An implicit premise of the traditional pipeline is that, if an intervention is shown to be efficacious and reaches the effectiveness phase, the intervention will be widely implemented. However, this reasoning has proven to be faulty (McCannon, Berwick, & Massoud, 2007). There is no empirical evidence to support the assumption that uptake of interventions occurs on the basis of the strength of the evidence that an efficacy trial may yield. Although a strong evidence base is an important prerequisite for knowledge translation or moving evidence from research to practice (Grimshaw, Eccles, Lavis, Hill, & Squires, 2012), the integration of evidence into practice does not happen magically or of its own accord (Wilson, Brady, & Lesesne, 2011). Furthermore, although the scientific reporting of trial outcomes is critical, publications alone do not lead to the adoption of evidence. A more systematic approach is necessary (see Chapter 21 on the dissemination process).
Hence, there is growing recognition that the road toward implementation of interventions in real settings is actually more challenging and nuanced, requiring time and enactment of purposeful actions, than previously considered (see Chapters 19 and 20 for further discussion of this point). This more recent way of thinking is reflected in an elongated pipeline shown in Figure 2.2. This alternative pipeline suggests that moving interventions forward into real-world settings requires additional phases and associated activities. As illustrated, this pipeline involves three additional phases reflecting the systematic processes that need to occur to move an intervention from effectiveness (Phase IV) to its integration within a practice environment (Gitlin, 2013). This elongated pipeline is referred to throughout this book.
Figure 2.2 Elongated pipeline.