Welcome to PCORI

Welcome to PCORIPlease be seated by 8:50 AM.The webinar will go live at 9 AM.

#PCORI

Welcome

Hello and welcome to PCORI’s roundtable

The goal for today is to obtain input to help PCORI develop a project for development of the PCORI Action Plan for Dissemination and Implementation

Thank you for joining us

2PCORI's Blueprint for a Dissemination and Implementation Action Plan

#PCORI

Information for Roundtable Participants

We have numerous webinar participants who are joining us online and telephone, so please state your name and title before speakingRestrooms are located outside near the elevators. You will need to stop by the front desk for a key fob to use the restroom and to get back into PCORIPlease use your name tents to let the moderator know that you are interested in speaking by standing them up when you would like to speak


Dissemination and Implementation Roundtable

July 29, 2013

#PCORI

Moderator

Ayodola Anise, MHSSenior Program AssociateAddressing Disparities

Ayodola Anise, MHS, supports the Health Disparities research priority area and the Methodology Committee. She joins PCORI from the Engelberg Center for Health Care Reform at Brookings, where she managed activities related to the Quality and Equity/Disparities Initiatives. Her work there focused on informing regional, state, and national practices on performance measurement, specifically addressing data collection, data integration/aggregation, patient-centered measurement, and vulnerable populations.

PCORI's Blueprint for a Dissemination and Implementation Action Plan 5

#PCORI

Information for Webinar Participants

Webinar participants may answer the discussion questions online at: http://pcori.org/events/dissemination-and-implementation-roundtable/Email: [email protected]: #pcoriThe webinar “chat” featurePublic Comment Period is 4:15 – 4:45 PM (ET)The prompts for public comment will be made available through July 31, 2013 at 5 PM (ET)


#PCORI

7

OverviewEstablishing PCORI’s Blueprint for a Dissemination and Implementation Action Plan

1

2

3

4

5

6

Welcome and Introductions

Overview of Dissemination and Implementation

Overview of AHRQ’s Dissemination and Implementation Efforts

Roundtable Discussion - Part 1: Questions 1, 2, and 3


Public Comment Period

7 Next Steps and Adjourn

Break

Break

PCORI's Blueprint for a Dissemination and Implementation Action Plan

#PCORI

Welcome: 9:00 am – 9:30 am

Anne C. Beal, MD, MPHDeputy Executive DirectorChief Officer for Engagement

A pediatrician and public health specialist, Anne C. Beal, MD, MPH, has devoted her career to providing access to high-quality health care. As PCORI’s first Chief Officer for Engagement, she will work to ensure the voices of patients and other stakeholders are reflected in our growing research portfolio. In her previous role as Chief Operating Officer, she worked to ensure PCORI develops the structure and capacity needed to carry out its mission as the nation’s largest research institute focused on patient-centered outcomes research. She joined PCORI from the Aetna Foundation, the independent charitable and philanthropic arm of Aetna Inc. She holds a BA from Brown University, an MD from Cornell University Medical College, and an MPH from Columbia University.


#PCORI

About Us

An independent non-profit research organization authorized by Congress as part of the 2010 Patient Protection and Affordable Care Act (PPACA)

Committed to continuously seeking input from patients and a broad range of stakeholders to guide our work


#PCORI

Our Mission and Vision

MissionThe Patient-Centered Outcomes Research Institute (PCORI) helps people make informed health care decisions, and improves health care delivery and outcomes, by producingand promoting high integrity, evidence-based information that comes from research guided by patients, caregivers and the broader health care community.

VisionPatients and the public have the information they need to make decisions that reflect their desired health outcomes.


#PCORI

Our Core Duties

Establish national research priorities

Establish and carry out a research agenda

Develop and update methodological standards

Disseminate research findings


#PCORI


Our Board of Governors Representsthe Entire Healthcare Community

PCORI Board of Governors, March 2012 in Baltimore, MD

This is really low resolution. Do we have better quality?

#PCORI

13

PCORI’s Vision for Dissemination and Implementation


#PCORI

The Case for Addressing the Implementation Gap

Research + Practice

Optimal Healthcare Delivery

PCORI’s Blueprint for Dissemination and Implementation Targets the Gap

Current Knowledge and Practice

New Investments in Knowledge

Implementation Gap to Improve Practice


#PCORIClinicians frequently use general Internet searches and colleagues to obtain information to diagnose and treat patients How often do you use the following sources to obtain information to diagnose, treat and care for patients?

15

40%

38%

34%

20%

18%

4%

31%

28%

28%

40%

35%

13%

0% 20% 40% 60% 80% 100%

General internet search engines

Online subscription services

Colleagues

Online free services

Peer reviewed literature

Cochrane Database or other systematicreviews

Daily A few times per week


#PCORI

6%

27%

34%

32%

2%

11%

26%

60%

0% 20% 40% 60% 80% 100%

Other source

Family or friends

Doctor or healthcare provider

Internet

Chronic Disease Patients Rare Disease Patients

Patients use the Internet as first source of health information The most recent time you looked for information about health or medical topics, where did you go first?

*p <0.0516PCORI's Blueprint for a Dissemination and Implementation Action Plan

#PCORI

Patients use a variety of Internet sourcesIn the past 12 months, which of the following internet sources have you used to get information about health or medical topics?

17

42%

54%

47%

45%

37%

36%

34%

37%

0% 20% 40% 60% 80% 100%

Website for disease focusedgroup

Website for government healthagency

Website for health plan

Patient online community


*p <0.05

*

*

*


#PCORIPatients’ trust in Internet is low compared to other sourcesHow much do you trust information about health or medical topics from each of the following?

18

23%

21%

20%

23%

24%

41%

69%

12%

13%

13%

15%

20%

40%

76%

0% 20% 40% 60% 80% 100%

Online patient communities

Family or friends

Internet

Your health plan

Government health agencies

Disease focused groups

Doctor

% “A lot” of trust


*p <0.05

*

*

**


#PCORIEstablishing a PCORI Blueprint for the Dissemination and Implementation Action Plan

PCORI’s Blueprint for Dissemination and Implementation is being established: To guide the organization in disseminating the research findings

of funded research conducted in the national program areas To speed implementation by actively facilitating how PCORI’s

research findings can be used by healthcare decision makers To evaluate how the effect of the dissemination of such findings

reduces practice variation and disparities in health care


DISSEMINATION IMPLEMENTATION+

#PCORI

Potential Mechanisms for Dissemination and Implementation

20

DISSEMINATION IMPLEMENTATION+Engage major patient organizationsEstablish partnerships with specialty organizations; Build working relationships with health plans;Develop partnerships with health systems; Connect with the National Patient-Centered Clinical Research Network; Publish findings in key journals; andExplore use of web services, social media, apps, etc.


