Research to practice is a hard journey, experts say

Meeting stresses need of research-to-practice process

"Evidence-based medicine" the term just sounds right — doesn’t it? Yet, while it flows easily off the tongues of quality professionals these days, that ease belies the true challenge of "TRIP," Translating Research into Practice, which served as the focal point of a conference held in Washington, DC, July 12-14.

The TRIP 2004 conference, Translating Research Into Practice: Advancing Excellence from Discovery to Delivery, featured sessions on the most current information technology for translating research into clinical practice, top strategies for leveraging research findings to improve care for patients with low health literacy, and key lessons learned in developing programs such as reducing health disparities.

The conference was sponsored by the Agency for Healthcare Research and Quality (AHRQ), the National Cancer Institute, and the Department of Veterans Affairs, with support from the Substance Abuse and Mental Health Services Administration, the National Institute of Mental Health, and the National Institute on Drug Abuse.

Asked if there was an overriding theme that emerged from the conference, Jean Slutsky, PA, MSPH, acting director of AHRQ’s centers for outcomes and evidence, whose staff played a key role in putting the conference together, replies, "Probably the biggest take-home message is that it’s really hard to do this."

Which makes forums like this all the more important, she points out. "Putting together researchers and users at conferences like this is incredibly fruitful. There were people there like your readers, who use the information, and then there were researchers, who produce it. It’s a unique opportunity for that interaction to take place," Slutsky observes.

Progress being made

Slutsky notes that there are already examples developing where research can be translated into practice.

"For example, there are certain uses of IT [information technology] that actually deliver this information to the bedside or the nurse’s station where it is needed, such as CPOE [computerized physician order entry], and PDA [personal digital assistant] downloads. The web sites can come up on your screen. Also, some electronic medical records can access evidence-based information," she says.

The advantage of systems like these, Slutsky explains, is that all the required information is delivered in a packaged form; the health care professional does not have to conduct his or her own haphazard search.

Being able to deliver the information at different levels of sophistication is equally important, she adds.

"One of the issues for patients is that there is very sophisticated work being done on the web. It may even be directed at the health professional," Slutsky adds. "There are some patients, however, who either speak a foreign language or are not well-educated or facile, which puts them at a disadvantage."

Thus, presentation should be adjusted so as not to shut these patients out, she says.

"We must target health information to a literacy level appropriate for different groups and perhaps translated into different languages," Slutsky suggests.

Networks showing promise

One approach showing particular promise is networks of health care organizations that share information and suggest needed areas of research, says Cynthia S. Palmer, MS, a research scientist at AHRQ who runs the Integrated Delivery Systems Research Network (IDSRN), which consists of nine partners and about 40 collaborating organizations.

"It’s a network of health plans, hospital systems, community health centers, safety nets, ambulatory care centers, and so on," she explains.

"What it does is act as a test bed to try to implement evidence-based practices. We have a very practical, applied approach, and highly demand-driven research. We try to look at issues that are important to people out in the field and try to help them resolve solutions to some of the key issues they are dealing with," Palmer adds.

At the TRIP conference, during a session moderated by Palmer, three examples were shared by Research Triangle Institute, which had its own small consortium. "One of the delivery systems is Providence Health Care in Oregon," she relates.

"They had some money for patient safety improvement, and they were looking to reduce medical errors for discharged patients. They developed a model that showed they might be able reduce them by up to 50% if they used an electronic medication list to accurately identify all meds the patient was on when they entered the hospital, and then tracked the meds throughout their stay," Palmer says.

The researchers discovered it would be too burdensome for one of their own pharmacists to take on this responsibility, but they were so optimistic this improvement could be achieved that they hired a transition pharmacist, she explains.

"We’re now doing a study about how this can reduce errors and improve care," Palmer reports.

Already, she adds, the researchers "learned they needed a team approach, a champion, a tool, and technical assistance, which is the transition pharmacist. That’s what they found they needed to effect any change."

When study results are received, the findings are presented to the operational leadership of the delivery systems involved, and the research is written up and published. "If it works, we try to disseminate the tool and approach to the rest of the network," Palmer says.

What can quality professionals be doing in general if they’re not already? "Very simply things: subscribe to AHRQ’s electronic newsletter; visit our web site very often, and review the several collateral tools the agency maintains on the web they can sign up for," Slutsky notes.

The tools include the National Guidelines Clearinghouse, the National Quality Measures Clearing House, and the Quality Tools Clearing House. "People can sign up and get an e-mail update every week," she adds.

(See these links for the tools mentioned in this article:

www.guideline.gov/whatsnew/subscription.aspx;

www.qualitymeasures.ahrq.gov/whatsnew/subscription.aspx;

www.qualitytools.ahrq.gov/whatsnew/subscription.aspx.)

Need More Information?

For more information, contact:

• Jean Slutsky, PA, MSPH, Acting Director, Center for Outcomes and Evidence, Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850. Phone: (301) 427-1601. Fax: (301) 427-1639.

• Cynthia S. Palmer, MS, Research Scientist, AHRQ, Integrated Delivery Systems Research Network (IDSRN). Phone: (301) 427-1441. E-mail: Cpalmer2@ahrq.gov.