Dissemination and Adoption of Comparative Effectiveness Research Findings When Findings Challenge Current Practices. Chapter Eight: Policy Implications of the Case-Study Results

01/01/2013

The federal investment in CER has many objectives. In contrast to the traditional research agenda defined by a peer-review process in which research priorities are based primarily on the novelty and scientific interest of the topic, the CER agenda is supposed to be set by a broader set of stakeholders. Providing better evidence to support the decisions of clinicians and patients, thereby making healthcare delivery more effective and efficient, is the overarching goal envisioned by the architects of CER.

Translation of research into practice is not a new concern. Since the dawn of scientific medicine, physicians have noted the difficulty of changing established patterns of practice on the basis of scientific evidence. In at least the past two decades, many efforts, including evidence-based medicine, quality measurement, quality improvement, and electronic clinical decision support, to name a few, have focused on improving the manner in which healthcare is delivered, overcoming what Eisenberg referred to as “voltage drops” along the pathway from scientific knowledge to clinical practice (Eisenberg and Power, 2000). More recently, implementation science has come into its own as a field of study.

The case studies in this report led us to conclude that the translation of CER research into practice comprises five phases: generation, interpretation, formalization, dissemination, and implementation. Under some circumstances, CER evidence can move through these five phases relatively quickly, but in many cases, the evidence languishes or is never implemented at all. Our case studies suggest that the pathway through the five phases is arduous and that there is a high risk that CER evidence will fail to influence practice.

Chapter Seven summarized our analysis of the root causes of the failure to translate CER evidence into clinical practice. While these are formidable, they are not insurmountable. In this chapter, we reflect on the policy implications of the case studies and identify policy options that can address the root causes of failure and promote more effective translation of CER evidence into local practice settings. We begin with a description of the infrastructure that would enable effective translation, and we then suggest policy options that could be deployed in the following areas: governance, standards, financing, professionalism, marketing and education, and research and evaluation. The list of options is not intended to be an exhaustive or detailed policy prescription. Rather, we believe that our case studies have identified some of the high-leverage opportunities that policymakers, including members of PCORI, may find useful as they chart a course forward.

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