#PCORI

AHRQ and PCORI’s Role in Dissemination and Implementation

21

Authorizing Legislation

AHRQ shall disseminate the research findings that are published by PCORI Sec. 937(a)(1)Create informational tools that organize and disseminate research findings for physicians, health care providers, patients, payers, and policy makers Sec. 937(a)(1)Develop a publicly available resource database that collects and contains government-funded evidence and research Sec. 937(a)(1)

The purpose of the Institute is to assist patients, clinicians, purchasers, and policy-makers in making informed health decisions by advancing the quality and relevance of evidence…and the dissemination of research findingswith respect to the relative health outcomes, clinical effectiveness, and appropriateness of the medical treatments, services, and items described in subsection (a)(2)(B).

Success for PCORI and AHRQ = Impact on practice and patient outcomes


Agency for Healthcare Research

and Quality(AHRQ)

Patient-CenteredOutcomes ResearchInstitute(PCORI)

#PCORI

PCORTF Distribution


Agency for Healthcare Research

and Quality

Patient-CenteredOutcomes Research

InstituteOffice of Secretary, Health and Human

Services

4%

Patient Centered Outcomes

Research Trust Fund

(PCORTF)

Patient Centered Outcomes

Research Trust Fund

(PCORTF)

16%80%

#PCORI3 Goals: PCORI’s Blueprint for a Dissemination and Implementation Action Plan


1. Gather opinions from experts on what PCORI’s blueprint should encompass

2. Identify gaps where there is a need to develop new knowledge on best practices for dissemination & implementation

3. Grow consensus behind an approach to our work in dissemination and implementation

#PCORI

Items PCORI Will Explore at a Later Date

Peer-reviewPublic commentAspects of scholarly publishingThe requirement that we make our research results available to clinicians, patients and the general public within 90 days “after the conduct or receipt of research findings”


#PCORI

Developing the PCORI Dissemination and Implementation Action Plan

25

Process for Developing PCORI’s Blueprint for Dissemination and Implementation Action Plan

Incorporate learning from workshop and develop PCORI Action Plan for Dissemination and Implementation

Host D & I Roundtable

Convene experts at D & I Roundtable to receive input which

will inform RFP

Conduct Phone Calls

Collect preliminary information from roundtable participants

Release RFP or RFPs

Award RFP or RFPsHost D & I WorkshopFINAL: PCORI D & I Action Plan

JULY 2013

Using input from the roundtable, develop and release an RFP or a series of RFPs

Award RFP or RFPs to finalists for development of background

materials

Convene D & I Workshop to hear results of project(s)

RFP

AUGUST 2013

OCTOBER 2013FEBRUARY 2014FEBRUARY 2014


#PCORI

Conflict of Interest

Roundtable participants will not be barred from participating in funding opportunities or service agreements. The roundtable is open to the public for others to listen in on the deliberations via call-in teleconference.


#PCORI

27

Question and Answer


#PCORI

Moderator

Ayodola Anise, MHSSenior Program AssociateAddressing Disparities

Ayodola Anise, MHS, supports the Health Disparities research priority area and the Methodology Committee. She joins PCORI from the Engelberg Center for Health Care Reform at Brookings, where she managed activities related to the Quality and Equity/Disparities Initiatives. Her work there focused on informing regional, state, and national practices on performance measurement, specifically addressing data collection, data integration/aggregation, patient-centered measurement, and vulnerable populations.


#PCORI

Participants

Gail HuntNational Alliance for Caregiving

Gail Hunt is President and CEO of the National Alliance for Caregiving, located in Bethesda. The Alliance is a diverse coalition of national organizations that seeks to advocate for and serve as a research and training resource for family caregivers of patients/consumers across the lifespan. She was a member of the Policy Committee of the 2005 White House Conference on Aging. She has been active in many national and international conferences on family caregiving and also helped to develop an international coalition of caregiving groups. She received her BA from Columbia University.


#PCORI

Participants

Sharon Levine, MDThe Permanente Medical Group of Northern California

Sharon Levine, MD, has been Associate Executive Medical Director for The Permanente Medical Group of Northern California since 1991. She is responsible for the recruitment, compensation, clinical education, management training, and leadership development for the group’s physicians; government and community relations; health policy and external affairs; and pharmacy policy and drug use management. A board-certified pediatrician, she has practiced with The Permanente Medical Group since 1977. A native of Boston, she received her undergraduate degree from Radcliffe College at Harvard University and her medical degree from Tufts University School of Medicine.


#PCORI

We Want to Hear From You





Today’s webinar participants can provide input via:Email: [email protected]: #pcoriThe webinar “chat” featureAnswer the discussion questions online: http://pcori.org/events/dissemination-and-implementation-roundtable

#PCORI

Participants

Craig Acomb, MSInstitute for Clinical Systems Improvement/Health Partners

Craig Acomb, MS, serves as Chief Operating Officer and Chief Science Officer for the Institute for Clinical Systems Improvement (ICSI). Previously, he was the Assistant Commissioner and COO for the Minnesota Department of Health (MDH), where he oversaw the operations and administration of a broad portfolio of public health programs and the agency’s 1,500 employees. His duties included organizational leadership, business direction and financial oversight, policy development, strategic and operational planning, workforce development, corporate communications, and government relations. From 2007 to 2009, he served as MDH’s Chief Financial Officer.


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Participants

Hilda BastianNational Center for Biotechnology Information

Hilda Bastian works at the National Center for Biotechnology Information (NCBI) at the National Institutes of Health in Bethesda. She is responsible for improving accessibility and usability of National Library of Medicine (NLM) resources based on systematic reviews, particularly the development of PubMed Health, a new NLM website. Before moving to the United States, she was the head of the Health Information Department at the German Institute for Quality and Efficiency in Health Care in Cologne, producing a bilingual evidence-based website for patients and consumers. Prior to that, she had been a health consumer advocate in Australia and internationally for over 20 years. She was the chairperson for several years of the Consumers Health Forum of Australia.


