Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA.
Med Care. 2013 Aug;51(8 Suppl 3):S87-91. doi: 10.1097/MLR.0b013e31829b1d66.
Accelerating clinical and translational science and improving healthcare effectiveness, quality, and efficiency are top priorities for the United States. Increasingly, the success of such initiatives relies on leveraging point-of-care activities, data, and resources to generate evidence through routine practice. At present, leveraging healthcare activities to advance knowledge is challenging. Underlying these challenges are a variety of persistent technological, regulatory, fiscal, and socio-organizational realities. Fundamentally, these result from the fact that the current healthcare system is designed around a paradigm that enables individual patient care and views the connection between research and practice as unidirectional (ie, research findings are applied to practice using evidence-based medicine) but does not support research-related activities during practice. We suggest that a fundamental paradigm shift is needed to redefine the relationship between research and practice as bidirectional rather than unidirectional and propose the concept of evidence generating medicine to provide a framework for realizing such a shift. We discuss how a transition toward evidence generating medicine would result in a range of much-needed system-level changes that would facilitate rather than frustrate the ongoing efforts of informaticians, health services researchers, and others working to accelerate research and improve healthcare.
加速临床和转化科学，提高医疗保健的效果、质量和效率，是美国的首要任务。此类举措的成功越来越依赖于利用即时医疗活动、数据和资源，通过常规实践产生证据。目前，利用医疗保健活动来推进知识发展具有挑战性。这些挑战的根本原因是存在各种持续存在的技术、监管、财政和社会组织现实问题。从根本上说，这是由于当前的医疗保健系统是围绕着一种模式设计的，这种模式能够实现个体患者护理，并将研究与实践之间的联系视为单向的（即，研究结果通过循证医学应用于实践），但不支持实践过程中的研究相关活动。我们认为，需要进行根本性的范式转变，将研究与实践之间的关系重新定义为双向的，而不是单向的，并提出循证医学的概念，为实现这一转变提供框架。我们讨论了向循证医学的转变将如何导致一系列急需的系统层面的变化，这些变化将促进而不是阻碍信息学家、卫生服务研究人员和其他致力于加速研究和改善医疗保健的人的努力。
