 00:35:49.089
who articulated the research agenda

NOTE Confidence: 0.98159325

00:35:49.390 --> 00:35:50.750
said just how important it

NOTE Confidence: 0.98159325

00:35:50.750 --> 00:35:52.349
was to engage the policy

NOTE Confidence: 0.98159325

00:35:52.349 --> 00:35:53.569
and practice community,

NOTE Confidence: 0.99715614

00:35:54.114 --> 00:35:55.975
twelve possible actions there,

NOTE Confidence: 0.9888508

00:35:56.755 --> 00:35:57.655
for understanding,

NOTE Confidence: 0.995094

00:35:58.355 --> 00:36:00.135
the perspectives of these partners,

NOTE Confidence: 0.96265936

00:36:00.995 --> 00:36:02.215
using things like,

NOTE Confidence: 0.99908626

00:36:02.675 --> 00:36:03.175
implementation

NOTE Confidence: 0.93133014

00:36:03.475 --> 00:36:05.555
mapping, cognitive walk throughs to

NOTE Confidence: 0.93133014

00:36:05.555 --> 00:36:06.855
unpack or surface,

NOTE Confidence: 0.9810028

00:36:07.599 --> 00:36:09.599
mechanisms, really needing to plain

NOTE Confidence: 0.9810028

00:36:09.599 --> 00:36:10.900
language this space

NOTE Confidence: 0.983438

00:36:11.359 --> 00:36:12.739
in order for it to,

NOTE Confidence: 0.9984678

00:36:13.359 --> 00:36:15.280
be engaging and informed by

NOTE Confidence: 0.9984678

00:36:15.280 --> 00:36:16.400
the people who really have

NOTE Confidence: 0.9984678

00:36:16.400 --> 00:36:18.260
the expertise to do so.

NOTE Confidence: 0.94461286

00:36:20.474 --> 00:36:22.154
Another priority area around engaging

NOTE Confidence: 0.94461286

00:36:22.154 --> 00:36:23.194
funders and the need for

NOTE Confidence: 0.94461286

00:36:23.194 --> 00:36:24.555
funding, and so this comes

NOTE Confidence: 0.94461286

00:36:24.555 --> 00:36:26.174
from the mechanisms of expertise

NOTE Confidence: 0.94461286

00:36:26.394 --> 00:36:27.135
saying that,

NOTE Confidence: 0.9944687

00:36:27.755 --> 00:36:29.434
there are seventeen actions that

NOTE Confidence: 0.9944687

00:36:29.434 --> 00:36:30.795
could be happening in this

NOTE Confidence: 0.9944687

00:36:30.795 --> 00:36:31.295
space,

NOTE Confidence: 0.99018234

00:36:31.914 --> 00:36:33.674
to leverage or stand up

NOTE Confidence: 0.99018234

00:36:33.674 --> 00:36:34.494
new opportunities

NOTE Confidence: 0.9898502

00:36:35.180 --> 00:36:36.560
and then building capacity.

NOTE Confidence: 0.9721595

00:36:36.860 --> 00:36:39.360
So, seventeen actions offering

NOTE Confidence: 0.9884987

00:36:39.739 --> 00:36:41.120
clarification or guidance,

NOTE Confidence: 0.9845103

00:36:41.739 --> 00:36:43.180
and avenues to build the

NOTE Confidence: 0.9845103

00:36:43.180 --> 00:36:44.160
field's capacity.

NOTE Confidence: 0.98542666

00:36:44.620 --> 00:36:46.300
And then finally, just this

NOTE Confidence: 0.98542666

00:36:46.300 --> 00:36:47.840
huge emphasis on dissemination.