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Participants

Kathleen Blake, MD, MPHAmerican Medical Association

Kathleen Blake, MD, MPH, is Vice President of the Physician Consortium for Performance Improvement® (PCPI®) convened by the American Medical Association. She ensures the successful execution of all components of the PCPI strategic direction, the integrity of its measure portfolio, and the expeditious development of the recently established PCPI Foundation. She is a clinical cardiac electrophysiologist who earned her medical degree from the University of Chicago, followed by internship, residency, and fellowship training in internal medicine and cardiovascular diseases at Stanford University. In 2011, she earned an MPH from Johns Hopkins Bloomberg School of Public Health.


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Participants

Barbara Edson, RN, MBA, MHAAmerican Hospital Association

Barbara Edson, RN, MBA, MHA is Vice President of Clinical Quality at HRET and assisted with leadership for the AHRQ-funded On the CUSP: Stop BSI national project, including developing and leading national neonatal project to prevent CLABSI. Currently, she is the Project Director for the AHRQ-funded On the CUSP: Stop CAUTI national project, TeamSTEPPS National Training Center Contract, the TeamSTEPPS Medical Office Contract and the AHA/NPSF Comprehensive Patient Safety Leadership Fellowship. She is a Master TeamSTEPPS trainer and has been a state Baldrigeexaminer. She has a BSN from Marquette University, an MBA/MHA from Pfeiffer University, and has completed Patient Safety Officer training at IHI and obtained Just Culture Certification from Outcome Engenuity.


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Participants

Kevin Fahey, MSAmerica’s Health Insurance Plans

Kevin Fahey is Executive Director in the Clinical Affairs Department of America’s Health Insurance Plans (AHIP). With AHIP, he has played a leadership role in several projects involving research data networks, including the Vaccine Safety Datalink, the Post-Licensure Rapid Immunization Safety Monitoring project for the H1N1 vaccine, and a number of other public health and safety initiatives. He also serves as the AHIP lead for the FDA Mini-Sentinel and was involved in the development of the initiative. He has worked in health and public policy research for over 25 years and holds a master’s degree in science and technology policy from George Washington University and a bachelor’s degree in government and sociology from Colby College.


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Participants

Tejal Gandhi, MD, MPHNational Patient Safety Foundation

Tejal Gandhi, MD, MPH, is President of the National Patient Safety Foundation. In this role, she is advocating patient safety at the national level, driving educational and certification efforts, and helping create and spread innovative new safety ideas. She was formerly the Executive Director of Quality and Safety at Brigham and Women’s Hospital, and Chief Quality and Safety Officer at Partners Healthcare. In these roles, she has led the efforts to standardize and implement patient safety best practices across hospital and health systems. She won the 2009 John M. Eisenberg award. She is a board-certified internist and Associate Professor of Medicine at Harvard Medical School. She received her MD and MPH from Harvard Medical School and the Harvard School of Public Health.


#PCORI

Participants

Don Goldmann, MDInstitute for Healthcare Improvement

Don Goldmann, MD, is the Chief Medical and Scientific Officer for the Institute for Healthcare Improvement (IHI). He works both internally and externally to deepen IHI’s profile, credibility, and influence in health care and health promotion. He also serves as senior lead for the IHI Fellowship Program, and he continues to train and mentor emerging investigators at Harvard Medical School, Boston Children’s Hospital, and the Harvard School of Public Health. He is also Clinical Professor of Pediatrics at Harvard Medical School, as well as Professor of Immunology and Infectious Diseases and Epidemiology at the Harvard School of Public Health.


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Participants

Jennifer Graff, PharmDNational Pharmaceutical Council

Jennifer Graff, PharmD, is the National Pharmaceutical Council’s (NPC) director of comparative effectiveness research. Dr. Graff works to advance NPC's comparative effectiveness research (CER) and evidence-based medicine policy research initiatives assessing the methods, interpretation and application of CER. Prior to MedImmune, she held several positions at the Pfizer Pharmaceuticals Group, most recently as the associate director for worldwide outcomes research. Jennifer holds a Doctorate of Pharmacy from the University of Nebraska Medical Center, and completed a Health Outcomes and Pharmacoeconomicsfellowship at the University of Michigan.


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Participants

Matthew HollandWebMD

Matthew Holland leads WebMD and Medscape’s focused efforts in online education and media serving the US government and the world’s leading pharmaceutical and medical device companies. He oversees the creation of marketing and support materials and directs WebMD and Medscape’s government relations activities with US federal agencies, the administration, and members of Congress.


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Participants

Bob Jesse, MD, PhDUS Department of Veterans Affairs

Bob Jesse, MD, PhD, was appointed Principal Deputy Under Secretary for Health in the Department of Veterans Affairs (VA) on July 4, 2010. In this position, he leads clinical policies and programs for the Veterans Health Administration (VHA). He received his bachelor of science degree in biochemistry from the University of New Hampshire. Later he earned his PhD in biophysics at the Medical College of Virginia, followed by his MD.


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Participants

Norm Kahn, MDCouncil of Medical Specialty Societies

Norm Kahn, MD, serves as Executive Vice President and Chief Executive Officer of the Council of Medical Specialty Societies (CMSS). He represents CMSS to the Physicians Consortium for Performance Improvement (PCPI), the National Quality Forum (NQF), the National Priorities Partnership (NPP), the Ambulatory Quality Alliance (AQA), and the National Committee for Quality Assurance (NCQA). He earned his medical degree from Kansas University Medical Center in Kansas City and a bachelor of arts in English literature from the University of Pennsylvania.


#PCORI

Participants

Christine Laine, MD, MPH, FACP American College of Physicians International Committee of Medical Journal Editors

Christine Laine, MD, MPH, FACP, is Editor-in-Chief of Annals of Internal Medicine and Senior Vice President of the American College of Physicians. She is board-certified in internal medicine and sees patients and teaches at Jefferson Medical College in Philadelphia. She received her medical degree from SUNY Stony Brook and completed residency at The New York Hospital (Cornell University) and fellowship in general internal medicine and clinical epidemiology at Beth Israel Hospital (Harvard University). Her master of public health degree is from Harvard University. She holds leadership positions in the International Committee of Medical Journal Editors, the Council of Science Editors, and the ethics committee of the World Association of Medical Editors.


#PCORI

Participants

Sarah Lock, JDAARP

Sarah Lock, JD is AARP’s Senior Vice President for Policy. She helps develop AARP’s public policy positions addressing the major issues facing older Americans. Sarah is a member of the American Society on Aging and the National Academy of Social Insurance. She also formerly served as a Commissioner for the American Bar Association’s Commission on Law and Aging. She graduated from the University of Maryland School of Law.


