Stevens Lesley Ann, Levin Adeera
Tufts-New England Medical Center, Boston, MA, USA.
Adv Ren Replace Ther. 2004 Jan;11(1):66-75. doi: 10.1053/j.arrt.2003.10.010.
Chronic Kidney disease (CKD) has been identified as a public health epidemic, fueled in part by improved outcomes of both diabetic and cardiac patient populations, as well as by the increasing recognition that it is possible to identify CKD at earlier stages. The estimated 8 to 10 million Americans that have CKD, with its concomitant morbidity and mortality, have the potential to overwhelm the current system of specialty practice medicine and health care resources. How can clinicians, clinician scientists, and health care administrators translate research findings into clinical practice in an effective manner to improve the care of this burgeoning patient group? The challenge of translating research into clinical care requires identification of that which we do and do not know, communication of knowledge between those who do and do not know, and efficient collection of information for systematic evaluation. This article will describe the challenges of translating current research findings into clinical practice. There is a need to identify the complexity of CKD disease processes and issues associated with delivery of care and to describe the difficulties in the dissemination of new knowledge to physicians. Because of the propensity of CKD to affect identifiable groups of patients, we will discuss the potential challenges of these strategies given the racial, ethnic, and cultural diversity in North America. A potential solution to these challenges is a new paradigm of "process-based medicine" that integrates clinical and basic science research findings with multidisciplinary and shared care models of health care delivery. In this context, attention to advances in information technology, the cognitive processes that underlie physician learning, and the findings of outcome research may ensure true integration of clinical research and clinical practice.
慢性肾脏病（CKD）已被视为一种公共卫生流行病，部分原因是糖尿病和心脏病患者群体的治疗效果有所改善，以及人们越来越认识到有可能在更早阶段识别出CKD。据估计，美国有800万至1000万人患有CKD，随之而来的发病率和死亡率有可能压垮当前的专科医疗体系和医疗保健资源。临床医生、临床科研人员和医疗保健管理人员如何才能有效地将研究成果转化为临床实践，以改善对这一不断壮大的患者群体的护理呢？将研究转化为临床护理面临的挑战需要明确我们已知和未知的内容，在已知者和未知者之间进行知识交流，并高效收集信息以进行系统评估。本文将描述将当前研究成果转化为临床实践所面临的挑战。有必要明确CKD疾病过程的复杂性以及与护理提供相关的问题，并描述向医生传播新知识的困难。由于CKD倾向于影响特定的患者群体，鉴于北美地区的种族、民族和文化多样性，我们将讨论这些策略可能面临的潜在挑战。应对这些挑战的一个潜在解决方案是一种新的“基于过程的医学”范式，它将临床和基础科学研究成果与多学科和共享护理的医疗保健提供模式相结合。在这种背景下，关注信息技术的进步、医生学习的认知过程以及结果研究的发现，可能确保临床研究与临床实践的真正整合。
