The Dissemination and Implementation Framework & Toolkit is a product of the Patient-Centered Outcomes Research Institute (PCORI). The toolkit was created in 2014 through a review of the dissemination and implementation literature, stakeholder feedback, and a working group convened by PCORI and Mathematica Policy Research. The goal of the implementation framework is to encourage researchers to think about the dissemination and implementation of the evidence-based program from the beginning of the research process.
The PCORI implementation framework and toolkit suggests that research about health and healthcare choices has the highest chance for impact when it includes early involvement of partners who may benefit from research results. The framework was created to incorporate key aspects of the dissemination and implementation models from the scholarly literature with the strategic goals of PCORI.
The PCORI framework is built around the 3 fundamental concepts of Context, Engagement and Evaluation. Layered on top of these concepts are the elements of the PCORI Dissemination and Implementation (D&I) activities, as these support the network of researchers engaging in PCORI activities, who might also be utilizers of the PCORI D&I framework.
The PCORI Framework focuses on the following 5 phases of implementation activities: evidence assessment, audience identification and partner engagement, dissemination, implementation, and evaluation.
The first stage of integrating D&I into your research activities is to plan for it. Starting with a review of the current evidence, it is essential to determine how the current context on your research topic may shape the pathways for dissemination. This process is of particular importance when research is occurring with representatives of underserved or traditionally vulnerable groups, as they have often been sidelined for the processes of determining a credible evidence base in health and health services research.
Consider who the potential audiences are for the dissemination of the program. In doing so, you can begin to incorporate their voices into the process as you identify research topics. By knowing who can benefit from research outcomes, and by considering this from the beginning, your research project can better reach your intended audiences.
There are likely going to be situations where you are not best suited to reach out to potential partners. In these situations, use partnerships and potential collaborations. Identify partners that can help you reach your intended audience when attempting to work with groups that may be wary of your research group. Having a partner like a patient advocacy organization, continuing education providers, or key community organizations, can aid your dissemination and implementation efforts before you start to create evidence.
It is vital to understand why a potential user would be interested in adopting your proposed change. By assessing the context for adoption, understanding the incentives that will be necessary for change, and the needs, values, motivations and expectations of your audience, you can make the dissemination process more effective.
As with all the PCORI D&I stages, dissemination begins with engagement of stakeholders. Partner with them to develop a plan for executing the dissemination of the program or practice. This should include a goal and plan for studying how the dissemination is executed, as this will also contribute to your knowledge base about the program and how to most effectively disseminate it across stakeholders and user groups.
Effective dissemination is dependent on users trusting the quality of the source of materials. Be sure to be intentional about your tactics, rhetoric, and how you present the evidence supporting the program or practice.
As the program is disseminated, it will begin to be put into place in specific contexts. Knowing the contextual factors that can help to support implementation and lead to sustainability can come from engagement with system stakeholders. Knowing how a local system works, and how widespread implementation can spread through a health system when results have been shown, can benefit implementation efforts.
The evidence base for effective D&I will grow when careful evaluation of these processes is built into research plans and approaches. Evaluation of D&I activities in the PCORI framework should include the continued engagement of stakeholders, clear planning for evaluation that includes multiple data sources, and the use of valid and reliable metrics.
PCORI’s Dissemination and Implementation Framework has been used in various randomized controlled trials, pragmatic clinical studies, observational studies, methodology studies, research on rare diseases, and for developing research infrastructure.
Central to the PCORI model is stakeholder engagement. Forsythe et al., 2015, reviewed how engagement has been implemented and systematically evaluated the optimal approaches to engagement via the PCORI pilot projects. They concluded that most studies engaged patients, clinicians, caregivers, advocates, and health system representatives, and tended to include them during the development of research questions. Time and resources—for both the researchers and stakeholders—were identified as key barriers to stakeholder involvement in care.
Continued development of the PCORI model has also led to the development of a rubric for engagement (Sheridan et al., 2017), as part of a continued effort to expand the tools and research-based resources available for the implementation of the PCORI framework. This example is just one of the many ongoing research projects and development processes being undertaken by PCORI researchers and through PCORI-funded research.
PCORI’s Dissemination and Implementation Framework can be used by different stakeholders, such as patients, caregivers, patient advocacy organizations, clinicians, clinician specialty societies, policymakers, healthcare delivery systems, payers, insurers, employers, purchasers, life sciences industry leaders, hospitals, funders, researchers, journal editors, training institutions, publishers, healthcare journalists, and bloggers.
Forsythe, L., Ellis, L., Edmundson, L., Sabharwal, R., Rein, A., Konopka, K., & Frank, L. (2015). Patient and stakeholder engagement in the PCORI pilot projects: Description and lessons learned. Journal of General Internal Medicine, 31, 13–21.
Mathematica Policy Research. (2015). PCORI: Dissemination & Implementation Toolkit. Retrieved from http://www.pcori.org/sites/default/files/PCORI-DI-Toolkit-February-2015.pdf
Sheridan, S., Schrandt, S., Forsythe, L., Hilliard, T., Paez, K. (2017). The PCORI engagement rubric: Promising practices for partnering in research. Annals of Family Medicine, 15, 165–170.