#PCORI

Participants

Renee Mentnech, MS, BSNCenters for Medicare and Medicaid Services

Renee Mentnech, MS, BSN, has been with the Centers for Medicare & Medicaid Services (CMS) since 1988 and has served the agency in a variety of positions, including as a Social Science Research Analyst, Special Assistant to the Office Director, and as a manager for the last 14 years. She is a nurse by training and has a graduate degree in health policy from the University of Maryland. Currently, she is the Director of the Research and Rapid Cycle Evaluations Group, Center for Medicare and Medicaid Innovation. She provides leadership and executive direction within CMS for a range of healthcare financing research activities.


No PhotoAvailable

#PCORI

Participants

Brian Mittman, PhDUS Department of Veteran Affairs

Brian Mittman, PhD, is Senior Advisor to the VA Center for Implementation Practice and Research Support and a senior research scientist at the Kaiser Permanente Southern California Department of Research and Evaluation. He is a member of the PCORI Methodology Committee and the Association of American Medical Colleges Advisory Panel on Research. He received a PhD in organizational behavior from the Stanford University Graduate School of Business.


#PCORI

Participants

Doris Peter, PhDConsumer Reports

Doris Peter, PhD, is the Associate Director of the Consumer Reports Health Ratings Center, where she leads multidisciplinary teams that develop ratings and consumer-friendly translations and presentations of data to help consumers understand comparisons of the quality of healthcare products (e.g., drugs) and services (e.g., hospitals, insurance plans). She is the principal investigator of a grant from the Consumer and Prescriber Education Grant Project (Consumer Reports Health Best Buy Drugs) that involves translating and disseminating comparative effectiveness research into actionable advice for consumers. Prior to joining Consumer Reports, she was an editor and publisher at The Medical Letter and then North American editor for an international evidence-based medicine journal.


#PCORI

Participants

Michelle Proser, MPPNational Association of Community Health Centers

Michelle Proser, MPP, PhD Candidate, is the Director of Research at the National Association of Community Health Centers, where she has 10 years of experience collecting data, conducting research and analysis, and applying information to empower communities in their efforts to improve population health. She has authored and co-authored numerous publications on health centers, disparities, primary care, community health, and medical underservice. Her work also includes building health center capacity for community-directed translational research. She has presented at AcademyHealth, the National Conference of State Legislatures, the American Public Health Association, the National Institutes of Health, and other meetings.


#PCORI

Participants

Pamela Rich, MPHNational Business Group on Health

Pamela Rich, MPH, joined the National Business Group on Health in 2007. She is a program analyst in the Institute on Health Care Costs and Solutions. In her role, she manages the National Committee on Evidence-Based Benefit Design and translates research into employer-based strategies. She also works on projects related to employee communications and engagement and maternal and child health. Prior to her current role, she managed the Business Group’s Pharmaceutical Council and completed work on specialty pharmaceuticals and medication adherence. Additionally, she has worked on projects on cancer care, racial and ethnic health disparities, tobacco cessation, and behavioral health. She received a bachelor of arts degree in international affairs and a master of public health degree from The George Washington University.


#PCORI

Participants

Kate Ryan, MPAConsumers United for Evidence-based Healthcare National Women’s Health Network

Kate Ryan, MPA, is Senior Program Coordinator at the National Women’s Health Network. In this role, she develops and implements a program of legislative and regulatory advocacy to reduce women’s exposure to unnecessary drug and medical treatment risks. As a member of the steering committee of Consumers United for Evidence-based Healthcare, she works to improve the quality of women’s health care through the use of evidence-based medicine. Previously, she worked in the Capitol Hill office of US Representative Joe Sestak on healthcare reform and women’s issues. She received her MPA from the NYU Wagner Graduate School of Public Service.


#PCORI

Participants

Bruce SeemanAgency for Healthcare Research & Quality


#PCORI

Participants

Joe Selby, MD, MPHPatient-Centered Outcomes Research Institute

A family physician, clinical epidemiologist, and health services researcher, Joe Selby has more than 35 years of experience in patient care, research, and administration. He is responsible for identifying strategic issues and opportunities for PCORI and implementing and administering programs authorized by the PCORI Board of Governors. He joined PCORI from Kaiser Permanente, Northern California, where he was Director of the Division of Research for 13 years and oversaw a department of more than 50 investigators and 500 research staff members working on more than 250 ongoing studies. He was with Kaiser Permanente for 27 years. An accomplished researcher, Joe has authored more than 200 peer-reviewed articles and continues to conduct research, primarily in the areas of diabetes outcomes and quality improvement.


#PCORI

Participants

Lisa Simpson, MB, BCh, MPH, FAAPAcademyHealth

Lisa Simpson, MB, BCh, MPH, FAAP, is President and Chief Executive Officer of AcademyHealth. A nationally recognized health policy researcher and pediatrician, she is a passionate advocate for the translation of research into policy and practice. Since joining AcademyHealth in 2011, she has worked to raise the visibility of the field of health services research and its contributions to improving the quality, value, and accessibility of care; reducing disparities; and improving health.


#PCORI

Participants

Jamie Skipper, PhD, RNUS Department of Health and Human ServicesOffice of the National Coordinator for Health Information Technology (ONC)

Jamie Skipper, PhD, RN, is currently Lead Analyst working on priority-setting activities for ONC and HHS regarding patient-centered outcomes research. She has also served as the coordinator for the Standards & Interoperability Framework within ONC at HHS. Prior to ONC, she was a policy consultant to EHR vendors, after serving on Capitol Hill as a healthcare advisor to Congressman Phil Gingrey (focusing on health IT policy) and after serving as a Grants Program Officer at NHLBI. She was also a Policy Fellow at the IOM’s Evidence-Based Medicine Roundtable. She has a PhD in cardiac physiology and is a registered nurse.


No PhotoAvailable

#PCORI

Participants

Jean Slutsky, PA, MSPHAgency for Healthcare Research & Quality

Jean Slutsky, PA, MSPH, has directed the Center for Outcomes and Evidence, Agency for Healthcare Research and Quality (AHRQ) of the US Department of Health and Human Services, since June 2003. She is also a member of the AcademyHealth Methods Council and a member of the Methodology Committee of PCORI. She received her bachelor of science degree at the University of Iowa, a master’s of science in public health from the University of North Carolina at Chapel Hill, and trained as a physician assistant at the University of Southern California.