NOTE Confidence: 0.95082724

00:36:48.140 --> 00:36:48.640
So,

NOTE Confidence: 0.9482197

00:36:49.185 --> 00:36:50.785
several goals listed for you,

NOTE Confidence: 0.9482197

00:36:50.785 --> 00:36:52.545
seventeen actions in the table

NOTE Confidence: 0.9482197

00:36:52.545 --> 00:36:53.905
and the paper. There are

NOTE Confidence: 0.9482197

00:36:53.905 --> 00:36:56.145
specific manuscript ideas that,

NOTE Confidence: 0.9922611

00:36:56.705 --> 00:36:57.665
if you happen to be

NOTE Confidence: 0.9922611

00:36:57.665 --> 00:36:59.205
looking for a paper topic,

NOTE Confidence: 0.9922611

00:36:59.344 --> 00:37:00.465
they're in there for you

NOTE Confidence: 0.9922611

00:37:00.465 --> 00:37:01.125
to consider,

NOTE Confidence: 0.92088866

00:37:01.730 --> 00:37:03.829
but also suggestions around forums

NOTE Confidence: 0.92088866

00:37:03.969 --> 00:37:05.109
to host dialogue,

NOTE Confidence: 0.9987026

00:37:06.609 --> 00:37:07.809
you know, ways to engage

NOTE Confidence: 0.9987026

00:37:07.809 --> 00:37:08.309
journal

NOTE Confidence: 0.8510575

00:37:08.609 --> 00:37:09.349
editors, and

NOTE Confidence: 0.97393596

00:37:09.650 --> 00:37:11.489
failing faster with wisdom was

NOTE Confidence: 0.97393596

00:37:11.489 --> 00:37:12.549
a paper type,

NOTE Confidence: 0.96096194

00:37:13.089 --> 00:37:15.010
that the mechanisms network of

NOTE Confidence: 0.96096194

00:37:15.010 --> 00:37:16.665
expertise came up with. We

NOTE Confidence: 0.96096194

00:37:16.665 --> 00:37:18.285
so often missed the opportunity

NOTE Confidence: 0.96096194

00:37:18.585 --> 00:37:20.025
to learn from null studies,

NOTE Confidence: 0.96096194

00:37:20.025 --> 00:37:22.025
and couldn't we just make

NOTE Confidence: 0.96096194

00:37:22.025 --> 00:37:23.785
that an explicit priority, for

NOTE Confidence: 0.96096194

00:37:23.785 --> 00:37:24.285
example?

NOTE Confidence: 0.9863403

00:37:25.225 --> 00:37:25.725
So,

NOTE Confidence: 0.99174416

00:37:26.425 --> 00:37:27.885
true to form, our mechanisms

NOTE Confidence: 0.99174416

00:37:27.945 --> 00:37:29.880
network of expertise couldn't stop

NOTE Confidence: 0.99174416

00:37:29.880 --> 00:37:31.480
with just articulating the research

NOTE Confidence: 0.99174416

00:37:31.480 --> 00:37:32.680
agenda. Many of them have

NOTE Confidence: 0.99174416

00:37:32.680 --> 00:37:34.119
written papers that address some

NOTE Confidence: 0.99174416

00:37:34.119 --> 00:37:35.079
of the items on the

NOTE Confidence: 0.99174416

00:37:35.079 --> 00:37:37.000
research agenda. So we stood

NOTE Confidence: 0.99174416

00:37:37.000 --> 00:37:38.680
up a special collection across

NOTE Confidence: 0.99174416

00:37:38.680 --> 00:37:39.420
the two,

NOTE Confidence: 0.9851382

00:37:40.200 --> 00:37:42.359
sibling journals, implementation science and

NOTE Confidence: 0.9851382

00:37:42.359 --> 00:37:43.900
implementation science communications.

NOTE Confidence: 0.9732473

00:37:44.405 --> 00:37:45.844
It's an open special collection.

NOTE Confidence: 0.9732473

00:37:45.844 --> 00:37:46.805
So if you're doing work

NOTE Confidence: 0.9732473

00:37:46.805 --> 00:37:47.844
in this space, we hope

NOTE Confidence: 0.9732473

00:37:47.844 --> 00:37:48.505
you'll consider

NOTE Confidence: 0.99525744

00:37:48.964 --> 00:37:50.645
selecting that special collection from

NOTE Confidence: 0.99525744

00:37:50.645 --> 00:37:51.765
the drop down menu and

NOTE Confidence: 0.99525744

00:37:51.765 --> 00:37:53.704
submitting to it directly.

NOTE Confidence: 0.9556558

00:37:55.204 --> 00:37:56.805
And I wanted to feature

NOTE Confidence: 0.9556558

00:37:56.805 --> 00:37:58.005
an article that came out

NOTE Confidence: 0.9556558

00:37:58.005 --> 00:37:59.370
last month by the editors

NOTE Confidence: 0.84680915

00:38:00.650 --> 00:38:02.410
and associate editors, several of

NOTE Confidence: 0.84680915

00:38:02.410 --> 00:38:03.150
them from those two

NOTE Confidence: 0.85331005

00:38:03.450 --> 00:38:04.650
journals where they update the

NOTE Confidence: 0.85331005

00:38:04.650 --> 00:38:05.150
scope,

NOTE Confidence: 0.948437

00:38:05.690 --> 00:38:07.150
of those two journals. And

NOTE Confidence: 0.948437

00:38:07.210 --> 00:38:08.510
I I had to highlight

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00:38:08.650 --> 00:38:09.790
that among the,

NOTE Confidence: 0.9707436

00:38:10.250 --> 00:38:12.030
items included in the abstract

NOTE Confidence: 0.9707436

00:38:12.090 --> 00:38:13.370
was the import of the

NOTE Confidence: 0.9707436

00:38:13.370 --> 00:38:13.870
study

NOTE Confidence: 0.98068404

00:38:14.424 --> 00:38:15.085
of of implementation

NOTE Confidence: 0.9994266

00:38:15.704 --> 00:38:16.204
mechanisms.

