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Consider…
- What are new opportunities for systems
science in implementation research?
- How do systems models evaluate the
impact of contextual factors on implementation of interventions?
- Can systems models help us consider
Applying Systems Models to Address Complexity Lisa Klesges, PhD, MS - - PowerPoint PPT Presentation
Applying Systems Models to Address Complexity Lisa Klesges, PhD, MS - - PowerPoint PPT Presentation
Enhancing Implementation Science: Applying Systems Models to Address Complexity Lisa Klesges, PhD, MS Session Chair 2017 Annual Research Meeting Consider What are new opportunities for systems science in implementation research?
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“…transform health care by moving from its historic “linear, deconstructed model” that falls along traditional disciplinary boundaries to a “complex, adaptive system” that drives better performance
- utcomes, and considers healthcare as a complex
social process.”
- -Paul Batalden
Aspiration for Systems Implementation
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Complicated Linear Logic Model of an Obesity Intervention
Setting Intervention Mediator Moderator Moderator Short-term Outcome
Longer- Term Outcome
Behavior Schools Obesity Family Environment Child Age Parent BMI BMI Moderator Low-income Neighborhood
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Linear deconstructed evidence not sufficient for complex implementation decisions:
- Based on narrowly selected groups of
participants, clinicians, settings
- Modeling does not account for adaptive, evolving
circumstances or interventions
- Lack contextual evaluation among community
characteristics, clinical settings, local priorities
- Outcomes often not relevant for clinical or policy
decisions
Glasgow RE et al. Practical clinical trials for translating research…Med Care 2005;43:551-557 Peek CJ, et al. 5 R’s: An Emerging Bold Standard for Conducting Relevant Research in a Changing World; Ann Family Med, 2014
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Characteristics of a Complex System
- Made up of a large number of heterogeneous elements
- Elements interact with each other often as non-linear
and non-deterministic
- Interactions produce an emergent effect that is different
from the effects of the individual elements
- Effects persist over time and adapt to changing
circumstances
Systems Science Methods in Public Health: Dynamics, Networks, and Agents. Luke DA, Stamatakis KA; Annu Rev Public Health. 33: 357–376, 2012.
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Obesity: Complex Systems Problem
Seeing obesity as a systems problem. Newell B, Proust K, Dyball R, McManus P. N S W Public Health Bull. 2007 Nov-Dec;18(11-12):214-8.
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Predominant System Modeling Approaches
Agent-based Modeling: examines actions of agents (e.g. individuals) in environments (e.g. neighborhood); decision rules simulate interactions of agents and environments Systems Dynamics Modeling: conceptualize trajectories of
- utcomes over defined time horizons; pathways complicated
and understood via computer simulations Network Analysis: studies structure of relationships between a set of nodes (e.g., people, sites); considers relational patterns within a system (e.g., how frequent is flow between nodes?)
Burke JG, Lich KH, Neal JW, et al. Enhancing Dissemination and Implementation Research Using Systems Science Methods. Int J Behav Med. 22(3): 283–291, 2015.
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- Multi-sector stakeholder perspectives to develop, assess,
and advocate for evidence-based improvements
- Propels discovery considering multi-level socio-technical
advances (e.g., social networks, bio-sensing, geospatial)
- Addresses large unexplained variation in clinical and
community outcomes (increases contextual information)
- Creates actionable evidence for decision-making for
clinical and community improvement
Opportunities for Systems and Implementation…
Patty Mabry, 2012
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Presenters
Lindsey Zimmerman, PhD, Clinical & Community Psychologist, Implementation Science, National Center for PTSD; Affiliate Instructor, University of Washington School of Medicine Stephanie B Wheeler, PhD MPH, Associate Professor Health Policy & Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill Douglas A Luke, PhD, Professor; Director, Center for Public Health Systems Science, Brown School of Social Work, Washington University in St Louis David Chambers, D.Phil., Deputy Director for Implementation Science, Div of Cancer Control and Population Sciences, National Cancer Institute
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