#PCORI

Participants

Roger Snow, MD, MPHMedicaid Medical Directors Learning Network

Roger Snow, MD, MPH, is the Deputy Medical Director for Medical Policy in the Office of Clinical Affairs of the Office of Medicaid in the Executive Office of Health and Human Services, Commonwealth of Massachusetts. Prior to his service in Medicaid, he practiced medicine at Massachusetts General Hospital for 20 years. He has recently served on the New England Comparative Effectiveness Public Advisory Council (CEPAC) and is presently a member of the CEPAC Advisory Board. He attended medical school at the University of North Carolina, Chapel Hill, and trained in medicine and pathology in Boston. He holds a degree in public health from Harvard.


#PCORI

Participants

Darius Tandon, PhDJohns Hopkins University

Darius Tandon, PhD, is Associate Professor in the Division of General Pediatrics and Adolescent Medicine at Johns Hopkins University School of Medicine. Trained as a community psychologist, he has a long-standing interest in the science and practice of incorporating community and patient perspectives into the research process and clinical care. He is Director of the Community Engagement Core of the Clinical and Translational Science Award at Johns Hopkins, where he has been the architect of several activities and programs to promote the practice of community-university partnerships throughout the research trajectory. He also serves as the Editor-in-Chief of Progress in Community Health Partnerships, the only peer-reviewed academic journal solely focused on community-based participatory research.


#PCORI

Participants

Daniel Wolfson, MHSAABIM Foundation

Daniel Wolfson, MHSA, is Executive Vice President and COO of the ABIM Foundation. Previously, he served for nearly two decades as the founding president and CEO of the Alliance of Community Health Plans (formerly The HMO Group), the nation’s leading association of not-for-profit and provider-sponsored health plans. During his tenure, he earned national recognition for spearheading the development of the Health Plan Employer Data and Information Set (HEDIS™), convening the RxHealthValue coalition to provide independent information on the pharmaceutical industry, and co-sponsoring with the American College of Physicians the journal Effective Clinical Practice. He received his master's degree in health sciences administration from the University of Michigan, School of Public Health.


#PCORI







#PCORI

Overview ofDissemination and Implementation

10:15 am – 11:15 am60 minutes


Dissemination and Implementation in Health: Policy, Practice, Research

Brian S. Mittman, PhDJuly 29, 2013

The implementation imperative

PCORI aims to improve healthcare and public health quality and outcomes via researchImprovement (PCORI’s impact, benefits) requires appropriate use (adoption, implementation) of PCORI findingsResearch findings are not self-implementing; explicit efforts to facilitate implementation are neededImplementation is challenging


Our plan

Overall plan: design a blueprint to guide PCORI’s D&I infrastructure and activities (individually, with AHRQ, and with -- or via -- other stakeholders)Process to develop this plan: collaborate with key stakeholders (roundtable, workshop) and contractors to1. Identify and understand barriers to implementation and

available strategies to address them2. Determine required D&I infrastructure, activity3. Inventory existing infrastructure and activity – and gaps4. Design PCORI activities to fill key gaps


Developing PCORI’s D&I Blueprint



AHRQ



AHRQ

OtherFederal



AHRQ

OtherFederal

PrivateSector



AHRQ

OtherFederal

PrivateSector

PCORI



AHRQ

OtherFederal

PrivateSector

PCORI

PCORIfacilitated


Our plan

Overall plan: design a blueprint to guide PCORI’s D&I infrastructure and activities (individually, with AHRQ, and with -- or via -- other stakeholders)Process to develop this plan: collaborate with key stakeholders (roundtable, workshop) and contractors to1. Identify and understand barriers to implementation and

available strategies to address them2. Determine required D&I infrastructure, activity3. Inventory existing infrastructure and activity – and gaps4. Design PCORI activities to fill key gaps


Key terms in D&I in health (per Lomas)

Diffusion: unplanned, uncontrolled, passive flow (spread) of information; “let it happen”

Dissemination: intentional, active communication and distribution of information to increase awareness, often targeting and tailoring the communication to specific audiences; “help it happen”

Implementation: intentional, active communication of information and additional actions to overcome barriers to achieve use of the information; “make it happen”

Source: Lomas J. Diffusion, dissemination, and implementation: who should do what? Ann NY Acad Sci. 993;703:226-35.


The Tower of Babel problem in D&I

Knowledge translation knowledge translation and exchange knowledge-to-action knowledge transfer translating research into practice (policy and practice)

Research utilization, knowledge utilization

Technology transfer

Knowing-doing gap

T1 - T2; T1 - T2 - T3; T1 - T2 - T3 - T4 - T5


Identify and understand barriers to implementation and available strategies to address them

Barriers: numerous, diverse, variable (across time and place)

Strategies: numerous, diverse, highly variable (across time and place) in operation and impacts, often uncontrollable

“It depends”


Identify and understand barriers to implementation and available strategies to address them


The implementation quandary, conventional wisdom

Dissemination and implementation are critical to achieve research impact and benefitImplementation (practice change) is remarkably difficult; practice inertia is considerable; quality and implementation gaps are incredibly resilientBarriers to practice change – and strategies to overcome them – remain poorly understood; more research is needed to discover the “keys to success” (i.e., effective implementation strategies)


The implementation quandary, conventional wisdom

Dissemination and implementation are critical to achieve research impact and benefitImplementation (practice change) is remarkably difficult; quality and implementation gaps are incredibly resilientBarriers to practice change – and strategies to overcome them – remain poorly understood; more research is needed to discover the “keys to success” (i.e., effective implementation strategies)


The implementation quandary, an alternative view

Dissemination and implementation are critical to achieve research impact and benefit

Implementation (practice change) is remarkably difficult; quality and implementation gaps are incredibly resilientBarriers to practice change are reasonably well understood; strategies to overcome these barriers are numerous and reasonably well-knownWe have the knowledge but lack the will and/or ability to apply this knowledge


I. Factors influencing implementation

II. Implementation strategies and necessary-but-sufficient conditions for practice change

III. Multi-level framework

Frameworks to guide D&I thinking


Framework I: Factors influencing implementation

1. Features of innovations, evidence

2. Features of target adopters

3. Features of the setting, environment

4. Features of innovation champions

5. Features of implementation strategies


Diffusion of innovations theory

Benefits

Relevance

Feasibility

Adoptability

Factor 1: Innovation features (perceived)


Resources and capability for adoption, e.g.,

Staffing, skill, time, space, equipment, funds

Motivation, internal incentives, culture/norms, leadership

Factor 2: Features of target adopters (internal context)


External pressure, expectations, mandates (normative, regulatory)

Incentives, rewards

Resources, support

Professional, community norms

Factor 3: Environment, outer context


Most innovations require a dedicated entity to encourage, guide and support adoption

The innovation champion must possess appropriate resources, capacity and skill, respect and influence, etc.

