Written by Kim Furlow, communications manager at the Institute for Public Health and Beth Prusacyk, PhD, MSW, Institute faculty scholar & instructor of medicine in the Division of General Medical Sciences
“It’s the wonkiest science of science,” says Beth Prusaczyk, PhD, Institute of Public Health Faculty Scholar and Dissemination and Implementation Science practitioner. She gets excited when asked to define the intricate and misunderstood science. “It’s all about getting into the weeds on a process. It’s about taking what we know works and getting people to use it.” That’s the answer to the often-asked question, “What the heck IS Dissemination & Implementation (D&I) Science, anyway?”
To illustrate, she gives a great example: Someone did a “whole bunch of research” to show that if hospital providers washed their hands more, the number of infections patients acquired in the hospital would go down. It’s a simple concept. “YET,” Dr. Prusaczyk says, “We still have low rates of hand-washing in hospitals.” This is where D&I researchers come in. They see a gap between the research evidence (hand washing = lower infection rates) and practice (providers actually washing their hands) and they come up with strategies to get that evidence put into practice. “D&I is really about any research finding getting used in the real world,” she says.
Dr. Prusaczyk doesn’t actually focus on hand-washing in hospitals, though. She just thinks it is a clear example of what D&I researchers study and helps people understand the importance of D&I science. Her work focuses instead on the more complicated area of healthcare for older adults, specifically how to implement care for vulnerable older adults like those with dementia. One type of care she looks at is “transitional care”, which is the care provided to patients when they are transitioning to and from different points of care. One common transition is when a patient is discharging from the hospital.
This transition involves the hospital providers who are working with the patient while he is in the hospital but it also involves providers who will work with the patient after he has left the hospital, like home health care or nursing home providers, social service providers such as Meals on Wheels, and even financial or legal service providers. Dr. Prusaczyk notes there are “decades” of research on how to improve this transition for older adults but it rarely gets put into practice.
There are many reasons for this, she says. Sometimes the issue is at the provider-level. She knows providers are already busy and have very little time to take on additional tasks. But it can also be at the organizational- or system-levels, where there are larger factors that make it difficult for providers to perform these tasks, even if they really want to.
THIS is D&I Science! Finding ways to bring studies, research and answers into action. Dr. Prusaczyk puts it this way, “We know it isn’t just a matter of people not knowing what to do. There are real barriers to doing these things, to changing real-world practice. And we study how we can remove those barriers. How can we make it easier and faster to change practice and, importantly, make sure that change is sustained over time?”
Dr. Prusaczyk’s goal is to take messy challenges like transitional care for older adults and use D&I science to help solve them. “We know what we need to do to but how do we actually MOVE the needle to make a difference in people’s lives?” she says. She is working to move that needle using D&I science, systems science, and data science. “WashU is a leader in D&I and a leader in Alzheimer’s research, so there’s no reason we can’t be a leader at the intersection of both. I want to help make us a leader in that space.”
She is also focused on making sure her own work doesn’t fail to get implemented like the transitional care research she works to implement. To do that, she is also active in engaging policymakers, the press, and the public in academic research.
“We are trained as researchers to talk to other researchers and grant reviewers,” she says. “We aren’t trained to talk to policymakers or reporters or even the general public. If we want to show the impact of our work, publications in journals is probably not the best way to do that.”
Today, Dr. Prusaczyk teaches other researchers this new way of communicating and encourages them to become advocates for their work and their causes. “We’re not just researchers. We’re trying to improve care,” she says. “If we can show people that, and the subsequent benefits to them, then we can further improve people’s lives. Amplifying our work helps everyone.”
If anyone can help do that, she can.