How can we be sure that scientific discoveries important to health care are actually put into effect in our professional and personal lives? What is being done to touch the right bases, speed the process and evaluate the results?" To shed light on these questions, the National Institute of Nursing Research and the Clinical Center department of nursing recently convened the conference "From Scientific Discovery to Practice -- What Does It Take to Bring Out Changes in Health Care?"
The morning session featured several nurse researchers funded by NINR who described their experiences translating their findings into practice.
The afternoon session was devoted to two panel discussions that identified barriers to use of research results in practice: Economics, specifically the issue of reimbursement, is of particular concern. Providers lack incentives for change, especially when payers will not reimburse them for new and untried approaches. Managed care organizations still take a short-term perspective that resists preventive and risk-reduction interventions. Furthermore, their payment codes do not adequately cover nursing and other services that are part of research projects.
Another obstacle is turf battles among disciplines. This can be alleviated through multidisciplinary approaches that involve different professions and specialties working together.
The sanctity of randomized controlled trials (RCTs) may also hamper research. It was suggested that not all studies need to be RCTs. For example, some are conducted simply to confirm what is already known from 30 years of clinical experience and anecdotal evidence. Behavioral studies, in particular, can be complex, expensive and time-consuming. While RCTs are invaluable to produce good science, there needs to be greater openness to evidence from other methodologies such as meta-analyses, observational studies and retrospective chart audits.
To speed research into practice, the panels highlighted the importance of champions -- advocates within institutions that push for innovations. Academic researchers are under pressure to move to the next study rather than spend time disseminating and implementing their findings. Moreover, guidelines from outside organizations have not been sufficient to ensure change. What has been helpful is to retrofit research findings and guidelines to make them the institution's own -- then enlist the help of internal "champions." Kaiser of Northern California trains at least one person in each of its 17 hospitals to act as a local champion for change. Researchers can also encourage dissemination up front by including clinicians and voluntary agencies as collaborators on study design and as part of the research team. This "buy-in" effect is a critical element for influencing change down the road. There were also suggestions that federal government provide funding for diffusion of research and for mechanisms promoting use of research findings, possibly as an adjunct to research grants.
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