Translating Knowledge into Practice

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In 2001, the Institute of Medicine report Crossing the Quality Chasm [1] found that it takes 17 years to translate scientific evidence into clinical practice and that today’s patients only receive evidence-based care 50 percent of the time. One promise of the electronic health record (EHR) was to close that gap by making it easier to incorporate best evidence into practice guidelines through improved collaboration and communication between the research setting and real-world clinical practice [2].

Evidence Generation Projects

In 2005 the Agency for Healthcare Research and Quality (AHRQ) [3] was authorized by Section 1013 of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 to take on two tasks. The first was to define what is known in medicine. This was aimed at ensuring programs benefit from past investments in research as well as defining what research gaps were critical to fill. The second was to establish the agenda for determining clinical effectiveness. This latter task was facilitated through a a series of evidence generation projects funded largely by the American Recovery and Reinvestment Act of 2009 [4].

CHOICE (Clinical and Health Outcomes Initiative in Comparative Effectiveness)

[5] is a coordinated national effort to establish a series of pragmatic clinical comparative effectiveness studies. Specifically, this funding ($100M) is focused on large projects in comparative effectiveness aimed at generating new knowledge to help inform decision making in priority areas of clinical care (i.e., underserved populations).

PROSPECT (Prospective Outcome Systems using Patient-specific Electronic data to Compare Tests and therapies)

[6] is focused on advancing the quality, depth and scale of the electronic data collection infrastructure as a basis for comparative effectiveness research ($48M). It is designed to fund up to five awards for the creation or enhancement of national patient registries with a primary focus on these 14 priority conditions [7]:

  • Arthritis and non-traumatic joint disorders
  • Cancer
  • Cardiovascular disease, including stroke and hypertension
  • Dementia, including Alzheimer Disease
  • Depression and other mental health disorders
  • Developmental delays, attention-deficit hyperactivity disorder and autism
  • Diabetes Mellitus
  • Functional limitations and disability
  • Infectious diseases including HIV/AIDS
  • Obesity
  • Peptic ulcer disease and dyspepsia
  • Pregnancy including pre-term birth
  • Pulmonary disease/Asthma
  • Substance abuse

DEcIDE (Developing Evidence to Inform Decisions about Effectiveness)

[8] is a multi-center research system that conducts studies on the outcomes, effectiveness, safety, and usefulness of medical treatments and services ($24M). It focuses on distributed data network models that use clinically rich data from electronic health records.

What About Now?

While it will take time for these projects to inform the practice of clinical medicine select models now exist that lead the way [9-11]. One recent example gives a high-level overview of a patient-centered EHR for the management of cancer across the continuum of care [11].


  1. [1] Committee on Quality Health Care in America, IOM. Crossing the quality chasm: a new health system for the 21st century. Washington DC: National Academy Press, 2001. Accessed February 24, 2010.
  2. [2]Stewart WF, Shah NR, Selna MJ, et al. Bridging The Inferential Gap:The Electronic Health Record and Clinical Evidence. Health Affairs 26, no. 2 (2007): w181–w191 Accessed February 24, 2010.
  3. [3] Accessed February 27, 2010.

[4] Accessed February 27, 2010.

[5] Accessed February 27, 2010.

[6] Accessed February 27, 2010.

[7] Accessed February 27, 2010.

[8] Accessed February 27, 2010

[9] Douglas PS, Brennan JM, Anstrom KJ, et al. Clinical Effectiveness of Coronary Stents in Elderly Persons - Results From 262,700 Medicare Patients in the American College of Cardiology-National Cardiovascular Data Registry. J Am Coll Cardiol, 2009; 53:1629-1641, doi:10.1016/j.jacc.2009.03.005 (Published online 28 March 2009). Accessed February 27, 2010.

[10]Eisenstein EL, Anstrom KJ, Kong DF, et al. Clopidogrel Use and Long-term Clinical Outcomes After Drug-Eluting Stent Implantation. JAMA. 2007;297:(doi:10.1001/jama.297.2.joc60179). Accessed February 27, 2010.

[11] Taplin SH, Rollason D, Camp A, et al. Imagining and Electronic Medical Record for Turning Cancer Screening Knowledge into Practice. Am J Prev Med 2010;38(1)89-97. Accessed February 24, 2010.

Submitted by Paula Scariati