Candidate: Andrew Quanbeck, Ph.D., is a health systems engineer seeking to launch an independent research career in implementation science, focused in the clinical area of addiction and drug abuse treatment. Systems engineers draw upon theories and principles from diverse scientific fields and apply them to problems in the real world. Having been trained as a systems engineer with a focus on healthcare systems, I have become especially interested in a critical problem in healthcare: the abysmal statistics on the rate of adoption of evidence-based practices. I formulate the process of implementation as a series of decisions made under uncertainty by healthcare stakeholders with potentially divergent values, and illustrate the many ways that implementation can fail from a systems perspective. My near-term goal is to learn and apply the technique of multi-attribute utility theory to assess the perceived value of an evidence-based practice for addiction treatment from the perspective of key healthcare stakeholders, and use it as a basis to identify and mitigate potential causes of failure. My long-term career goal is to work towards solving the problem of implementation in healthcare, and a mentored career award will help me gain the further training I need to do it. Development plan: Multi-attribute utility theory falls under the general discipline of decision analysis, a field with which I have little experience. My primary mentor (Dr. Gustafson) is a pioneer in applying multi-attribute utility theory to healthcare problems, with 33 articles publishd on the topic. Dr. Gustafson will guide me in developing the expertise in multi-attribute utility theory and implementation science I need to fulfill my career goals. Dr. Gustafson will be joined by a world-class mentoring team, including Dr. John Mullahy, Professor of Population Health Sciences and an internationally known authority on health economics (particularly in the area of drug abuse); Dr. Ramon Aldag, Professor of Management, former President of the Academy of Management and an expert on behavioral decision-making; Dr. Oguzhan Alagoz, Associate Professor of Industrial & Systems Engineering and an expert in medical decision making; Dr. Barbara Bowers, Professor of Nursing and an international authority on mixed-methods research; and Dr. Randall Brown, Associate Professor of Family Medicine and head of the University of Wisconsin Addiction Medicine Residency program. Environment: The University of Wisconsin has a worldwide reputation as a research university, ranking second among public universities in overall research expenditures. The University's College of Engineering's Center for Health Enhancement Systems Studies (CHESS) offers an unparalleled environment to conduct research on healthcare implementation science. Over the past 25 years CHESS has developed an international reputation for its innovative application of systems engineering principles and designs to healthcare, specifically in areas of organizational and individual change. Housed in the Department of Industrial & Systems Engineering, CHESS has played a key role in making the University of Wisconsin the world's leading health systems engineering research department in terms of research funding. CHESS, currently home to two R01-level NIH implementation studies, holds a trove of implementation research data and connections with research participants that is unparalleled in the field of implementation science, allowing examination of cross-cutting implementation issues between different healthcare organizations. Research plan: The research plan capitalizes on the strong research environment CHESS affords by studying a group of healthcare clinics seeking to implement an evidence-based practice for addiction named A-CHESS. The objective of the research plan is to develop and pilot test a multi-attribute utility model that assesses the perceived value of an evidence-based practice from multiple stakeholder perspectives. Several fields- decision science, health economics, behavioral economics, and game theory, among others-all suggest ideas that can help explain how people make decisions under uncertainty. I will first seek to develop the multi- attribute utility model, using a mixed methods approach, in three pilot clinics. The content of the model will be developed and validated through qualitative interviews with clinic managers, staff, and patients. Then, I will test how the model correlates with the uptake of A-CHESS by surveying managers, staff, and patients from clinics engaged in implementation. Achieving these aims will elucidate how to integrate the multi-attribute utility model into a comprehensive implementation strategy, and will generate preliminary data to conduct a prospective R01 implementation study testing this strategy. Ultimately, fulfillment of the career development and research plan will offer a data-driven means of assessing the potential impact of evidence-based practice adoption using multi-attribute utility theory, an approach that is well-established in the health economics literature. The resulting product will be a diagnostic tool for assessing the prospects of evidence-based practice adoption and refining implementation strategies to make adoption more appealing to critical stakeholders.
Research has demonstrated that many new practices are effective in healthcare, but very few are ever adopted. Andrew Quanbeck, Ph.D., a systems engineer from the University of Wisconsin launching a career in implementation science, seeks to develop new approaches to assess whether an organization is likely to adopt a new practice and will apply this new tool to the treatment of substance abuse. This new approach may ultimately improve the quality of healthcare by boosting its adoption of proven best practices.
