At a time of significant upheaval in American health policy, maintaining a focus on a "North Star" is critical. For implementation science, this star is the knowledge base on how to optimally disseminate evidence related to health and health care, how to implement interventions to improve care within the many settings where people receive health care and make health-related decisions, and how to improve the health of the global population. To that end, the end of 2016 brought over 1100 engaged and activated "disciples of D & I" to Washington, DC for the 9 th Annual Conference on the Science of Dissemination and Implementation in Health. Once again, the accompanying abstracts in this issue demonstrate the breadth, depth and vigor of this continually expanding and evolving subset of health research. During three dynamic plenaries with rows and rows of filled seats and packed concurrent sessions presenters and attendees shared findings, raised methodologic and other challenges, and discussed future priorities, trends, and next steps for this community of research. For the third year in a row, we were buoyed by a strong partnership, co-led by AcademyHealth and the National Institutes of Health (NIH), with co-sponsorship from others committed to implementation science: the Agency for Healthcare Research and Quality (AHRQ), the Patient Centered Outcomes Research Institute (PCORI), the Robert Wood Johnson Foundation (RWJF), and the US Department of Veterans Affairs (VA). The multidisciplinary program planning committee informed the development of the key themes for the conference, identified the plenary sessions topics and speakers, established track leads to manage the review process for concurrent panels, papers, and posters, and convened a scientific advisory panel to advise on the overall conference, thus ensuring a robust, inclusive, and rigorous process. Together, the opening keynote address and the three plenary panel sessions set a tone of innovation and dialogue, raised critical issues, surfaced different perspectives, and ensured that follow on lunchtime and hallway discussions delved deeper into thorny challenges facing the field. Roy Rosin, Chief Innovation Officer for the University of Pennsylvania's Perelman School of Medicine, introduced the audience to a range of methods for rapid testing, innovation in healthcare delivery, and lessons learned from other industries to maximize potential of new practices to be scaled-up. Each of the three plenary panels presented a general discussion on a high priority challenge for dissemination and implementation (D & I) research. A panel on the balance between intervention and implementation fidelity and local adaptation touched on the very real dynamic that is playing out in communities across this country as policy and payment changes are driving providers and others to seek new ways to solve the challenges in their particular contexts. A panel on the longerterm decisions around sustainment or de-implementation of interventions could not be more timely given the "im...

The U.S. health care system is currently heading toward unsustainable health care expenditures and increased dissatisfaction with health outcomes. The objective of this population-based study is to uncover practical insights regarding patients with 1 or more chronic illnesses. A cross-sectional investigation was designed to gather data from health records drawn from diverse US geographic markets. A database of 9.74 million fully-insured, working individuals was used, together with members in the same households. Among nearly 3.43 million patients with claims, 2.22 million had chronic conditions. About 24.3% had 1 chronic condition and 40.4% had multi-morbidity. Health care expenditures for chronic conditions accounted for 92% of all costs (52% for chronic costs and 40% for nonchronic costs). Psychiatry, orthopedics-rheumatology, endocrinology, and cardiology areas accounted for two thirds of these chronic condition costs; nonchronic condition costs were dominated by otolaryngology, gastroenterology, dermatology, orthopedics-rheumatology conditions, and preventive services. About 50.1% of all households had 2 or more members with chronic conditions. In summary, multi-morbidity is prevalent not only among those older than age 65 years but also in younger and working individuals, and commonly occurs among several members of a household. The authors suggest that the disease-focused model of medicine should change to a more holistic illness-wellness model, emphasizing not only the physical but also the mental and social elements that can influence individual health. In that way the chronic care model could be broadened in context and content to improve the health of patients and households.

