Schneider Eric C, Timbie Justin W, Fox D Steven, Van Busum Kristin R, Caloyeras John P
Rand Health Q. 2013 Feb 28;2(4):5. eCollection 2013 Winter.
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 article 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.
关于医学治疗效果的证据不足已被认定为美国医疗体系效率低下的一个关键根源。对于症状或病情相似的患者，诊断检测和治疗方法的使用存在差异，这被归因于临床不确定性，因为已发表的科学证据基础并未提供足够信息来确定哪些治疗方法对有特定临床需求的患者最为有效。联邦政府已对比较效果研究（CER）进行了巨额投资，期望CER能影响临床实践并提高医疗服务的效率。要做到这一点，CER必须提供支持医疗服务根本性变革的信息，并为诊断和治疗策略的选择提供依据。本文总结了对阻碍CER转化为临床实践的因素以及促进其转化的因素进行定性分析的结果。采用案例研究方法来探究在最近五项关键的CER研究之后，这些因素在多大程度上导致了临床实践的变化。讨论了每项研究中转化的促成因素和障碍，综合了这些研究中翻译失败的共同根本原因，并提出了可能优化未来CER影响的政策选择，特别是通过2009年《美国复苏与再投资法案》资助的CER。
