摘要：A comprehensive guide that identifies critical evaluation and reporting elements necessary to move research into practice is needed. We propose a framework that highlights the domains required to enhance the value of dissemination and implementation research for end users. We emphasize the importance of transparent reporting on the planning phase of research in addition to delivery, evaluation, and long-term outcomes. We highlight key topics for which well-established reporting and assessment tools are underused (e.g., cost of intervention, implementation strategy, adoption) and where such tools are inadequate or lacking (e.g., context, sustainability, evolution) within the context of existing reporting guidelines. Consistent evaluation of and reporting on these issues with standardized approaches would enhance the value of research for practitioners and decision-makers. A major challenge for practitioners and policymakers is that most evidence-based interventions are not ready for widespread dissemination. 1 Not only does most research on evidence-based interventions not translate into practice or policy; but also, if it does, it usually takes an extraordinarily long time. 2,3 This matters for public health practice and policy because the knowledge generated from taxpayer expenditures on research are not reaching the public, and especially not those most in need. 4 This reflects poor return on investment, suboptimal health outcomes, and significant opportunity costs. Thus, there has been greatly increased attention to dissemination and implementation (D&I) research in the past few years both in the United States and internationally. 5,6 For present purposes, we adopted the definitions in the National Institutes of Health (NIH) program announcement on D&I research. 7 Dissemination is defined as the targeted distribution of information and intervention materials to a specific public health or clinical practice audience. The intent is to spread knowledge and the associated evidence-based interventions. Implementation is the use of strategies to adopt and integrate evidence-based health interventions and change practice patterns within specific settings. 7 There are many reasons for this slow and incomplete translation, 1 including research methods and reporting standards that do not seem relevant to the situations and decisions faced by practitioners and policymakers. 8–10 To address these issues, the NIH and the Veterans Administration held a series of invited state-of-the-science meetings in late 2013 and early 2014 to address key gaps and opportunities in D&I research. Three separate assembled working groups focused on 1 of the following 3 issues: (1) training, (2) study design, and (3) reporting and measurement. The goals of the working group focused on reporting and measurement were to identify key areas in need of better measurement and reporting at all stages of research for dissemination and implementation. We describe a framework developed by this working group. The working group included 23 D&I researchers, practitioners, and decision-makers from the United States and Canada. At the meeting, there was considerable discussion around guidelines for research reporting and their impact, and whether the D&I field was ready for Consolidated Standards of Reporting Trials (CONSORT)–like reporting guidelines. The consensus was that, given the plethora of existing guidelines and reporting criteria, 11 it was premature to propose a specific set of guidelines until more was known about whether there are D&I-related gaps in existing guidelines. Participants decided that, to advance the field and state of knowledge, a reasonable and important first step was to construct a framework that could serve as a guide to researchers to enhance D&I evaluation and reporting relevant to stakeholders. Such a framework is not intended as a formal theory or another model of D&I research; currently, more than 60 such models exist, with many overlapping constructs. 12 Rather, the purposes of the proposed framework are to (1) focus attention on needs and opportunities to increase the value and usefulness of research for end users, and (2) identify key needs for evaluation, before issuing formal reporting guidelines for D&I research. Whereas previously published reviews of D&I models have developed strategies to select or use models for research or practice, 12–15 here we provide a comprehensive framework to guide researchers across the different phases of research. The purposes of this article are threefold: (1) to present and discuss implications of the framework, organized by different steps in the research process; (2) to highlight areas that are underreported, but would substantially enhance the value of research for end users with the end goal of improving population health; and (3) to compare concepts in existing reporting guidelines to our framework. The target audience for this article includes D&I and comparative effectiveness researchers 16 and those who are users of D&I evidence, who might consider asking the questions identified here when reviewing research reports or considering adoption of programs and policies. In addition, researchers at earlier stages of the translation cycle (efficacy researchers) could likely benefit from attention to these issues if their goal is to have the products of their research advance to policy or practice. We realize that efficacy research is quite different and are not implying that these issues need to be addressed at that stage. We do think, however, that it is never too early to begin considerations of translation and “designing for dissemination.” 17,18 If the products of efficacy or effectiveness research are substantially misaligned with conditions, resources, and policies that have an impact on real world public health and health care delivery contexts, it is very unlikely that such interventions or guidelines will ever be adopted, or if adopted, will be implemented with quality or will be sustained. 19 Therefore, the issues in this article should be relevant to both D&I and comparative effectiveness researchers and those seeking to develop, or select and make decisions about real-world use of interventions, programs, and guidelines.
