"Funding from the Agency for Healthcare Research and Quality (AHRQ) provided the basis for knowledge generation, accelerating my translational research work, and putting evidence into practice.  Over time, AHRQ funding was also fundamental in supporting my efforts to develop career and scientific training programs that accelerated learning health systems research and implementation science."

Implementation research—the science of putting evidence-based interventions and findings into practice and policy—can help researchers and practitioners identify what, why, and how interventions work.  It can also help them identify challenges and make adaptations in order to maximize results, thereby improving patient outcomes.

Patient safety, coupled with implementation science, are important components in the research career of Ralph Gonzales, M.D., M.S.P.H., professor of medicine, epidemiology & biostatistics, and health policy at the University of California San Francisco (UCSF), School of Medicine.  After beginning his AHRQ research more than 20 years ago, Dr. Gonzales has played a significant role in national and global efforts to combat antimicrobial resistance by improving antibiotic prescribing.  When antibiotics are prescribed inappropriately or not taken correctly, the bacteria that antibiotics are meant to treat can develop resistance; medications no longer work to combat infection.  In 2001, Dr. Gonzales received a 5-year AHRQ grant to reduce the overuse of antibiotics to treat acute respiratory tract infections in Denver primary care practices.  His project, Minimizing Antibiotic Resistance in Colorado (MARC), evaluated the impact of educational interventions and a mass media campaign, "Get Smart Colorado," to inform patients, physicians, and the general public about unnecessary antibiotic use.  The MARC project did help reduce antibiotic use in the community.  However, results varied depending on the age group and ethnicity.  "The approaches used in MARC have been shared and adopted by many international initiatives and countries: Mexico, Central and South America, Europe, and Africa," Dr. Gonzales said.

In 2003, Dr. Gonzales received another 5-year AHRQ grant that allowed him to expand on his antibiotic stewardship work.  This time, he worked to translate some of the lessons learned from primary care practices and apply them to other acute care settings.  Dr. Gonzales used combined educational interventions for both prescribers and patients and found a reduction in antibiotic use in upper respiratory infections and acute bronchitis.  These measures for appropriate antibiotic prescribing were adopted by the Healthcare Effectiveness Data and Information Set (HEDIS®), a performance measurement improvement tool from the National Committee on Quality Assurance.

Dr. Gonzales's first two grants focused on changing physician and patient behaviors to advance appropriate antibiotic prescribing practices for acute respiratory infections.  These approaches served as the foundation for his evolution as an implementation scientist and innovator.  “In order to achieve meaningful and sustainable behavior changes, the research must be embedded within the healthcare delivery system from intervention design to implementation and evaluation,” Dr. Gonzales explained.

The pivotal evolution of his research shift towards implementation science and learning health systems (LHS) began with his third AHRQ grant in 2018.  Learning Health Systems are health and healthcare systems in which knowledge generation processes are put into practice to improve individual and population health.  As a result, patients receive higher quality, safer, more efficient care, and health delivery organizations become better places to work.  As lead investigator, Dr. Gonzales served as a mentor to eight researchers who conducted patient-centered outcomes research within a LHS.

Building on his LHS project, Dr. Gonzales received a 4-year AHRQ grant in 2024.  This project creates a training program for 60 LHS scientists with diverse backgrounds.  The program aims to provide researchers with the research, engagement, and leadership skills necessary to pursue successful careers as LHS scientists.  Their research projects will improve the quality and health outcomes for patients of all backgrounds, with results disseminated through local health systems, publications in medical literature, and presentations at national meetings.  This project ends December 31, 2028.

Related AHRQ Resources

• Learning Health Systems
• Translational Research
• Patient-Centered Care
• Patient Safety
• Healthcare-Associated Infections