The federal investment in CER made possible through ARRA was a dramatic commitment of resources to clinical research, with the expectation that CER results would not simply influence clinical practice but would also improve the efficiency of healthcare delivery. To do this, CER must provide information that supports fundamental changes to healthcare delivery and informs the choice of diagnostic and treatment strategies. Such information could produce substantial reductions in the growth of healthcare spending. In an economy largely driven by technological innovation, the dissemination of new diagnostic tests, procedures, and treatments is relatively frequent and ongoing. However, many of these new tests and treatments, even those that are widely adopted, are not completely grounded in scientific evidence. Some (including prostate screening tests, use of drug-eluting stents, and certain types of surgery for vertebral fractures) become widely entrenched and are difficult to dislodge despite unambiguous scientific evidence about superior alternative approaches (Redberg, 2011). At the same time, many new clinical practices are not quickly adopted, either because information does not reach decisionmakers in a usable format or because other barriers prevent their adoption.
If the goal of CER is to quickly achieve maximal impact on practice, historical barriers to the translation of CER evidence into new practices must be overcome. The CER translation process occurs within a complex environment involving multiple stakeholders who influence the way in which CER results are interpreted through the dissemination of messages, policies, or decision support tools that may facilitate or retard the rate at which new practices are adopted. These stakeholders, including pharmaceutical and device manufacturers, payers, federal and state policymakers, medical publishers, and the popular press, each have financial, professional, or advocacy interests that may conflict or align with new research findings. Many current dissemination strategies fail to address the specific social context in which physicians practice and may also fail to address patients’ needs for unbiased information. Effective dissemination strategies will be needed to overcome CER translation barriers, but there is limited evidence on the effectiveness of strategies used to disseminate past CER evidence and associated clinical practices.