Dissemination and Adoption of Comparative Effectiveness Research Findings When Findings Challenge Current Practices.

摘要

Insufficient evidence regarding the effectiveness of medical treatments has been identified as a key source of inefficiency in the U.S. healthcare system. Clinicians vary widely in their recommendation and use of diagnostic tests and treatments for patients with similar symptoms or conditions. This variation 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. A dramatic federal investment in comparative effectiveness research (CER) was made possible through the American Recovery and Reinvestment Act of 2009 (ARRA), with the expectation that the results will not only influence clinical practice but will also 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. Many new tests and treatments commonly adopted today are not completely grounded in scientific evidence. Some remain entrenched even when unambiguous scientific evidence about superior alternative approaches emerges. Other new clinical practices are not quickly adopted, either because information about them does not reach decisionmakers in a usable format or because of other barriers to their adoption.