Skip to main content
SpringerLink
Log in

Wie gelangt Wissen in die Versorgung?

Implementierungsforschung und Wissenszirkulation

How does knowledge reach health care practice?

Implementation research and knowledge circulation

  • Originalien und Übersichten
  • Published:
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Aims and scope

Zusammenfassung

Hintergrund

Evidenzbasiertes Wissen zählt zu den wichtigsten Ressourcen in der Gesundheitsversorgung. Relevantes Wissen wird jedoch oft nicht umgesetzt. Für diese „Wissen-Praxis-Lücke“ existieren rund 100 verschiedene Begriffe.

Fragestellung/Ziel

Vorgestellt werden die häufigsten Konzepte, die zur Beschreibung und Überwindung dieses Zustandes zur Anwendung kommen: die Implementierungsforschung und die Wissenstranslation oder Wissenszirkulation.

Material und Methoden

Initial erfolgte eine systematische Recherche in den Datenbanken Cinahl, Embase, ERIC, Medline, PsychInfo, Scopus, Cochrane Library und Web of Science ohne zeitliche oder sprachliche Einschränkungen. Aufgrund der Vielzahl der gefundenen Artikel und deren Heterogenität entschied sich das Autorenteam jedoch für eine Fokussierung und infolgedessen für eine narrative Übersicht.

Ergebnisse

Implementierungsforschung beschreibt die wissenschaftliche Untersuchung von Methoden, die systematisch die Übertragung aktueller Forschungsergebnisse und evidenzbasierter Praktiken in die Versorgung unterstützen und das Ziel verfolgen, die Qualität und Effektivität des Gesundheitssystems zu verbessern. Bereits aus dieser Definition wird die Nähe zur Versorgungsforschung deutlich. Wissenstranslation ist umfassender und schließt die Wissenssynthese mit ein. Besser erscheint der Begriff Wissenszirkulation, um den Charakter des Teilens von Wissen zwischen Wissenschaft und Praxis deutlich zu machen.

Diskussion

Implementierungsforschung und Wissenszirkulation sind ähnliche Forschungskonzepte, die versuchen auf der Mikro‑, Meso- und Makroebene des Gesundheitswesens Strategien zu entwickeln, um Wissen in die Praxis zu bringen. Hieraus ergeben sich meist komplexe Forschungsfragen, die interdisziplinär zu bearbeiten sind.

Abstract

Background

Evidence-based knowledge is among the most important resources in health care. However, relevant knowledge is often not implemented. There are about 100 different concepts for the “knowledge-to-practice gap”.

Objectives

We conducted this review to identify relevant concepts that describe and try to overcome this situation: implementation research and knowledge translation or circulation.

Materials and methods

We initially conducted a systematic search in the databases CINAHL, Embase, ERIC, Medline, PsycINFO, Scopus, Cochrane Library and Web of Science without time or language restrictions. Owing to the huge number of relevant articles and their heterogeneity, we decided to focus on the most important concepts thus perform a narrative review.

Results

Implementation research is the scientific study of methods of systematically promoting the uptake of current research findings and other evidence-based practices into routine practice, with the aim of improving the quality and effectiveness of health services. From this definition, the affinity with health services research seems to be clear. Knowledge translation has a wider spectrum and includes the synthesis of knowledge. The term “knowledge circulation” seems to fit better, because it underlines the sharing of knowledge between research and practice.

Conclusion

Implementation research and knowledge circulation are similar research approaches, which try to develop micro-, meso-, and macro-level strategies for health services to bring knowledge into practice. This results in often complex research questions, which should be processed in interdisciplinary teams.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  1. Antes G, Galandi D, Bouillon B (1999) What is evidence-based medicine? Langenbecks Arch Surg 384:409–416

    Article  CAS  PubMed  Google Scholar 

  2. Gray M (2009) Evidence-based healthcare and public health, 3. Aufl. Elsevier, Edinburgh

    Google Scholar 

  3. Institute of Medicine (IOM) (2001) Crossing the quality chasm: a new health system for the 21st century. National Academy Press, Washington DC

