University of California San Diego launches new center to help conduct meaningful research in real-world settings

Throughout the history of medicine and science, researchers have frequently discovered evidence of promising ways to improve health outcomes for patients and communities -- only to have those findings languish in papers published in scientific journals.

To help bridge this gap between research findings and their application in the real world, the University of California San Diego launched the Dissemination and Implementation Science Center (DISC) earlier this year.

The center aims to provide researchers and practitioners with the training, technical assistance, mentoring and resources they need to conduct research that is meaningful in real-world settings, and implement these findings for the equitable benefit of diverse communities served in a variety of health settings.

UC San Diego DISC, administratively housed in the Altman Clinical and Translational Research Institute at UC San Diego, is funded by the Office of the Vice Chancellor of Health Sciences at UC San Diego and led by the following UC San Diego School of Medicine faculty members:

• Borsika Rabin, PhD, MPH, PharmD, assistant professor in the Department of Family Medicine and Public Health
• Gregory Aarons, PhD, professor and director of the Child and Adolescent Services Research Center, Department of Psychiatry
• Lauren Brookman-Frazee, PhD, professor and associate director of the Child and Adolescent Services Research Center, Department of Psychiatry
• Nicole Stadnick, PhD, MPH, assistant professor and investigator in the Child and Adolescent Services Research Center, Department of Psychiatry

"Most health studies focus on how well interventions designed to reduce illness and death fare in ideal settings, but little is known about how to scale them up effectively in real-world settings," Stadnick said.

"As a result, many life-enriching interventions fail to reach their full potential. "

"The promise of dissemination and implementation science, a relatively new area in health sciences, is to acknowledge the realities of communities and settings as we design ways to improve care in various contexts."

UC San Diego DISC provides leadership and guidance in conducting research in dissemination and implementation science, funding for pilot grants, education, and training in dissemination and implementation science methodologies, and consultation and mentoring to researchers and community partners.

In addition, UC San Diego DISC is committed to advancing dissemination and implementation science to promote health equity and justice through training, research and community engagement activities.

The overarching goal is to build capacity and a dissemination and implementation science community that will maximize the public health impact of research.

UC San Diego DISC already comprises 250 members and investigators, offers a doctoral course and leads a seminar series and monthly journal club.

In addition, the center offers the Autism Research and Practice Continuing Medical Education series, in which the latest research and actionable strategies for translating research to practice are discussed.

The team plans to post a call for pilot grant applications and host an Advanced Mixed Methods Workshop this fall.

At some point in their careers, UC San Diego DISC leaders each found themselves wondering: What good is a health-improving intervention or innovation if it isn't -- or can't be -- used?

For example, when Stadnick was a doctoral student in clinical psychology, she studied ways to collaborate with caregivers to improve outcomes for children with autism.

As she collected evidence for best practices, she started to see just how difficult it might be to get these evidence-based interventions adopted and scaled in diverse community health settings.

Rabin trained as a pharmacist and then as a public health researcher. Like Stadnick, she found that many programs that are effective in high-resource settings will not work for communities that have fewer resources and more complex problems.

This leaves the most in need without viable solutions for various public health problems, deepening existing health disparities, she said.

"That's where dissemination and implementation science comes in -- it's a way of helping researchers identify which new interventions and strategies are most relevant and needed in the community, understand how they can be used in routine care and ensure that evidence-based interventions are accessible to the community," Brookman-Frazee said.

UC San Diego DISC plans to engage experts across the broader UC San Diego campus, collaborating with teams at UC San Diego Rady School of Management, Jacobs School of Engineering, Scripps Institution of Oceanography and other organizations.

"Dissemination and implementation science doesn't fit squarely in one discipline, such as psychology or public health," Aarons said.

"Our transdisciplinary nature is what makes it exciting -- we can take ideas and ways of thinking from many fields, including engineering, public policy, organizational development and economics to make sure our study designs and methods will make the biggest impact."

Community engagement is also important throughout the dissemination and implementation process, the UC San Diego DISC team said.

They plan to meaningfully collaborate with community partners to make sure every study or intervention includes the voices of the stakeholders at all relevant levels, including health system leaders, clinicians, patients, community members, families and caregivers.

"For any implementation to be successful, we need engagement from 'the decision makers, funders, doers and users,'" Rabin said.

We hear from our health care partners that even if we provide them with the most state-of-the-art programs, they won't be successful if we don't take into account the needs, resources, priorities and preferences of their clinic and health system as well as the specific characteristics and realities of the patients they serve."

Borsika Rabin, PhD, MPH, PharmD, Assistant Professor, Department of Family Medicine and Public Health, University of California - San Deigo

"In traditional clinical trials, we try to control for and exclude factors that could influence the outcomes of your primary hypothesis."

"But in dissemination and implementation science, we're trying to account for and measure all of these factors, not get rid of them."

"This allows us to have a more contextual and complex understanding of what works, for whom, under what circumstances. This is at the heart of dissemination and implementation science and practice."