Dissemination and Adoption of Comparative Effectiveness Research Findings When Findings Challenge Current Practices

Dissemination and Adoption of Comparative Effectiveness Research Findings When Findings Challenge Current Practices

Eric C. Schneider
Justin W. Timbie
D. Steven Fox
Kristin R. Van Busum
John P. Caloyeras
Copyright Date: 2011
Published by: RAND Corporation
Pages: 132
https://www.jstor.org/stable/10.7249/j.ctt3fh0hb
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  • Book Info
    Dissemination and Adoption of Comparative Effectiveness Research Findings When Findings Challenge Current Practices
    Book Description:

    A qualitative analysis of the factors that impede the translation of comparative effectiveness research (CER) into clinical practice and those that facilitate it. Case studies of five recent CER studies are used to explore the extent to which these factors led to changes in clinical practice. The root causes for the failure of translation are synthesized, and policy options to optimize the impact of future CER are proposed.

    eISBN: 978-0-8330-7936-7
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-ii)
  2. Preface
    (pp. iii-iv)
  3. Table of Contents
    (pp. v-viii)
  4. Figures and Tables
    (pp. ix-x)
  5. Executive Summary
    (pp. xi-xxx)

    Insufficient evidence regarding the effectiveness of medical treatments has been identified as a key source of inefficiency in the U.S. healthcare system. Clinicians vary widely in their recommendation and use of diagnostic tests and treatments for patients with similar symptoms or conditions. This variation has been attributed to clinical uncertainty, since the published scientific evidence base does not provide adequate information to determine which treatments are most effective for patients with specific clinical needs.

    A dramatic federal investment in comparative effectiveness research (CER) was made possible through the American Recovery and Reinvestment Act of 2009 (ARRA), with the expectation that...

  6. Acknowledgments
    (pp. xxxi-xxxii)
  7. Abbreviations
    (pp. xxxiii-xxxv)
  8. CHAPTER ONE Introduction and Summary of Approach
    (pp. 1-14)

    Insufficient evidence regarding the effectiveness of medical treatments has been identified as a key source of inefficiency in the U.S. healthcare system. Clinicians vary widely in their recommendation and use of diagnostic tests and treatments for patients with similar symptoms or conditions. This variation has been attributed to clinical uncertainty, since the current published scientific evidence base does not provide adequate information to determine which treatments are most effective for patients with specific clinical needs. A surprisingly high proportion of the healthcare services received by patients today may have limited value, while some care may even be harmful (Owens, Qaseem,...

  9. CHAPTER TWO CATIE Case Study
    (pp. 15-24)

    The first antipsychotic medication, chlorpromazine, was introduced in 1954. A major side effect of this and other “first-generation” drugs was the development of extrapyramidal symptoms, including several serious movement disorders such as tardive dyskinesia. In 1990, the Food and Drug Administration (FDA) approved clozapine for a limited set of indications (limited because of the risk of serious, life-threatening side effects), ushering in the second generation of antipsychotic medications. The fundamental clinical difference between the first- and second-generation antipsychotics was the lower risk of extrapyramidal symptoms in the latter. The second-generation medications came to be known as “atypical” antipsychotics. The mechanism...

  10. CHAPTER THREE COURAGE Case-Study Report
    (pp. 25-36)

    Treatment guidelines for patients with stable coronary artery disease (CAD) recommend an initial strategy of intensive medical therapy along with risk-factor reduction and initiation of lifestyle interventions, collectively known as optimal medical therapy (OMT). However, over the past 30 years, percutaneous coronary intervention (PCI) has increasingly been used as an initial strategy for patients with stable CAD. Approximately 85 percent of all PCI procedures are performed on patients with stable CAD (Boden, O’Rourke, et al., 2007); the remaining 15 percent are performed on patients with acute coronary syndrome (ACS), an emergency condition. PCI is also indicated for the relief of...

  11. CHAPTER FOUR SPORT Case-Study Report
    (pp. 37-48)

    Spinal stenosis is a narrowing of the vertebral canal that compresses spinal nerves and may cause back and leg pain and difficulty walking. Lumbar spinal stenosis is one of the most common degenerative conditions of the spine and is the most common reason for lumbar spine surgery on the elderly (Weinstein, Tosteson, et al., 2008). Treatment of spinal stenosis may involve nonsurgical care, decompression surgery (involving the removal of bone and ligaments around the stenosis), or spinal fusion surgery (with or without the use of implants).

    Rates of spinal surgery increased dramatically in the Medicare population between 1992 and 2003...

  12. CHAPTER FIVE COMPANION Case-Study Report
    (pp. 49-60)

    The five-year mortality rate following a diagnosis of heart failure (HF) is 50 percent, even with optimal medical therapy. HF is also associated with a poor functional status (Friedewald, Boehmer, et al., 2007). For patients with both HF and delayed electrical conduction in the ventricles (wide QRS), treatment with cardiac resynchronization therapy (CRT), using an implantable pacemaker to stimulate both ventricles, has been shown to be effective in improving functional status (Abraham, Fisher, et al., 2002). However, the efficacy of CRT had not been established for those HF patients who also require an implantable cardiac defibrillator (ICD) to treat intermittent...

  13. CHAPTER SIX CPOE Case-Study Report
    (pp. 61-70)

    Over at least two decades, concerns have grown about the prevalence and impact of medication errors. It is estimated that more than 1 million serious medication errors occur annually in the United States, contributing to 7,000 annual medication-error-related deaths (Kuperman, Bobb, et al., 2007). On average, a medication error is estimated to add $2,000 to the cost of hospitalization. These numbers suggest that medication errors account for roughly $7.5 billion a year nationwide in hospital costs alone (Leapfrog Group, 2008). Medication (prescribing) errors occur for many reasons. Traditionally, physicians have relied on paper-based, handwritten prescribing, followed by the actions of...

  14. CHAPTER SEVEN Factors Influencing the Translation of CER Research into New Clinical Practices: A Synthesis of Themes from the Case Studies
    (pp. 71-80)

    As the preceding chapters illustrate, a myriad of factors influence whether CER translation into clinical practice is ultimately successful. However, our synthesis suggests that some of these factors are “root causes,” i.e., they are fundamental and may represent high-leverage points for action to improve adoption of a new practice. We have identified at least five root causes of the failure of CER to change clinical practice. They manifest themselves in somewhat different ways across the case studies, appear to explain the strategies of many stakeholders who have an interest in CER, and typically exert their effects over multiple phases of...

  15. CHAPTER EIGHT Policy Implications of the Case-Study Results
    (pp. 81-90)

    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...

  16. References
    (pp. 91-97)