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It is widely held that fee-for-service (FFS) payment systems reward volume and intensity of services, contributing to overall cost inflation, while doing little to reward quality, efficiency, or care coordination. Recently, The National Commission on Physician Payment Reform (sponsored by SGIM) has recommended that payers "should largely eliminate stand-alone fee-for-service payment to medical practices because of its inherent inefficiencies and problematic financial incentives." As the current and former Chief Medical Officers of a large national insurer, we agree that payment reform is a critical component of health care modernization. But calls to transform payment simultaneously go too far, and don't go far enough. Based on our experience, we believe there are several critical ingredients that are either missing or under-emphasized in most payment reform proposals, including: health care is local so no one size fits all; upgrading performance measures; monitoring/overcoming unintended consequences; using a full toolbox to achieve transformation; and ensuring that the necessary components for successful delivery reform are in place. Thinking holistically and remembering that healthcare is a complex adaptive system are crucial to achieving better results for patients and the health system.

Table of contentsA1 Introduction to the 8th Annual Conference on the Science of Dissemination and Implementation: Optimizing Personal and Population HealthDavid Chambers, Lisa SimpsonD1 Discussion forum: Population health D&I researchFelicia Hill-BriggsD2 Discussion forum: Global health D&I researchGila Neta, Cynthia VinsonD3 Discussion forum: Precision medicine and D&I researchDavid ChambersS1 Predictors of community therapists’ use of therapy techniques in a large public mental health systemRinad Beidas, Steven Marcus, Gregory Aarons, Kimberly Hoagwood, Sonja Schoenwald, Arthur Evans, Matthew Hurford, Ronnie Rubin, Trevor Hadley, Frances Barg, Lucia Walsh, Danielle Adams, David MandellS2 Implementing brief cognitive behavioral therapy (CBT) in primary care: Clinicians' experiences from the fieldLindsey Martin, Joseph Mignogna, Juliette Mott, Natalie Hundt, Michael Kauth, Mark Kunik, Aanand Naik, Jeffrey CullyS3 Clinician competence: Natural variation, factors affecting, and effect on patient outcomesAlan McGuire, Dominique White, Tom Bartholomew, John McGrew, Lauren Luther, Angie Rollins, Michelle SalyersS4 Exploring the multifaceted nature of sustainability in community-based prevention: A mixed-method approachBrittany Cooper, Angie FunaioleS5 Theory informed behavioral health integration in primary care: Mixed methods evaluation of the implementation of routine depression and alcohol screening and assessmentJulie Richards, Amy Lee, Gwen Lapham, Ryan Caldeiro, Paula Lozano, Tory Gildred, Carol Achtmeyer, Evette Ludman, Megan Addis, Larry Marx, Katharine BradleyS6 Enhancing the evidence for specialty mental health probation through a hybrid efficacy and implementation studyTonya VanDeinse, Amy Blank Wilson, Burgin Stacey, Byron Powell, Alicia Bunger, Gary CuddebackS7 Personalizing evidence-based child mental health care within a fiscally mandated policy reformMiya Barnett, Nicole Stadnick, Lauren Brookman-Frazee, Anna LauS8 Leveraging an existing resource for technical assistance: Community-based supervisors in public mental healthShannon Dorsey, Michael PullmannS9 SBIRT implementation for adolescents in urban federally qualified health centers: Implementation outcomesShannon Mitchell, Robert Schwartz, Arethusa Kirk, Kristi Dusek, Marla Oros, Colleen Hosler, Jan Gryczynski, Carolina Barbosa, Laura Dunlap, David Lounsbury, Kevin O'Grady, Barry BrownS10 PANEL: Tailoring Implementation Strategies to Context - Expert recommendations for tailoring strategies to contextLaura Damschroder, Thomas Waltz, Byron PowellS11 PANEL: Tailoring Implementation Strategies to Context - Extreme facilitation: Helping challenged healthcare settings implement complex programsMona RitchieS12 PANEL: Tailoring Implementation Strategies to Context - Using menu-based choice tasks to obtain expert recommendations for implementing three high-priority practices in the VAThomas WaltzS13 PANEL: The Use of Technology to Improve Efficient Monitoring of Implementation of Evidence-based Programs - Siri, rate my therapist: Using technology to automa...