title: Using the interactive systems framework to support a quality improvement approach to dissemination of evidence-based strategies to promote early detection of breast cancer: planning a comprehensive dynamic trial.
abstract: Dissemination efforts must optimize interventions for new settings and populations. As such, dissemination research should incorporate principles of quality improvement. Comprehensive Dynamic Trial (CDT) designs examine how information gained during dissemination may be used to modify interventions and improve performance. Although CDT may offer distinct advantages over static designs, organizing the many necessary roles and activities is a significant challenge. In this article, we discuss use of the Interactive Systems Framework for Dissemination and Implementation to systematically implement a CDT. Specifically, we describe "Bronx ACCESS", a program designed to disseminate evidence-based strategies to promote adherence to mammography guidelines. In Bronx ACCESS, the Intervention Delivery System will elicit information needed to adapt strategies to specific settings and circumstances. The Intervention Synthesis and Translation System will use this information to test changes to strategies through "embedded experiments". The Intervention Support System will build local capacities found to be necessary for intervention institutionalization. Simulation modeling will be used to integrate findings across systems. Results will inform on-going policy debate about interventions needed to promote population-level screening. More generally, this project is intended to advance understanding of research paradigms necessary to study dissemination.
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 3300 Kossuth Avenue, Bronx, NY 10467, USA. bruce.rapkin@einstein.yu.edu
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Rapkin
authors.forename: Elisa S
authors.initials: ES
authors.lastname: Weiss
authors.forename: David W
authors.initials: DW
authors.lastname: Lounsbury
authors.forename: Hayley S
authors.initials: HS
authors.lastname: Thompson
authors.forename: Robert M
authors.initials: RM
authors.lastname: Goodman
authors.forename: Clyde B
authors.initials: CB
authors.lastname: Schechter
authors.forename: Cheryl
authors.initials: C
authors.lastname: Merzel
authors.forename: Rachel C
authors.initials: RC
authors.lastname: Shelton
authors.forename: Arthur E
authors.initials: AE
authors.lastname: Blank
authors.forename: Jennifer
authors.initials: J
authors.lastname: Erb-Downward
authors.forename: Abigail
authors.initials: A
authors.lastname: Williams
authors.forename: Pamela
authors.initials: P
authors.lastname: Valera
authors.forename: Deborah K
authors.initials: DK
authors.lastname: Padgett
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis*; D019058:Community Networks; D055088:Early Detection of Cancer / Q000379:methods*; D055317:Evidence-Based Practice / Q000193:education* / Q000379:methods; D005260:Female; D006801:Humans; D033181:Information Dissemination / Q000379:methods*; D008327:Mammography; D009519:New York City; D010349:Patient Compliance; D058996:Quality Improvement; D012107:Research Design