Background

“Up to two decades may pass before the findings of original research becomes part of routine clinical practice” (IOM, 2014)

The National Institutes of Health (NIH) defines implementation science as the “study of methods to promote the integration of research findings and evidence into healthcare policy and practice…seeks to understand the behavior of healthcare professionals and other stakeholders as a key variable in the sustainable uptake, adoption, and implementation of evidence-based interventions…[with the intent to] investigate and address major bottlenecks (e.g. social, behavioral, economic, management) that impede effective implementation, test new approaches to improve health programming, as well as determine a causal relationship between the intervention and its impact” (NIH, 2016).

The Department of Defense (DoD) along with the Department of Veterans Affairs (VA) have been an integral part of a young evolving interdisciplinary field of study called implementation science (IS).

In late 2012, the Integrated Mental Health Strategy Strategic Action #26 task group developed a pilot (“Establish a PBI Network in Mental Health”), and proposed funding via a VA Joint Incentive Fund (JIF). The PBI Network pilot was funded, implemented and evaluated over a two-year period. It brought together clinicians and clinic leaders at 32 mental health clinics across VA and DoD.

The PBI Network pilot structure was then tested through implementation of a selected pilot practice change: use of Posttraumatic Stress Disorder (PTSD) Checklist (PCL) to monitor PTSD treatment outcomes. The pilot demonstrated that the PBI Network facilitated accelerated sustained practice change in the use of PCL to monitor PTSD treatment, across both departments, and served to identify barriers and facilitators to clinician use of evidence-based care at the clinics in the PBI Network. At the conclusion of the test pilot, each participating DoD PBI Network site received a participating clinic outbrief on the overall results of the practice change pilot, as well as their individual clinic’s outcomes. Site Champions and staff continue to receive ongoing IS training.

VA site - Tuskegee, Alabama, VA site - Little Rock, Arkansas, DOD site - Camp Pendleton, California, VA site - San Diego Naval Medical Center, California, DOD site – San Diego Naval Center , California, DOD site - Eglin AFB, Florida, DOD site - Fort Stewart, Georgia, DOD site – Fort Benning, Georgia, DOD site - Schofield Barracks, Hawaii, VA Site - Boise, Idaho, DOD site - Fort Riley, Kansas, VA site - Alexandria, Louisiana, VA site - Detroit, Michigan, DOD site - Offutt AFB, Nebraska, VA site - Bedford, Massachusetts, VA site - Fargo, North Dakota, DOD site - Wright – Patterson, Ohio, VA site - Philadelphia, Pennsylvania, VA site - Lebanon, Pennsylvania, VA site - Columbia, South Carolina, VA site - Valley Coastal Bend, Texas, VA site - Salt Lake City, Utah, DOD site - Portsmouth Naval Medical Center, Virginia, VA site, Richmond, Virginia, VA sites - Mount Vernon and Tacoma, Washington,

The PBI Network increases provider knowledge and accountability, promotes coordination and information sharing, and aims to reduce costs by testing practice change initiatives prior to broader dissemination throughout the Military Health System (MHS). The PBI Network also utilizes an online website that serves as both a knowledge repository and a resource to support practice changes, allowing DoD and VA providers to share information, materials and lessons learned.