Factor 4: Innovation champions


Communication to achieve awareness – and desired interpretation and understanding of benefits, requirements

Technical assistance, tools and resources

Address gaps in presence of the critical necessary but not sufficient conditions for implementation success

Factor 5: Implementation strategy


Framework II: Conditions for practice change (necessary but not sufficient)

Valid, relevant, accepted evidence (Factor 1)

Knowledge, skill (Factor 2)

Evidence of quality/implementation gaps (Factor 2)

Requisite logistics, resources (Factor 2)

External expectations, pressure (Factor 3)

Supportive professional norms (Factor 3)

Facilitation, technical assistance (Factor 4)

Implementation gap etiology, planning (Factor 5)


Framework III:Multi-level influences on implementation

Source: Taplin & Rodgers, 2010PCORI's Blueprint for a Dissemination and Implementation Action Plan 86

Framework III:Multi-level influences on implementation


Limitations of typical implementation efforts


Limitations of typical implementation efforts


Implications for D&I blueprint:Factor 1, innovation features (perceived)

Desired features of research findings – research done differently – are important and necessary but not sufficient

All research findings should be disseminated passively; many should be disseminated actively; a few should be implemented proactively; which?

Benefits, impacts of engagement on adoptionremain poorly understood (i.e., practice-based evidence hypothesis; engagement hypothesis)


Implications for D&I blueprint:Factor 2, adopter characteristics

Implementation requires conducive clinician and delivery system knowledge, skill, capacity, culture, leadership, funding, motivation


Implications for D&I blueprint:Factor 3, environmental factors

Productive environmental influences require collaboration (or alignment) with a broad range of stakeholders (regulatory, professional, industry, consumer, community) at all levels (national, regional, state, local)


Implications for D&I blueprint:Factor 4, innovation champions

Champions (purveyors) are institutions and individuals

Researchers are not suitable

PCORI and AHRQ have some desired attributes

Multi-stakeholder partnerships, to include target audience peers and professional associations, are optimal (ref. evidence on guideline credibility)


Implications for D&I blueprint:Factor 5, implementation strategy

Barriers, facilitators, contextual factors, quality gaps –and their root causes – vary Implementation initiatives must be local and localized, based on root cause analyses and barrier-linked theoryImplementation processes, strategies and impacts vary and are largely unpredictable; ongoing evaluation and refinement (vs. 20-20 foresight) are neededImplementation strategies are complex social interventions (i.e., highly adaptable, variable, context-dependent and directed on heterogeneous, unstable targets)


A few concluding thoughts on ..

Implementation challenges, progress and contributions to date from research, policy and practice

Implications for PCORI’s D&I Blueprint

Implications for the Blueprint development process and planned contract work

Implications for PCORI’s D&I research agenda


#PCORI

96

Question and Answer

30 minutes


#PCORI

Group Photo and Lunch Break

11:15 am – 12:00 pm45 Minutes

97

• Visit us at www.pcori.org• Follow @PCORI on Twitter• Watch our YouTube channel PCORINews


Dissemination and Implementation Roundtable

Lunch break until 12:00 pm *The webinar will be muted during lunch


#PCORI

Orientation to AHRQ’s Dissemination and Implementation Efforts

12:00 pm – 1:00 pm60 minutes


AHRQ PCORTF ACTIVITIES:FY 2011 - Present

Jean SlutskyDirector, Center for Outcomes and EvidenceAgency for Healthcare Research and Quality

Rockville, MD

Patient Protection and Affordable Care Act SEC. 937. DISSEMINATION AND BUILDING

CAPACITY FOR RESEARCH

Allocates a portion of the PCORTF (16%) annually to AHRQ in support of programs that may:– Disseminate and translate PCOR research findings– Obtain stakeholder feedback on the value of the information

to be disseminated and subsequent disseminations efforts– Assist users of Health IT to incorporate PCOR research

findings into clinical practice– Provide training and career development for researchers

and institutions in methods to conduct comparative effectiveness research

PCORTF Distribution

PCORTF

OS HHS 4%

PCORI 80%

AHRQ 16%

Importance of Stakeholders and Partnerships

Framework for PCORTF Investments in Dissemination, Implementation and

Training

Evidence Synthesis

Hor

izon

Sca

nnin

g

Patients

Providers

Systems and Policy Makers

(e.g. CMOs,PBMs, States)

Implementation(including CDS)

Dissemination

Translation

Improvements in Health Care

and Health

Prioritization and Topic

Development

Message Development and Strategy Selection

Audience Identification

Data Methods Evaluation

Early Career Mid-Career Institutional

Infrastructure

Stakeholders

PCORTF Planning

Allocations from the PCORTF are available for expenditure through 2019

Programs are responsive to language in ACA legislation Sec. 937 in regard to purpose and use of funds in three overarching areas: – Dissemination, Translation, and Implementation– Training and Career Development – Data Methods

Build on current AHRQ efforts, while also being distinct and innovative– Investments focused on improving patient’s health, the

health care system, the Triple Aim, and supporting the implementation of the ACA

Dissemination and Implementation

Focus on dissemination and implementation research activities related to PCOR findings to:

– Identify efficient and successful dissemination methods

– Identify successful methods of translation for intended audiences

– Identify methods for implementation of findings into practice

Training and Career Development

Support training and development opportunities in PCOR for:

– Individuals at different career stages

– Institutional training opportunities that focus on applied settings

– Institutions that have not previously developed expertise in PCOR training

– Special emphasis on training for dissemination and implementation science

Availability of Funds Before Sequestration

FY2011 $8M

FY2012 $24M

FY2013 $60M

FY2014 $100M

Obligations to Date

57%37%

6%

% of Total Funds Awarded to Each Emphasis Area to Date

Dissemination andImplementation

Training and CareerDevelopment

Data Methods

DISSEMINATION, TRANSLATION, AND IMPLEMENTATION

AWARDED AND IN PROCESS

Dissemination, Translation, and Implementation

Evidence Synthesis

Hor

izon

Sca

nnin

g

Patients

Providers




and Health


Development




Infrastructure

Stakeholders


Dissemination

Translation


Dissemination, Translation, and ImplementationFY 2011 & FY 2012 - Contracts

Horizon Scanning System: Dissemination of Information on Emerging Interventions

– System for searching for emerging interventions, prioritizing which are most likely to have a large impact in the near future, and disseminating the information to the public Dissemination of timely information about emerging medical and

health systems interventions

– Assist stakeholders by providing critical information for decisions about planning and prioritizing research investments so that studies can be completed on the emerging interventions with the highest potential impact on the health of patients


