Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact.
OBJECTIVE
This study proposes methods for blending design components of clinical effectiveness and implementation research. Such blending can provide benefits over pursuing these lines of research independently; for example, more rapid translational gains, more effective implementation strategies, and more useful information for decision makers. This study proposes a "hybrid effectiveness-implementation" typology, describes a rationale for their use, outlines the design decisions that must be faced, and provides several real-world examples.


RESULTS
An effectiveness-implementation hybrid design is one that takes a dual focus a priori in assessing clinical effectiveness and implementation. We propose 3 hybrid types: (1) testing effects of a clinical intervention on relevant outcomes while observing and gathering information on implementation; (2) dual testing of clinical and implementation interventions/strategies; and (3) testing of an implementation strategy while observing and gathering information on the clinical intervention's impact on relevant outcomes.


CONCLUSIONS
The hybrid typology proposed herein must be considered a construct still in evolution. Although traditional clinical effectiveness and implementation trials are likely to remain the most common approach to moving a clinical intervention through from efficacy research to public health impact, judicious use of the proposed hybrid designs could speed the translation of research findings into routine practice.
Central Arkansas Veterans Healthcare System, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA. currangeoffreym@uams.edu
Geoffrey M
GM
Curran
Mark
M
Bauer
Brian
B
Mittman
Jeffrey M
JM
Pyne
Cheryl
C
Stetler
D057186:Comparative Effectiveness Research / Q000379:methods; D006302:Health Services Research / Q000379:methods*; D006801:Humans; D010043:Outcome and Process Assessment, Health Care / Q000379:methods; D011634:Public Health; D012107:Research Design; D057170:Translational Research, Biomedical / Q000379:methods; D014481:United States; D014493:United States Department of Veterans Affairs