Office of Research and Development, US Department of Veterans Affairs, Washington, District of Columbia 20420, USA.
Am J Med. 2010 Dec;123(12 Suppl 1):e38-45. doi: 10.1016/j.amjmed.2010.10.007.
Comparative effectiveness research (CER) holds the promise of improving patient-centered care and increasing value in the healthcare system. Achieving these goals, however, depends on effectively implementing the findings of CER. In this article, we draw on lessons from implementation research and our experience in the Veterans Administration (VA) healthcare system to offer recommendations about what is needed to support implementation of CER. There is no single strategy for successful implementation. Implementation efforts must take into account the nature of the evidence, the type of change being implemented, the clinical context in which the findings are being applied, and the specific barriers and facilitators to implementing new practices. The experience of the VA illustrates the importance of taking a systems approach that aligns numerous elements of the healthcare system--guidelines, decision support, performance measures, financial incentives, coverage and benefits policy, and health information technology--to support implementation:. We illustrate these principles with an example of implementing a new model of evidence-based depression care.
比较疗效研究（CER）有望改善以患者为中心的医疗服务并提高医疗体系的价值。然而，要实现这些目标，取决于能否有效地将 CER 的研究结果付诸实施。本文借鉴实施研究的经验教训以及我们在退伍军人管理局（VA）医疗体系中的经验，就如何为支持 CER 的实施提供建议。成功实施没有单一的策略。实施工作必须考虑证据的性质、实施的变革类型、应用研究结果的临床背景，以及实施新实践的具体障碍和促进因素。VA 的经验表明，采取系统方法的重要性，该方法需要调整医疗体系的众多要素——指南、决策支持、绩效指标、财务激励、覆盖范围和福利政策以及健康信息技术——以支持实施：我们用一个实施新的基于证据的抑郁症治疗模式的例子来说明这些原则。
