Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Canada.
Computational Statistics and Machine Learning Group, Department of Statistics, University of Oxford, Oxford, United Kingdom.
Elife. 2023 Feb 28;12:e82498. doi: 10.7554/eLife.82498.
The absence of evidence to assess treatment efficacy partially underpins the unsustainable expenditure of the US healthcare system, a challenge exacerbated by a limited understanding of the factors influencing the translation of clinical research into practice. Leveraging a dataset of >10,000 UpToDate articles, sampled every 3 months between 2011 and 2020, we trace the path of research (37,050 newly added articles from 887 journals) from initial publication to the point-of-care, compared to the 2.4 million uncited studies published during the same time window across 18 medical specialties. Our analysis reveals substantial variation in how specialties prioritize/adopt research, with regards to a fraction of literature cited (0.4-2.4%) and quality-of-evidence incorporated. In 9 of 18 specialties, less than 1 in 10 clinical trials are ever cited. Furthermore, case reports represent one of the most cited article types in 12 of 18 specialties, comprising nearly a third of newly added references for some specialties (e.g. dermatology). Anesthesiology, cardiology, critical care, geriatrics, internal medicine, and oncology tended to favor higher-quality evidence. By modeling citations as a function of National Institutes of Health (NIH) department-specific funding, we estimate the cost of bringing one new clinical citation to the point-of-care as ranging from thousands to tens of thousands of dollars depending on specialty. The success of a subset of specialties in incorporating a larger proportion of published research, as well as high(er) quality of evidence, demonstrates the existence of translational strategies that should be applied more broadly. In addition to providing a baseline for monitoring the efficiency of research investments, we also describe new 'impact' indices to assess the efficacy of reforms to the clinical scientific enterprise.
缺乏评估治疗效果的证据部分导致美国医疗保健系统的支出不可持续，由于对影响将临床研究转化为实践的因素的理解有限，这一挑战更加严重。利用一个包含超过 10000 篇 UpToDate 文章的数据集，这些文章是在 2011 年至 2020 年期间每 3 个月采样一次的，我们追溯了研究的路径（从 887 种期刊中新增的 37050 篇文章），从最初的发表到实际应用，与同一时期在 18 个医学专业中发表的 240 万篇未被引用的研究进行了比较。我们的分析表明，不同专业在优先考虑/采用研究方面存在很大差异，涉及到引用文献的比例（0.4-2.4%）和纳入的证据质量。在 18 个专业中的 9 个专业中，不到 10%的临床试验被引用。此外，病例报告在 18 个专业中的 12 个专业中是被引用最多的文章类型之一，在一些专业（如皮肤科）中占新增参考文献的近三分之一。麻醉学、心脏病学、危重病学、老年病学、内科学和肿瘤学倾向于采用更高质量的证据。通过将引用次数建模为 NIH 特定部门资助的函数，我们估计将一个新的临床引用带到实际应用中的成本因专业而异，从几千美元到几万美元不等。少数几个专业能够纳入更大比例的已发表研究，并采用更高质量的证据，这表明存在应该更广泛应用的转化策略。除了为监测研究投资效率提供基准外，我们还描述了新的“影响”指数，以评估对临床科学事业改革的效果。