    Google Scholar 

  4. Morris ZS, Wooding S, Grant J (2011) The answer is 17 years, what is the question: understanding time lags in translational research. J R Soc Med 104:510–520

    Article  PubMed  PubMed Central  Google Scholar 

  5. Lomas J (1993) Diffusion, dissemination, and implementation: Who should do what? Ann N Y Acad Sci 703:226–237

    Article  CAS  PubMed  Google Scholar 

  6. McKibbon KA, Lokker C, Wilczynski NL et al (2010) A cross-sectional study of the number and frequency of terms used to refer to knowledge translation in a body of health literature in 2006: a Tower of Babel? Implement Sci 5:16

    Article  PubMed  PubMed Central  Google Scholar 

  7. Eccles MP, Mittman BS (2006) Welcome to implementation science. Implement Sci. doi:10.1186/1748-5908-1-1

    Google Scholar 

  8. Straus SE, Tetroe J, Graham ID (2009) Knowledge translation in health care: moving from evidence to practice. Wiley-Blackwell, Oxford

    Book  Google Scholar 

  9. Rubenstein LV, Pugh J (2006) Strategies for promoting organizational and practice change by advancing implementation research. J Gen Intern Med 21:S58–S64

    Article  PubMed  PubMed Central  Google Scholar 

  10. Grenz-Farenholtz B, Schmidt A, Verheyen F, Pfaff H (2012) The future issues of health services research: What do experts say? Gesundheitswesen 74:605–611

    Article  CAS  PubMed  Google Scholar 

  11. Green BN, Johnson CD, Adams A (2001) Writing narrative literature reviews for peer-reviewed journals: secrets of the trade. J Sports Chiropr Rehabil 15:5–19

    Google Scholar 

  12. Brach C, Lenfestey N, Roussel A, Amoozegar J, Sorenson A (2008) Will it work here? A decisionmaker’s guide to adopting innovations. Agency for Healthcare Research and Quality (AHRQ), Rockville

    Google Scholar 

  13. Grol R, Wensing M, Eccles M (2005) Improving patient care. Elsevier, Edinburgh

    Google Scholar 

  14. Korzcak D, Schöffmann C (2010) Medizinische Wirksamkeit und Kosten-Effektivität von Präventions- und Kontrollmaßnahmen gegen Methicillinresistente Staphylococcus aureus (MRSA)-Infektionen im Krankenhaus. In: DIMDI (Hrsg) Health Technology Assessment (HTA) in der Bundesrepublik Deutschland. Deutsches Institut für Medizinische Dokumentation und Information (DIMDI), Köln

    Google Scholar 

  15. Larson JH, Peterson DJ, Heath VA, Birch P (2000) The relationship between perceived dysfunctional family-of-origin rules and intimacy in young adult dating relationships. J Sex Marital Ther 26:161–175

    Article  CAS  PubMed  Google Scholar 

  16. Haggard M (2011) Poor adherence to antibiotic prescribing guidelines in acute otitis media – obstacles, implications, and possible solutions. Eur J Pediatr 170:323–332

    Article  PubMed  Google Scholar 

  17. Cabana MD, Rand CS, Powe NR et al (1999) Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA 282:1458–1465

    Article  CAS  PubMed  Google Scholar 

  18. Fixsen DL, Naoom SF, Blase KA, Friedman RM, Wallace F (2005) Implementation research: a synthesis of the literature. University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network, Tampa

    Google Scholar 

  19. Davis D (2000) Clinical practice guidelines and the translation of knowledge: the science of continuing medical education. CMAJ 163:1278–1279

    CAS  PubMed  PubMed Central  Google Scholar 

  20. Grol R, Grimshaw J (2003) From best evidence to best practice: effective implementation of change in patients’ care. Lancet 362:1225–1230

    Article  PubMed  Google Scholar 

  21. Grimshaw JM, Thomas RE, MacLennan G et al (2004) Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess 8(6):iii–iv (1–72)

