This project had three main objectives. First, we sought to develop a framework with which to organize the array of barriers and enablers that influence the translation of CER evidence into new clinical practices. Prior frameworks, such as those developed by Rogers and many of those summarized by Greenhalgh, were extraordinarily helpful but were not necessarily tailored to the unique interaction between healthcare innovations, scientific evidence, payment policy, professional norms, and the asymmetry of knowledge between patients and clinicians about new practices and technologies (Rogers, 1995; Greenhalgh, Robert, et al. 2004). We anticipated that a simplified framework would enable us to isolate the key factors affecting each phase of the CER translation process, beginning with the generation of CER evidence and ending with actual adoption of new practices. We believed this framework could also inform future research on translation of CER into practice.
The second objective was to conduct case studies of the adoption of new clinical practices, using five key CER studies published in the past 15 years, and to identify key themes relating to the rapid or delayed adoption of new practices that emerged from the case studies. We held discussions with stakeholders representing a broad range of perspectives and examined the peer-reviewed literature associated with each study. Our framework guided our discussions and helped to ensure that we considered potential factors influencing all phases of the CER translation process. Synthesizing common themes across case studies provided insight into the “root causes” for the failure of CER to rapidly change clinical practice.
Our third objective was to help policymakers develop practical strategies that facilitate dissemination of CER-based clinical practices and thus maximize the effectiveness of the federal government’s current investment in CER. To do this, we developed policy options—informed by our expert panel and partners at the HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE)—and identified research needs. Our overall approach comprises a replicable methodology that can inform larger-scale, prospective, in-depth qualitative and quantitative research on the impact of the federal investment in CER.