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Editorial
Dissemination, implementation, and de-implementation: the trauma perspective
  1. Vanessa P Ho1,
  2. Rochelle A Dicker2,
  3. Elliott R Haut3,4
  4. Coalition for National Trauma Research Scientific Advisory Committee
    1. 1Departments of Surgery and Population and Quantitative Health Sciences, MetroHealth Medical Center, Cleveland, Ohio, USA
    2. 2Department of Surgery, David Geffen School of Medicine, Los Angeles, California, USA
    3. 3Departments of Surgery, Anesthesiology and Critical Care Medicine, and Emergency Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USA
    4. 4Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
    1. Correspondence to Dr Elliott R Haut, Departments of Surgery, Anesthesiology & Critical Care Medicine, and Emergency Medicine, Johns Hopkins Medicine, Baltimore, MD 21205, USA; ehaut1{at}jhmi.edu

    https://doi.org/10.1136/tsaco-2019-000423

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      Introduction

      Trauma surgery moves fast. Clinical decisions and treatment of injured patients must occur expeditiously, or patients suffer. Trauma research also moves fast, and new high-quality studies about treatment of injured patients frequently reshape the field and our understanding of best practices. Historically, medicine relied on the dissemination of best practices through publication of manuscripts and the endorsement of trusted physicians to change practices. However, implementation of research has proven to be slow. When research does not reach the bedside, patients are not offered proven therapies or are treated with dated or ineffective therapies. Implementation science, or the rigorous studying of the timely uptake of evidence into routine practice, is the next vital frontier in surgery,1 with the potential to have a profound positive effect on the care provided to our patients.

      The purpose of this paper is to describe the principles of implementation science and propose their wider use in trauma care. This paper is published as an initiative of the Coalition for National Trauma Research (CNTR) to further advance high-quality research and promote sustainable research funding to improve the care of injured patients, commensurate with the burden of disease in the USA. We will review definitions of implementation, dissemination, and de-implementation, as well as research frameworks, study design, and funding opportunities.

      Implementation science is an umbrella term that includes implementation research, dissemination research, and de-implementation research. The key with implementation science is focusing on “how to do it” rather than “what to do.” As a result, the outcomes of interest are not those typically considered in outcomes research such as mortality or morbidity. To study implementation, we assume that the “best practice” treatment is already known. Implementation science focuses on how to obtain sustained use of the best practice treatment in real-world settings. Implementation research is the study …

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