NOTE Confidence: 0.9960953

00:38:17.145 --> 00:38:18.184
I'll wrap up with a

NOTE Confidence: 0.9960953

00:38:18.184 --> 00:38:19.005
few NHLBI

NOTE Confidence: 0.9629644

00:38:19.545 --> 00:38:20.045
specific,

NOTE Confidence: 0.9910507

00:38:20.664 --> 00:38:22.184
items for you. So,

NOTE Confidence: 0.9414689

00:38:22.585 --> 00:38:23.545
as you can see from

NOTE Confidence: 0.9414689

00:38:23.545 --> 00:38:25.005
my background, I sit,

NOTE Confidence: 0.9542666

00:38:25.704 --> 00:38:26.605
within NHLBI,

NOTE Confidence: 0.92132664

00:38:27.145 --> 00:38:28.940
specifically the Center for Translation

NOTE Confidence: 0.92132664

00:38:29.000 --> 00:38:30.859
Research and Implementation Science.

NOTE Confidence: 0.99884033

00:38:31.320 --> 00:38:32.600
And over the last year

NOTE Confidence: 0.99884033

00:38:32.600 --> 00:38:34.040
or so, we've been wrapping

NOTE Confidence: 0.99884033

00:38:34.040 --> 00:38:35.160
our arms around a ten

NOTE Confidence: 0.99884033

00:38:35.160 --> 00:38:35.900
year investment,

NOTE Confidence: 0.99250054

00:38:36.600 --> 00:38:37.260
in implementation

NOTE Confidence: 0.98604023

00:38:37.640 --> 00:38:39.800
science and making sense of

NOTE Confidence: 0.98604023

00:38:39.800 --> 00:38:40.619
our institute's

NOTE Confidence: 0.99138707

00:38:40.994 --> 00:38:42.855
contributions and that of other

NOTE Confidence: 0.99138707

00:38:42.914 --> 00:38:43.414
ICs,

NOTE Confidence: 0.9892333

00:38:43.875 --> 00:38:45.394
in the National Institutes of

NOTE Confidence: 0.9892333

00:38:45.394 --> 00:38:46.755
Health. And what you can

NOTE Confidence: 0.9892333

00:38:46.755 --> 00:38:47.714
see on the screen on

NOTE Confidence: 0.9892333

00:38:47.714 --> 00:38:49.174
the left here is that

NOTE Confidence: 0.9596692

00:38:49.795 --> 00:38:51.875
the proportion of NIH awards

NOTE Confidence: 0.9596692

00:38:51.875 --> 00:38:53.015
has grown substantially

NOTE Confidence: 0.99966145

00:38:53.394 --> 00:38:54.180
over the last

NOTE Confidence: 0.99824095

00:38:54.660 --> 00:38:56.020
ten years or so,

NOTE Confidence: 0.91890746

00:38:56.739 --> 00:38:58.920
which is very exciting. And

NOTE Confidence: 0.91890746

00:38:59.059 --> 00:38:59.559
NHLBI

NOTE Confidence: 0.96424073

00:38:59.940 --> 00:39:01.239
holds thirteen percent,

NOTE Confidence: 0.9996586

00:39:02.020 --> 00:39:03.559
share of all NIH

NOTE Confidence: 0.95529866

00:39:03.859 --> 00:39:06.180
implementation science awards with fourth,

NOTE Confidence: 0.95529866

00:39:06.500 --> 00:39:07.960
overall for total costs.

