In yesterday's plenary discussion, "The Impact of Comparative Effectiveness Research on the Field of Health Services Research," the unanimous sentiment among the panelists was that there's an incredible need for health services researchers to make a difference. Though there was agreement on how important our work can be, so much about how to translate that research remains uncertain, especially as comparative effectiveness research studies become more prevalent.

"We can have the right answers, but if we can't move them into practice they won't help anyone," explained Arnold Epstein, member of the Board of Governors for the Patient-Centered Outcomes Research (PCORI). "Dissemination is an extremely important part of the [PCORI] mandate."
It's true that translation strategies need to be in the minds of all researchers -- something we've written about here more than once -- but what opportunities and challenges associated with CER should be considered? Sunday morning's policy roundtable "Translating Knowledge into Action: Lessons in Translation and Dissemination for Comparative Effectiveness Research" focused on the quantitative and qualitative evidence on the success of translation across a broad range of CER studies, as well as the specific barriers and facilitators to success. Panelists shared their experiences with the so-called "real world" impact of CER on utilization. Teresa Gibson of Thomson Reuters  explained that there's little analysis on the net effect of CER on practice. Gibson examined utilization of four different studies and found several interesting trends: publication is necessary but not sufficient to result in adoption; change is slow, especially when the findings conflict with standard practice; and in many cases, more than one study is needed to have an influence. Above all, Gibson explained that the clarity and strength of the findings is critical, and that future research is needed to explore whether CER leads or lags change. RAND's Justin Timbie shared his experience with some of the key barriers to CER dissemination and utilization. Some of the most prevalent barriers include misaligned financial incentives, ambiguous results, cognitive biases in decision making, and inadequatee use of decision support. Timbie also mentioned the failure to address the needs of end users as one of the barriers to utilization, and the plenary speakers spoke about that issue at length in their discussion as well. They explained that more collaboration is needed among patients, clinicians, and researchers to ensure that the end-user's needs are met.
"We're putting extra emphasis to make certain that patients and stakeholders are engaged in defining the [research] question. That will help enhance the dissemination," said PCORI Executive Director Joe Selby. "We need to ensure that questions are driven by patients and other stakeholders...and investigate and disseminate knowing that they have different preferences."
In the afternoon session "Making the Science Count: Overcoming the Challenges to Patient-Centered Care," AHRQ Director Carolyn Clancy echoed the importance of engaging all stakeholders. "Think about how this information is going to be used, and by whom. We will then need to train people to take this information up and use it in their [clinical] work," said Clancy. Overall, researchers need a better understanding of how to transfer and maintain interventions in the real world of patients, payers, communities, and families. And UnitedHealth Group Executive Vice President Reed Tuckson closed the plenary with an interesting issue to consider when thinking about dissemination and utilization: there's evidence there, but the challenge isn't finding better ways to disseminate -- it's finding ways to make patients comfortable with making decisions amidst uncertainty.
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