'Bench To Behavior': Translating Comparative Effectiveness Research Into Improved Clinical Practice

From Health Affairs.

By Jerry Avorn, MD and Michael Fischer, MD.

SUMMARY: This Health Affairs article by Avorn and Fischer addresses the challenge of translating comparative effectiveness research (CER) findings from the bench into actual improvements in clinical practice. The authors argue that the national investment in CER — stimulated in part by the American Recovery and Reinvestment Act — will generate an unprecedented volume of new head-to-head comparisons of drugs and other interventions, but that generating evidence is insufficient if it does not reach and change the behavior of front-line health care professionals. The piece draws on the academic detailing literature and behavioral change theory to identify the obstacles clinicians face in adopting new evidence and proposes strategies — including academic detailing — for bridging the gap.

BACKGROUND: A new national emphasis on comparative effectiveness research was projected to generate unprecedented volumes of clinical evidence comparing therapeutic alternatives. The challenge of translating this evidence into clinical practice remained largely unaddressed.

KEY FINDINGS: Front-line health care professionals face significant obstacles in translating CER findings into improved clinical decision-making. Academic detailing and similar educational outreach interventions offer evidence-based mechanisms for bridging the gap between research findings and clinical behavior.

IMPLICATIONS: National investment in CER must be paired with investment in evidence dissemination strategies — including academic detailing — or the clinical value of that research will not be realized at the bedside.