Shortening the journey from evidence to practice: The benefits and complexities of hybrid implementation-effectiveness trials

Translating evidence into practice is a long and arduous journey: 17 years, as the refrain goes. A traditional view sees this journey as linear; first, efficacy studies prove benefit, then effectiveness research creates knowledge in real-world settings, and finally, implementation science focuses on understanding and promoting uptake. With any one study in any phase potentially taking years to complete, the long period between the start of this journey and its end is unsurprising but, unfortunately, infeasible in the modern clinical care environment that needs treatment answers today. To address this evidence-to-implementation gap, hybrid effectiveness–implementation study designs have emerged, blending elements of effectiveness and implementation design to improve research efficiency and speed up knowledge translation. In this issue of AnnalsATS, Peltan and colleagues give us an opportunity to consider the value and challenges of implementation research and hybrid implementation–effectiveness study designs. They report the results of a pilot hybrid trial of a complex and multifaceted program of several implementation strategies that, together, aimed to increase the use of lung protective ventilation directly (through audit and feedback, education, and championing of lung protective ventilation) and indirectly (by promoting increased use of clinical decision support tools in place to facilitate clinical decision-making). Not only was the implementation itself multimodal, but the intended mechanism of practice change was also multipronged. They found that adherence to low tidal volume ventilation and other implementation outcomes indeed improved after intervention; however, no improvement was noted in several effectiveness outcomes, including mortality and ventilator-free days.