    Article  CAS  PubMed  Google Scholar 

  22. Ollenschläger G, Kirchner H, Fiene M (2001) Leitlinien in der Medizin – scheitern sie an der praktischen Umsetzung? Internist 42:473–483

    Article  PubMed  Google Scholar 

  23. Vollmar H, Gerlach FM, Szecsenyi J, Butzlaff M (2008) Wissenstransfer: DEGAM-Serie „Betreuung von Menschen mit chronischen Krankheiten“. Z Allg Med 84:214–217

    Article  Google Scholar 

  24. Bero LA, Grilli R, Grimshaw JM, Harvey E, Oxman AD, Thomson MA (1998) Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. BMJ 317:465–468

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Canadian Institutes of Health Research (2008) About knowledge translation. CHIR, Ottawa

    Google Scholar 

  26. Straus SE, Tetroe J, Graham I (2009) Defining knowledge translation. CMAJ 181:165–168

    Article  PubMed  PubMed Central  Google Scholar 

  27. Graham ID, Logan J, Harrison MB et al (2006) Lost in knowledge translation: time for a map? J Contin Educ Health Prof 26:13–24

    Article  PubMed  Google Scholar 

  28. Bartholomeyczik S, Halek M, Müller-Hergl C et al (2008) Institut für Forschung und Transfer in der Pflege und Behandlung von Menschen mit Demenz: Konzept. Pflege Ges 13:337–349

    Google Scholar 

  29. Rycroft-Malone J (2004) The PARIHS framework – a framework for guiding the implementation of evidence-based practice. J Nurs Care Qual 19:297–304

    Article  PubMed  Google Scholar 

  30. HBO-Raad (2004) Innovation agenda of universities of professional education: maximum participation and knowledge circulation. Netherlands Association of Universities of Applied Sciences, Den Haag

    Google Scholar 

  31. Serbânicâ C (2011) Knowledge circulation between universities, public research organizations and business in the EU 27. Drivers, barriers, actions to be put forward. Eur J Interdiscip Stud 3:43–54

    Google Scholar 

  32. Crites GE, McNamara MC, Akl EA, Richardson WS, Umscheid CA, Nishikawa J (2009) Evidence in the learning organization. Health Res Policy Syst 7:4

    Article  PubMed  PubMed Central  Google Scholar 

  33. Van Achterberg T, Schoonhoven L, Grol R (2008) Nursing implementation science: How evidence-based nursing requires evidence-based implementation. J Nurs Scholarsh 40:302–310

    Article  PubMed  Google Scholar 

  34. Schrappe M, Pfaff H (2016) Versorgungsforschung vor neuen Herausforderungen: Konsequenzen fur Definition und Konzept. Gesundheitswesen 78:689–694

    Article  CAS  PubMed  Google Scholar 

  35. Campbell M, Fitzpatrick R, Haines A et al (2000) Framework for design and evaluation of complex interventions to improve health. BMJ 321:694–696

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Pfaff H, Glaeske G, Neugebauer EA et al (2009) Memorandum III: “methods for health services research” (part 1). Gesundheitswesen 71:505–510

    Article  CAS  PubMed  Google Scholar 

  37. Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M (2008) Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ 337:a1655

    Article  PubMed  PubMed Central  Google Scholar 

  38. Moore GF, Audrey S, Barker M et al (2015) Process evaluation of complex interventions: Medical Research Council guidance. BMJ 350:h1258

    Article  PubMed  PubMed Central  Google Scholar 

  39. Nilsen P (2015) Making sense of implementation theories, models and frameworks. Implement Sci 10:53

    Article  PubMed  PubMed Central  Google Scholar 

  40. Pinnock H, Barwick M, Carpenter CR et al (2017) Standards for reporting implementation studies (StaRI) statement. BMJ 356:i6795

    Article  PubMed  PubMed Central  Google Scholar 

  41. European Science Foundation (2011) Forward look: implementation of medical research in clinical practice. European Science Foundation, Strasbourg

    Google Scholar 

  42. Fisher ES, Shortell SM, Savitz LA (2016) Implementation science: a potential catalyst for delivery system reform. JAMA 315:339–340

