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Outcomes/Effectiveness Research

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Researchers describe challenges in translating research findings into clinical practice

Up to two decades may pass before the findings of original research become part of routine clinical practice, and often the findings are never implemented. A recent survey of principal investigators (PIs) of 13 Translating Research into Practice (TRIP) II projects supported by the Agency for Healthcare Research and Quality revealed several barriers to implementing TRIP projects as well as some successful solutions. The projects were designed to evaluate strategies to help accelerate the impact of health services research on direct patient care and to improve the outcomes, quality, effectiveness, efficiency, and/or cost-effectiveness of care through partnership arrangements.

The survey was conducted 6 months and 18 months into project implementation. Seven of the PIs responded during both survey periods, and all responded at least once. In the early months of TRIP implementation, challenges occurred often with the human subjects application process and with introducing new TRIP responsibilities at the study sites. A year later, the most prevalent barriers were process (such as blocked access to data), behavioral (target audience not participating), and structural (skill or system limitations at the study site).

For example, implementation of an intervention to improve asthma management met with resistance from agency staff. The research team found that the staff appeared not to trust the intervention and were sometimes overwhelmed by the tasks required for asthma management. To address the problems, the researchers made several minor adjustments to the intervention and provided the staff with necessary training. Early evidence of the positive impact of the intervention on families was used to win staff acceptance. An incentive program, including small monetary rewards and social recognition, was implemented for "asthma champions."

See "From research to daily clinical practice: What are the challenges in 'translation'?" by Chris Feifer, Dr.P.H., Judith Fifield, Ph.D., Steven Ornstein, M.D., and others, in the May 2004 Joint Commission Journal on Quality and Safety 30(5), pp. 235-245.

Editor's Note: Another AHRQ-supported study on a related topic applies methods to evaluate performance from industrial engineering to aid clinicians' efforts to measure safety and quality in acute care. For more details, see: Pronovost, P.J., Nolan, T., Zeger, S., and others (2004, March). "How can clinicians measure safety and quality in acute care?" (AHRQ grant HS11902). Lancet 363, pp. 1061-1067.

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