John M. Eisenberg Clinical Decisions and Communications Science Center (Eisenberg Center)

– Continue the establishment and expansion of a research and translation decision science and communication center Facilitate access to and use of evidence-based clinical and health care

delivery information Foster informed health care decisions by patients, providers, and

policy makers

– Apply state of the art research in decision science, communication science, and other relevant fields to ensure high impact of the Decision Science Center products on informed decision making for multiple audiences

Sample PCOR Dissemination Products

Consumer Summary Clinician Summary

Tools and Resources Decision Aids English Spanish

http://www.effectivehealthcare.ahrq.gov

CME/CE Slide Library Research Reviews


Dissemination of PCOR to Students of Health Professions– Aims to develop PCOR information tools to support educators across

health care disciplines Interviews, focus groups with health professional student associations to

evaluate students’ understanding of PCOR, shared decision making Clarify students’ educational preferences for integrating PCOR into training

curricula– Project will culminate with student-focused summit

In-Store Promotion of PCOR Findings to Consumers– Promotes EHC Program materials via PSAs and giveaways in grocery

stores and pharmacies Audio announcements encourage consumers to access free EHC Program

materials at store pharmacies In ~5,000 stores nationwide

To date, more than 1 million consumer publications distributed


Educating the Educators– Aims to develop EHC Program tools to help educators use PCOR

information certified health education specialists, nurses, nurse practitioners, nurses, physician

assistants, medical assistants, others

– Includes a baseline survey to understand PCOR awareness and information needs of educators

– Tools will be implemented in “train the trainer” workshops across U.S., focusing on areas with high health disparities

Targeted Dissemination of PCOR Findings In “Stroke Belt”– Aims to promote the use of EHC Program products via multi-media

campaign including print, radio, social media, billboards, Web– Encourage use of PCOR evidence in shared decision-making in stroke

belt states– Emphasis on EHC Program tools related to chronic conditions


Methods Center in Decision and Simulation Modeling– Develop a multidisciplinary group of experts to act as a decision and

simulation modeling methods core for AHRQ programs– Develop methods guidance on modeling alongside systematic reviews, e.g.

structuring decision models, model validation, communication of results– Conduct research on modeling methodology in areas of knowledge gaps

and controversies in order to advance the field

Implementation of a Systematic Review Data Repository Collaborative

– Web-based Systematic Review Data Repository (SRDR) for study data extracted from primary research publications during the course of conducting systematic reviews Fully functional, open-access data system and systematic review infrastructure

Dissemination, Translation, and ImplementationFY 2013 - Contracts

Integrating PCOR into Clinical Decision Support Systems

– Aims to identify steps to integrate PCOR information into clinical decision support systems on a wide scale Project tasks include:

• Consulting medical, clinical organizations to understand needs• Environmental scan and market analysis of available health information

technologies• Engaging HIT vendors to understand capabilities, limitations

– Project to inform future investments on incorporating PCOR information into HIT

Dissemination, Translation, and ImplementationFY 2011 & FY 2012 - Grants

Patient-Centered Outcomes Research -Dissemination by Health Professionals Associations (PCOR-DHPA) (R18)

– Aimed at health professionals associations to develop dissemination programs that integrate patient-centered outcomes research into clinical practice Eligible applicants included health professionals associations, health

professionals education accrediting agencies, and health professionals licensing boards

Special emphasis on use of multi-factorial mechanisms such as education, credentialing, scientific programs, social media platforms, and other innovative methods

– 3 year projects ($100,000/yr max)

http://grants.nih.gov/grants/guide/rfa-files/RFA-HS-12-006.html

Dissemination, Translation, and ImplementationFY 2011 & FY 2012 - Grants

Partnerships for Sustainable Research and Dissemination of Evidence-based Medicine (R24)

– Resource-related research projects to: Build or enhance the applicants capacity to create a sustainable

infrastructure for on-going dissemination of evidence-based health information

Conduct research studies that advance our knowledge of how to extend the reach and impact of evidence-based health information/tools to populations with a demonstrated need for the information



Dissemination, Translation, and ImplementationProjects in Progress

Closing the Gap in Disparities with PCOR (U18)– Identify strategies to engage stakeholders through shared

decision making that can be used to effectively implement interventions specific to health care delivery systems, clinicians, and/or patients that focus on the reduction of racial/ethnic healthcare disparities in under-resourced settings. Incorporate the translation, dissemination, and implementation of

PCOR findings for racial/ethnic minority populations. Applicants are required to demonstrate an ability to leverage the

capacities of relevant and diverse stakeholders in their strategies to reduce healthcare disparities in under-resourced settings


– Application due July 31, 2013


Dissemination, Translation, and ImplementationProjects in Progress

Disseminating PCOR Evidence To Improve Healthcare Delivery (R18)– Aims to disseminate and implement existing PCOR evidence

for improving the quality of health care delivery Addresses challenges of spreading delivery system evidence by

requiring applicants representing existing, multi-stakeholder networks, with:

• Demonstrated history of collaborative relationships• Robust communication/dissemination/data-sharing channels, processes, &

infrastructures • Knowledge of local conditions & ability to adapt to them• Experience with taking proven practices to scale

– 4 year projects ($1M/yr max)

– Applications due September 27, 2013


Dissemination, Translation, and ImplementationPending Funding Opportunities

Bringing Evidence to Stakeholders for Translation (BEST) to Primary Care

– Expand the current AHRQ dissemination programs to patients and providers in primary care settings

– Funded projects will focus on dissemination via practice facilitation, which has been shown in controlled trials to nearly triple the adoption of evidence-based guidelines in primary care

Deliberative Approaches for Patient Involvement in Implementing Evidence-Based Health Care

– Projects will use a deliberative approach, based on findings of the AHRQ Community Forum deliberative methods experiment, to gather input from patients on a complex topic related to the implementation of evidence-based health-care decision making.