NOTE Confidence: 0.9863414

00:39:08.260 --> 00:39:09.000
It's an exciting

NOTE Confidence: 0.9785142

00:39:09.300 --> 00:39:10.555
trajectory to see. And then

NOTE Confidence: 0.9785142

00:39:10.555 --> 00:39:12.175
when we look within NHLBI,

NOTE Confidence: 0.99412745

00:39:12.955 --> 00:39:14.575
that trajectory of increase,

NOTE Confidence: 0.9988761

00:39:15.355 --> 00:39:17.215
is also evident. However,

NOTE Confidence: 0.9810629

00:39:18.235 --> 00:39:19.435
I think you'll find it

NOTE Confidence: 0.9810629

00:39:19.435 --> 00:39:21.195
staggering as do I that,

NOTE Confidence: 0.9810629

00:39:21.515 --> 00:39:22.255
the percent

NOTE Confidence: 0.99351484

00:39:22.635 --> 00:39:24.200
of our total cost for

NOTE Confidence: 0.99351484

00:39:24.200 --> 00:39:25.960
competing awards is about two

NOTE Confidence: 0.99351484

00:39:25.960 --> 00:39:26.460
percent

NOTE Confidence: 0.9975185

00:39:26.839 --> 00:39:27.900
focused on implementation

NOTE Confidence: 0.99882996

00:39:28.200 --> 00:39:30.200
science. So it's not just

NOTE Confidence: 0.99882996

00:39:30.200 --> 00:39:31.260
the study of implementation

NOTE Confidence: 0.97467345

00:39:31.640 --> 00:39:33.160
mechanisms that we need. It's

NOTE Confidence: 0.97467345

00:39:33.160 --> 00:39:33.660
implementation

NOTE Confidence: 0.9952752

00:39:33.960 --> 00:39:35.319
science more broadly, and we

NOTE Confidence: 0.9952752

00:39:35.319 --> 00:39:37.315
hope you'll consider targeting,

NOTE Confidence: 0.9996488

00:39:37.775 --> 00:39:38.275
NHLBI

NOTE Confidence: 0.99884933

00:39:38.575 --> 00:39:39.535
with some of your good

NOTE Confidence: 0.99884933

00:39:39.535 --> 00:39:40.434
grant ideas,

NOTE Confidence: 0.99981695

00:39:41.055 --> 00:39:42.094
in the coming months and

NOTE Confidence: 0.99981695

00:39:42.094 --> 00:39:42.594
years.

NOTE Confidence: 0.93748283

00:39:43.135 --> 00:39:44.815
So as I mentioned, just

NOTE Confidence: 0.93748283

00:39:44.815 --> 00:39:46.255
this week, the new program

NOTE Confidence: 0.93748283

00:39:46.255 --> 00:39:47.855
announcement has been released. I'm

NOTE Confidence: 0.93748283

00:39:47.855 --> 00:39:48.895
just showing you the r

NOTE Confidence: 0.93748283

00:39:48.895 --> 00:39:50.530
l one for for investigator

NOTE Confidence: 0.93748283

00:39:50.589 --> 00:39:52.830
initiated awards here, PAR twenty

NOTE Confidence: 0.93748283

00:39:52.830 --> 00:39:53.869
five one hundred and forty

NOTE Confidence: 0.93748283

00:39:53.869 --> 00:39:54.369
four.

NOTE Confidence: 0.9731035

00:39:54.670 --> 00:39:56.750
Again, US, US with foreign

NOTE Confidence: 0.9731035

00:39:56.750 --> 00:39:58.369
components, and foreign investigators

NOTE Confidence: 0.9600744

00:39:58.670 --> 00:39:59.890
can submit to this.

NOTE Confidence: 0.9811396

00:40:00.510 --> 00:40:01.790
And we're here for you.

NOTE Confidence: 0.9811396

00:40:01.790 --> 00:40:03.885
Right? So the our job

NOTE Confidence: 0.9811396

00:40:03.885 --> 00:40:05.645
is to be available for

NOTE Confidence: 0.9811396

00:40:05.645 --> 00:40:07.165
technical assistance is what we

NOTE Confidence: 0.9811396

00:40:07.165 --> 00:40:08.525
call it, to help you

NOTE Confidence: 0.9811396

00:40:08.525 --> 00:40:10.045
think through the ideas, their

NOTE Confidence: 0.9811396

00:40:10.045 --> 00:40:11.825
alignment with the various institutes,

NOTE Confidence: 0.9962391

00:40:12.765 --> 00:40:14.525
and responsiveness to the program

NOTE Confidence: 0.9962391

00:40:14.525 --> 00:40:15.985
announcements such as this.

NOTE Confidence: 0.9939102

00:40:16.580 --> 00:40:18.180
Donna shared that we're celebrating

NOTE Confidence: 0.9939102

00:40:18.180 --> 00:40:19.080
our tenth anniversary.

NOTE Confidence: 0.997289

00:40:19.540 --> 00:40:20.500
There's a lot of red

NOTE Confidence: 0.997289

00:40:20.500 --> 00:40:21.480
around me today.

