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

by Eric C. Schneider, Justin W. Timbie, D. Steven Fox, Kristin R. Van Busum, John Caloyeras

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Abstract

Insufficient evidence regarding the effectiveness of medical treatments has been identified as a key source of inefficiency in the U.S. healthcare system. Variation in the use of diagnostic tests and treatments for patients with similar symptoms or conditions 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. The federal government has made a dramatic investment in comparative effectiveness research (CER), with the expectation that CER will influence clinical practice and improve the efficiency of healthcare delivery. To do this, CER must provide information that supports fundamental changes in healthcare delivery and informs the choice of diagnostic and treatment strategies. This report summarizes findings from a qualitative analysis of the factors that impede the translation of CER into clinical practice and those that facilitate it. A case-study methodology is used to explore the extent to which these factors led to changes in clinical practice following five recent key CER studies. The enabling factors and barriers to translation for each study are discussed, the root causes for the failure of translation common to the studies are synthesized, and policy options that may optimize the impact of future CER — particularly CER funded through the American Recovery and Reinvestment Act of 2009 — are proposed.

Table of Contents

  • Chapter One

    Introduction and Summary of Approach

  • Chapter Two

    CATIE Case Study

  • Chapter Three

    COURAGE Case-Study Report

  • Chapter Four

    SPORT Case-Study Report

  • Chapter Five

    COMPANION Case-Study Report

  • Chapter Six

    CPOE Case-Study Report

  • Chapter Seven

    Factors Influencing the Translation of CER Research into New Clinical Practices: A Synthesis of Themes from the Case Studies

  • Chapter Eight

    Policy Implications of the Case-Study Results

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The research described in this report was sponsored by the U.S. Department of Health and Human Services and was conducted in RAND Health, a division of the RAND Corporation.

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