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      The Evolve to Next-Gen ACT Network: An evolving open-access, real-world data resource primed for real-world evidence research across the Clinical and Translational Science Award Consortium

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          Abstract

          The ACT Network was funded by NIH to provide investigators from across the Clinical and Translational Science Award (CTSA) Consortium the ability to directly query national federated electronic health record (EHR) data for cohort discovery and feasibility assessment of multi-site studies. NIH refunded the program for expanded research application to become “Evolve to Next-Gen ACT” (ENACT). In parallel, the US Food and Drug Administration has been evaluating the use of real-world data (RWD), including EHR data, as sources of real-world evidence (RWE) for its regulatory decisions involving drug and biological products. Using insights from implementation science, six lessons learned from ACT for developing and sustaining RWD/RWE infrastructures and networks across the CTSA Consortium are presented in order to inform ENACT’s development from the outset. Lessons include intentional institutional relationship management, end-user engagement, beta-testing, and customer-driven adaptation. The ENACT team is also conducting customer discovery interviews with CTSA hub and investigators using Innovation-Corps@NCATS (I-Corps™) methodology for biomedical entrepreneurs to uncover unmet RWD needs. Possible ENACT value proposition hypotheses are presented by stage of research. Developing evidence about methods for sustaining academically derived data infrastructures and support can advance the science of translation and support our nation’s RWD/RWE research capacity.

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          The dynamic sustainability framework: addressing the paradox of sustainment amid ongoing change

          Background Despite growth in implementation research, limited scientific attention has focused on understanding and improving sustainability of health interventions. Models of sustainability have been evolving to reflect challenges in the fit between intervention and context. Discussion We examine the development of concepts of sustainability, and respond to two frequent assumptions —'voltage drop,’ whereby interventions are expected to yield lower benefits as they move from efficacy to effectiveness to implementation and sustainability, and 'program drift,’ whereby deviation from manualized protocols is assumed to decrease benefit. We posit that these assumptions limit opportunities to improve care, and instead argue for understanding the changing context of healthcare to continuously refine and improve interventions as they are sustained. Sustainability has evolved from being considered as the endgame of a translational research process to a suggested 'adaptation phase’ that integrates and institutionalizes interventions within local organizational and cultural contexts. These recent approaches locate sustainability in the implementation phase of knowledge transfer, but still do not address intervention improvement as a central theme. We propose a Dynamic Sustainability Framework that involves: continued learning and problem solving, ongoing adaptation of interventions with a primary focus on fit between interventions and multi-level contexts, and expectations for ongoing improvement as opposed to diminishing outcomes over time. Summary A Dynamic Sustainability Framework provides a foundation for research, policy and practice that supports development and testing of falsifiable hypotheses and continued learning to advance the implementation, transportability and impact of health services research.
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            Diffusion Of Innovations Theory, Principles, And Practice

            Aspects of the research and practice paradigm known as the diffusion of innovations are applicable to the complex context of health care, for both explanatory and interventionist purposes. This article answers the question, "What is diffusion?" by identifying the parameters of diffusion processes: what they are, how they operate, and why worthy innovations in health care do not spread more rapidly. We clarify how the diffusion of innovations is related to processes of dissemination and implementation, sustainability, improvement activity, and scale-up, and we suggest the diffusion principles that can be readily used in the design of interventions.
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              Navigating the sustainability landscape: a systematic review of sustainability approaches in healthcare

              Background Improvement initiatives offer a valuable mechanism for delivering and testing innovations in healthcare settings. Many of these initiatives deliver meaningful and necessary changes to patient care and outcomes. However, many improvement initiatives fail to sustain to a point where their full benefits can be realised. This has led many researchers and healthcare practitioners to develop frameworks, models and tools to support and monitor sustainability. This work aimed to identify what approaches are available to assess and influence sustainability in healthcare and to describe the different perspectives, applications and constructs within these approaches to guide their future use. Methods A systematic review was carried out following PRISMA guidelines to identify publications that reported approaches to support or influence sustainability in healthcare. Eligibility criteria were defined through an iterative process in which two reviewers independently assessed 20% of articles to test the objectivity of the selection criteria. Data were extracted from the identified articles, and a template analysis was undertaken to identify and assess the sustainability constructs within each reported approach. Results The search strategy identified 1748 publications with 227 articles retrieved in full text for full documentary analysis. In total, 62 publications identifying a sustainability approach were included in this review (32 frameworks, 16 models, 8 tools, 4 strategies, 1 checklist and 1 process). Constructs across approaches were compared and 40 individual constructs for sustainability were found. Comparison across approaches demonstrated consistent constructs were seen regardless of proposed interventions, setting or level of application with 6 constructs included in 75% of the approaches. Although similarities were found, no approaches contained the same combination of the constructs nor did any single approach capture all identified constructs. From these results, a consolidated framework for sustainability constructs in healthcare was developed. Conclusions Choosing a sustainability method can pose a challenge because of the diverse approaches reported in the literature. This review provides a valuable resource to researchers, healthcare professionals and improvement practitioners by providing a summary of available sustainability approaches and their characteristics. Trial registration This review was registered on the PROSPERO database: CRD42016040081 in June 2016. Electronic supplementary material The online version of this article (10.1186/s13012-017-0707-4) contains supplementary material, which is available to authorized users.
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                Author and article information

                Journal
                J Clin Transl Sci
                J Clin Transl Sci
                CTS
                Journal of Clinical and Translational Science
                Cambridge University Press (Cambridge, UK )
                2059-8661
                2023
                29 September 2023
                : 7
                : 1
                : e224
                Affiliations
                [ 1 ] Parkinson School of Health Sciences and Public Health, Loyola University Chicago , Chicago, IL, USA
                [ 2 ] Institute for Translational Medicine, Loyola University Chicago , Chicago, IL, USA
                [ 3 ] Colorado Clinical and Translational Sciences Institute, CU Anschutz Medical Campus , Aurora, CO, USA
                [ 4 ] College of Communications, Arts and Sciences, Michigan State University , East Lansing, MI, USA
                [ 5 ] Kellogg School of Management, Northwestern University , Evanston, IL, USA
                [ 6 ] The Chartis Group , Pittsburgh, PA, USA
                [ 7 ] Harvard Catalyst, Harvard University , Boston, MA, USA
                [ 8 ] Irving Institute for Clinical and Translational Research, Columbia University and New York State Psychiatric Institute , New York, NY, USA
                [ 9 ] Altman Clinical and Translational Research Institute at the University of California San Diego , San Diego, CA, USA
                [ 10 ] Center for Translational Medicine, UT Southwestern , Dallas, TX, USA
                [ 11 ] Clinical and Translational Science Institute, University of Pittsburgh , Pittsburgh, PA, USA
                Author notes
                Corresponding author: E. H. Morrato, DrPH, MPH; Email: emorrato@ 123456luc.edu
                Author information
                https://orcid.org/0000-0001-6105-7826
                Article
                S2059866123006179
                10.1017/cts.2023.617
                10643916
                38028333
                1a5d2ca8-8e60-4df7-95e5-637234d5d2a6
                © The Author(s) 2023

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.

                History
                : 15 March 2023
                : 09 August 2023
                : 21 August 2023
                Page count
                Figures: 2, Tables: 2, References: 30, Pages: 8
                Categories
                Special Communications
                Implementation, Policy and Community Engagement
                Advancing Translational Science through Real-World Data and Real-World Evidence

                clinical and translational science award,clinical informatics,electronic health records,real-world data,real-world evidence,diffusion of innovation,dissemination,implementation science,us food and drug administration,sustainability

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