http://grants.nih.gov/grants/guide/notice-files/NOT-HS-13-003.html

Dissemination, Translation, and ImplementationPending Funding Opportunities

Registry of Patient Registries (RoPR)– Build upon ongoing AHRQ investment in RoPR– Disseminate information on registries and registry-

based studies– Integrated into CT.gov and stand alone

https://www.fbo.gov/spg/HHS/AHRQ/DCM/AHRQ-13-10010/listing.html

http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=690

TRAINING AND CAREER DEVELOPMENT

AWARDED AND IN PROCESS

Framework for PCOR

Evidence Synthesis

Hor

izon

Sca

nnin

g

Patients

Providers




Dissemination

Translation


and Health


Development



Data Methods EvaluationInfrastructure

Stakeholders


Training and Career Development

Special Emphasis Notice: PCOR Mentored Career Development Grants focused on Methodologies and Research in Translation, Implementation, and Diffusion of Research into Practice and Policy

– Applicable to current AHRQ-sponsored PCOR career development mechanisms (K01/K08, K12)

– Will support the mentored career development of clinical and research doctorates who are interested in the development, implementation and evaluation of strategies for the translation, dissemination, and uptake of PCOR and effective clinical and system interventions. Areas of interest include: Health Communication in PCOR Decision Making in PCOR Evidence Dissemination and Implementation in PCOR

http://grants.nih.gov/grants/guide/notice-files/NOT-HS-13-010.html

OPEN AND PENDING PCOR FUNDING OPPORTUNITIES -SUMMARY

FY 2013

Open Opportunities Disseminating PCOR Evidence To Improve

Healthcare Delivery (R18)(http://grants.nih.gov/grants/guide/rfa-files/RFA-HS-14-003.html)

Closing the Gap in Disparities with PCOR (U18)http://grants.nih.gov/grants/guide/rfa-files/RFA-HS-13-010.html

Registry of Patient Registries (RoPR)https://www.fbo.gov/spg/HHS/AHRQ/DCM/AHRQ-13-10010/listing.html

Coming Soon

Bringing Evidence to Stakeholders for Translation (BEST) to Primary Care(http://grants.nih.gov/grants/guide/notice-files/NOT-HS-13-003.html)

Deliberative Approaches for Patient Involvement in Implementing Evidence-Based Health Carehttp://grants.nih.gov/grants/guide/notice-files/NOT-HS-13-003.html

FY2014 PCORTF Goals Continued emphasis on projects that:

– Disseminate, translate, implement PCOR research findings– Provide training and career development for researchers and

institutions in methods to conduct comparative effectiveness research

– Build capacity for CER through the development of research data bases, clinical registries, and health outcomes research data networks

Special focus on transformative projects aimed at the rapidly transforming health care delivery system– 2014 marks the implementation of the ACA– Intended to show real impact

Continued investment in projects that will build upon and enhance current AHRQ sponsored PCOR investments and infrastructure

Framework for PCORTF Investments in Dissemination, Implementation and

Training

Evidence Synthesis

Hor

izon

Sca

nnin

g

Patients

Providers




Dissemination

Translation


and Health


Development





Infrastructure

Stakeholders

Questions??

#PCORI

134

Question and Answer


#PCORI


1:00 pm – 2:30 pm90 Minutes


#PCORI

136

Discussion Questions

1

2

3

Given your personal experience in dissemination and implementation, what are the lessons learned, barriers, and successful facilitators in dissemination and implementation?

What strategies can PCORI use to build on or complement AHRQ’s current work in dissemination and implementation?

What key elements would you like to see in PCORI's Blueprint to help your organization with implementing research findings?


#PCORI







#PCORI

Given your personal experience in dissemination and implementation, what are the lessons learned, barriers, and facilitators in successful spread and uptake?


1

#PCORIWhat strategies can PCORI use to build on or complement AHRQ’s current work in dissemination and implementation?


2

#PCORIWhat key elements would you like to see in PCORI’s Blueprint to help your organization with implementing research findings?


3

#PCORI

Housekeeping and Break

2:30 pm – 2:45 pm15 Minutes

141



#PCORI


90 Minutes


#PCORI

143

Discussion Questions

4

5

6

What is the best approach to develop a framework for implementing results of comparative effectiveness research (CER)?

Which already existing frameworks would you recommend be reviewed for developing PCORI’s blueprint for dissemination and implementation?

What would you include in the scope of work for the request for proposal (RFP)? What are the key abilities we should seek among applicants interested in developing a framework in response to the request for proposal (RFP)?


#PCORI







#PCORIWhat is the best approach to develop a framework for implementing results of comparative effectiveness research (CER)?


4

#PCORI

Which already existing frameworks would you recommend be reviewed for developing PCORI’s blueprint for dissemination and implementation?


5

#PCORIWhat would you include in the scope of work for the request for proposal (RFP)? What are the key abilities we should seek among applicants interested in developing a framework in response to the request for proposal (RFP)?


6

#PCORI

Public Comment Period

4:15 pm – 4:45 pm 30 Minutes

If you would like to make a comment, press #7 on your keypad and you will be added to the queue

For questions regarding the request for proposal (RFP) please view our FAQ page:

http://www.pcori.org/assets/PCORI-August-2013-Funding-Announcement-FAQs-0528132.pdf


#PCORI

Next Steps & Adjourn


#PCORI

Closing Remarks – 15 minutes

Anne C. Beal, MD, MPHDeputy Executive DirectorChief Officer for Engagement

A pediatrician and public health specialist, Anne C. Beal, MD, MPH, has devoted her career to providing access to high-quality health care. As PCORI’s first Chief Officer for Engagement, she will work to ensure the voices of patients and other stakeholders are reflected in our growing research portfolio. In her previous role as Chief Operating Officer, she worked to ensure PCORI develops the structure and capacity needed to carry out its mission as the nation’s largest research institute focused on patient-centered outcomes research. She joined PCORI from the Aetna Foundation, the independent charitable and philanthropic arm of Aetna Inc. She holds a BA from Brown University, an MD from Cornell University Medical College, and an MPH from Columbia University.


#PCORI

We Still Want to Hear from You

We welcome your input on today’s discussionsWe are accepting comments and questions for consideration on this topic through July 31, 2013 at 5 PM (ET) E-mail ([email protected]) Respond to discussion questions at:

http://pcori.org/events/dissemination-and-implementation-roundtable/

We will take all feedback into consideration


Thank You for Your Participation

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