Having the best evidence at hand is vitally important for making health care treatment decisions. But even when the right—or best—information is available, it isn’t always put to use in clinical practice.
Why? Although we are getting better at generating evidence, we’re still not doing a great job of using it.
Our progress in creating a robust pipeline of comparative effectiveness research (CER) is clear. By 2019, the Patient Centered Outcomes Research Institute (PCORI) is expected to receive an estimated $3.5 billion from the PCOR Trust Fund to fund CER. CER is not new, but the investment in PCORI represents a national appetite for a robust and reliable queue of research to overcome one of the greatest perennial challenges in health care delivery—knowing what works, for whom it will work and under what conditions.
CER offers every provider, patient and payer the promise of better care, yet its impact on patient outcomes remains on the horizon, rather than a reality in health care settings today. Why? Research published recently in the American Journal of Managed Care suggests that changes are needed in order to see more consistent translation of research findings into clinical practice. In short, at the moment, we have a hard time using what we learn from CER.
This research examined how major CER studies have impacted care. We evaluated real-world utilization trends before and after a) publication of CER findings and b) the release of relevant clinical practice guidelines (CPGs) from four high-profile CER studies published within the last decade.
The research we examined tells the story. Under the microscope were four major studies, including: PROVE-IT, an examination of cholesterol-lowering treatment strategies from 2004; MAMMOGRAPHY WITH MAGNETIC RESONANCE IMAGING (MRI), a comparison of diagnostics to detect breast cancer from 2004; SPORT a comparison of surgical and non-operative treatments for herniated disks from 2006; and COURAGE, a comparison of percutaneous coronary intervention (PCI) to optimal medical therapy (OMT) for people with coronary artery disease, from 2007.
These studies delved into pressing therapeutic questions, and the findings of each study revealed new thinking in optimizing care for patients. But, despite the shifts in care that could have—or should have—occurred, our analysis revealed no clear pattern of utilization in the first four quarters after publication. Even after the studies were incorporated into CPG, we were not able to consistently find changes in utilization or clinical practice.