Having great data about how to solve a problem is dependent on one last step: putting the solution to work. Implementation science has been defined as “the scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice, and, hence, to improve the quality and effectiveness of health services.” Members of Internal Medicine have embraced this work both in University of Iowa Health Care and across the street at the Iowa City VA Health Care System.

CADRE is the VA-funded Center for Innovation at the Iowa City VA and its Ethnographic Methods and Implementation Core (EMIC) drove much of the early growth in implementation science in the department. With 12 staff and five faculty from the Division of General Internal Medicine, EMIC is the largest research core of its kind in the country.  Heather Schacht Reisinger, PhD, and Samantha Solimeo, PhD, MPH, are former directors of EMIC and Aaron Seaman, PhD, is the current EMIC Director. In 2019, Reisinger was asked to build a similar core at the University of Iowa’s Institute for Clinical and Translational Science (ICTS) as the Associate Director of Engagement, Integration, and Implementation (EII).

What is unique is that all five of the faculty affiliated with EMIC—and now the EII Core—are medical anthropologists, and many of the staff in each core are anthropologists or sociologists as well. What they bring to implementation science is ethnography, a complex, richly layered methodology deeply rooted in the social sciences of anthropology and sociology. Ethnographic methods require engagement with people and organizations through observation and participation in everyday social interactions in an effort to understand their beliefs, values, and behaviors. “Health care is brimming with everyday social interactions that have important implications for bringing evidence-based practices into everyday encounters,” Reisinger said.

The aims of implementation science can be restated. “What is getting in the way of an evidence-based intervention from reaching the patients who need it? Or where is it being successfully implemented and how can we spread the lessons learned? Ethnographic methods are well-suited to systematically study these questions.”

What sorts of questions
In the VA, Reisinger has studied the barriers to effectively implementing the evidence-based intervention of trauma-exposure therapy for post-traumatic stress disorder (PTSD), especially among rural-dwelling Veterans. The implementation strategies have ranged from improving the use of a smart phone application that supports PTSD treatment to tailoring workflows in telehealth clinics in response to their local context.

Reisinger offered some additional examples of the broad range of clinical areas faculty in the department are contributing to the field of implementation science.

Elissa Faro, PhD, is on the cusp of R01 funding from the National Institute of Mental Health to adapt an evidence-based strategy to implement a mental health intervention with birthing people into existing home visiting programs in Iowa and Indiana. The study integrates context into the randomized control trial in a unique way.

Seaman is collaborating with Sato Ashida, PhD, College of Public Health, studying the adaptation and implementation of the evidence-based program Disaster PrepWise to help people with dementia and their caregivers prepare for natural disasters. Solimeo is working to improve the implementation of osteoporosis care among male Veterans by addressing how gender constructs create barriers to fracture prevention and how structural barriers such as distance from bone densitometry services limits access to care.

Kimberly Dukes, PhD, studies the de-implementation of ineffective healthcare practices and the implementation of infection prevention interventions in a range of settings, from surgery and hemodialysis to migrant labor.