    Article  CAS  PubMed  Google Scholar 

  43. Wallin L (2009) Knowledge translation and implementation research in nursing. Int J Nurs Stud 46:576–587

    Article  PubMed  Google Scholar 

  44. Madon T, Hofman KJ, Kupfer L, Glass RI (2007) Public health. Implementation science. Science 318:1728–1729

    Article  CAS  PubMed  Google Scholar 

  45. Sanders D, Haines A (2006) Implementation research is needed to achieve international health goals. PLoS Med 3:0719–0722

    Article  Google Scholar 

  46. Graham ID, Logan J (2004) Innovations in knowledge transfer and continuity of care. Can J Nurs Res 36:89–103

    PubMed  Google Scholar 

  47. Schneider K, Brinker-Meyendriesch E, Schneider A (2005) Pflegepädagogik. Springer, Heidelberg

    Google Scholar 

  48. Schrappe M, Scriba PC (2006) Health services research: innovation transfer in clinical research. Z Arztl Fortbild Qualitatssich 100:571–580

    PubMed  Google Scholar 

  49. Gifford DR, Holloway RG, Frankel MR et al (1999) Improving adherence to dementia guidelines through education and opinion leaders. A randomized, controlled trial. Ann Intern Med 131:237–246

    Article  CAS  PubMed  Google Scholar 

  50. Segal L, Dalziel K, Bolton T (2008) A work force model to support the adoption of best practice care in chronic diseases – a missing piece in clinical guideline implementation. Implement Sci 3:35

    Article  PubMed  PubMed Central  Google Scholar 

  51. Green LW, Ottoson JM, Garcia C, Hiatt RA (2009) Diffusion theory and knowledge dissemination, utilization, and integration in public health. Annu Rev Public Health 30:151–174

    Article  PubMed  Google Scholar 

  52. Meiland FJ, Droes RM, De Lange J, Vernooij-Dassen MJ (2004) Development of a theoretical model for tracing facilitators and barriers in adaptive implementation of innovative practices in dementia care. Arch Gerontol Geriatr Suppl 38:279–290. doi:10.1016/j.archger.2004.04.038

    Article  Google Scholar 

Download references

Danksagung

Die Autoren danken Karla Bergerhoff von der Düsseldorfer Cochrane Group für die Durchführung der systematischen Recherche. Weiterhin danken sie den Mitgliedern der Integrierten Arbeitsgruppe Wissenszirkulation und Implementierungsforschung der Universität Witten/Herdecke sowie den Mitarbeitern der gleichnamigen Arbeitsgruppe am Deutschen Zentrum für Neurodegenerative Erkrankungen (DZNE) für die fruchtbaren Diskussionen in den Jahren 2006–2012.

Author information

Authors and Affiliations

  1. Institut für Allgemeinmedizin, Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena, Bachstr. 18, 07743, Jena, Deutschland

    Horst Christian Vollmar MPH

  2. Institut für Allgemeinmedizin und Familienmedizin, Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Deutschland

    Horst Christian Vollmar MPH

  3. Institut für Allgemeinmedizin, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland

    Sara Santos &  Stefan Wilm

  4. Department für Pflegewissenschaft, Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Deutschland

    Anneke de Jong

  5. Institute for Nursing Studies, University of Applied Sciences Utrecht, Utrecht, Niederlande

    Anneke de Jong

  6. Institut für Gesundheits- und Pflegewissenschaft, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland

    Gabriele Meyer

Authors
  1. Horst Christian Vollmar MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sara Santos
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anneke de Jong
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gabriele Meyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stefan Wilm
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Horst Christian Vollmar MPH.

Ethics declarations

Interessenkonflikt

H.C. Vollmar, S. Santos, A. de Jong, G. Meyer und S. Wilm geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vollmar, H.C., Santos, S., de Jong, A. et al. Wie gelangt Wissen in die Versorgung?. Bundesgesundheitsbl 60, 1139–1146 (2017). https://doi.org/10.1007/s00103-017-2612-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00103-017-2612-z

Schlüsselwörter

Keywords

Search

Navigation