NOTE Confidence: 0.9846654

00:40:21.780 --> 00:40:23.380
It's a hybrid event. And

NOTE Confidence: 0.9846654

00:40:23.380 --> 00:40:24.660
if you're interested, send me

NOTE Confidence: 0.9846654

00:40:24.660 --> 00:40:25.400
an email.

NOTE Confidence: 0.98039913

00:40:25.940 --> 00:40:26.980
There is going to be

NOTE Confidence: 0.98039913

00:40:26.980 --> 00:40:27.960
a cap, unfortunately,

NOTE Confidence: 0.99145585

00:40:28.340 --> 00:40:30.224
just given size of rooms

NOTE Confidence: 0.99145585

00:40:30.224 --> 00:40:31.984
and ability to host virtually,

NOTE Confidence: 0.99145585

00:40:31.984 --> 00:40:33.184
but you'll email me, and

NOTE Confidence: 0.99145585

00:40:33.184 --> 00:40:34.385
I'll I'll help you find

NOTE Confidence: 0.99145585

00:40:34.385 --> 00:40:35.045
your way.

NOTE Confidence: 0.9829419

00:40:35.664 --> 00:40:36.484
And lastly,

NOTE Confidence: 0.962696

00:40:37.265 --> 00:40:38.785
we're hiring, and there are

NOTE Confidence: 0.962696

00:40:38.785 --> 00:40:40.464
several opportunities if you're an

NOTE Confidence: 0.962696

00:40:40.464 --> 00:40:40.964
implementation

NOTE Confidence: 0.9960757

00:40:41.344 --> 00:40:43.260
scientist looking to have a

NOTE Confidence: 0.9960757

00:40:43.260 --> 00:40:44.540
seat at the table and

NOTE Confidence: 0.9960757

00:40:44.540 --> 00:40:45.680
contribute to,

NOTE Confidence: 0.92928493

00:40:46.300 --> 00:40:46.780
the,

NOTE Confidence: 0.9968532

00:40:47.260 --> 00:40:48.719
strategic vision implementation

NOTE Confidence: 0.9991364

00:40:49.020 --> 00:40:50.300
plan for this work at

NOTE Confidence: 0.9991364

00:40:50.300 --> 00:40:50.800
NHLBI.

NOTE Confidence: 0.9946925

00:40:52.140 --> 00:40:53.420
And if you wanna stay

NOTE Confidence: 0.9946925

00:40:53.420 --> 00:40:55.200
abreast of when those opportunities

NOTE Confidence: 0.9946925

00:40:55.260 --> 00:40:56.960
emerge, follow us on LinkedIn.

NOTE Confidence: 0.91292995

00:40:58.445 --> 00:41:00.285
NIH largely has moved away

NOTE Confidence: 0.91292995

00:41:00.285 --> 00:41:02.285
from Twitter and accent is

NOTE Confidence: 0.91292995

00:41:02.285 --> 00:41:03.805
finding our new social media

NOTE Confidence: 0.91292995

00:41:03.805 --> 00:41:04.864
home in LinkedIn,

NOTE Confidence: 0.9852468

00:41:05.245 --> 00:41:07.165
and this is the, Citrus

NOTE Confidence: 0.9852468

00:41:07.165 --> 00:41:09.005
official page here. So on

NOTE Confidence: 0.9852468

00:41:09.005 --> 00:41:10.440
that note, thank you so

NOTE Confidence: 0.9852468

00:41:10.440 --> 00:41:11.719
much for hanging in there

NOTE Confidence: 0.9852468

00:41:11.719 --> 00:41:13.080
with me. It's a super

NOTE Confidence: 0.9852468

00:41:13.080 --> 00:41:14.760
nerdy topic. Hopefully, I made

NOTE Confidence: 0.9852468

00:41:14.760 --> 00:41:16.680
it accessible, but now is

NOTE Confidence: 0.9852468

00:41:16.680 --> 00:41:17.820
our chance to dialogue.

NOTE Confidence: 0.92933947

00:41:19.871 --> 00:41:21.710
Yeah. Thanks very much, Kara.

NOTE Confidence: 0.92933947

00:41:21.710 --> 00:41:22.991
That was a really excellent

NOTE Confidence: 0.92933947

00:41:22.991 --> 00:41:23.491
comprehensive

NOTE Confidence: 0.9358424

00:41:23.951 --> 00:41:25.390
talk that covered a lot

NOTE Confidence: 0.9358424

00:41:25.390 --> 00:41:27.231
of the key points, so

NOTE Confidence: 0.9358424

00:41:27.231 --> 00:41:28.576
we really appreciate it.