Perspectives

From Bench to Every Bedside: Improving the Adoption of Evidence-Based Practices

Authors: Benjamin A. Rodwin, MD, Naseema B. Merchant, MD

Abstract

The medical research industry in the United States is impressive, with more than 119 billion spent annually on biomedical research and development, including discoveries of effective treatments, diagnostic tests, and procedures.1 These discoveries are meaningless, however, unless they are effectively implemented into routine clinical practice. The often-repeated paradigm of translational research, “from bench to bedside,” is useful only if newly discovered treatments and updated guidelines recommendations are spread widely and quickly, from the bench to every bedside. In today’s practice, however, many of the newest evidence-based treatments and guidelines are not readily implemented.2

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Chakma J, Sun GH, Steinberg JD, et al. Asia's ascent—global trends in biomedical R&D expenditures. N Engl J Med 2014;370:3–6. 2. Levine DM, Linder JA, Landon BE. The quality of outpatient care delivered to adults in the United States, 2002 to 2013. JAMA Intern Med 2016;176:1778–1790. 3. Rogers EM. Diffusion of Innovations. 5th ed. New York: Free Press; 2003. 4. Antman EM, Lau J, Kupelnick B, et al. A comparison of results of meta-analyses of randomized control trials and recommendations of clinical experts. Treatments for myocardial infarction. JAMA 1992;268:240–248. 5. Green LW, Ottoson JM, Garcia C, et al. Diffusion theory and knowledge dissemination, utilization, and integration in public health. Annu Rev Public Health 2009;30:151–174. 6. Fonarow GC, Yancy CW, Hernandez AF, et al. Potential impact of optimal implementation of evidence-based heart failure therapies on mortality. Am Heart J 2011;161:1024–1030.e3. 7. Darmstadt GL, Bhutta ZA, Cousens S, et al. Evidence-based, cost-effective interventions: how many newborn babies can we save? Lancet 2005;365:977–988. 8. Fonarow GC, Hernandez AF, Solomon SD, et al. Potential mortality reduction with optimal implementation of angiotensin receptor neprilysin inhibitor therapy in heart failure. JAMA Cardiol 2016;1:714–717. 9. Cabana MD, Rand CS, Powe NR, et al. Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA 1999;282: 1458–1465. 10. Bristow RE, Chang J, Ziogas A, et al. Adherence to treatment guidelines for ovarian cancer as a measure of quality care. Obstet Gynecol 2013;121:1226–1234. 11. Lo-Ciganic WH, Gellad WF, Huskamp HA, et al. Who were the early adopters of dabigatran? An application of group-based trajectory models. Med Care 2016;54:725–732. 12. Tamblyn R, McLeod P, Hanley JA, et al. Physician and practice characteristics associated with the early utilization of new prescription drugs. Med Care 2003;41:895–908. 13. Flack JM, Calhoun D, Schiffrin EL. The new ACC/AHA hypertension guidelines for the prevention, detection, evaluation, and management of high blood pressure in adults. Am J Hypertens 2018;31:133–135. 14. US Preventive Services Task Force. Final recommendation statement: colorectal cancer: screening. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/colorectal-cancer-screening. Published June 15, 2016. Accessed June 12, 2018. 15. Rex DK, Boland CR, Dominitz JA, et al. Colorectal cancer screening: recommendations for physicians and patients from the U.S. Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2017;153:307–323. 16. Department of Veterans Affairs. Pain as the 5th vital sign toolkit. https://www.va.gov/PAINMANAGEMENT/docs/Pain_As_the_5th_Vital_Sign_Toolkit.pdf. Published October 2000. Accessed September17, 2018. 17. Bodenheimer T. The American health care system—the movement for improved quality in health care. N Engl J Med 1999;340:488–492. 18. US Preventive Services Task Force, Curry SJ, Krist AH, et al. Behavioral weight loss interventions to prevent obesity-related morbidity and mortality in adults: US Preventive Services Task Force Recommendation Statement. JAMA 2018;320:1163–1171. 19. Shiffman RN, Dixon J, Brandt C, et al. The GuideLine Implementability Appraisal (GLIA): development of an instrument to identify obstacles to guideline implementation. BMC Med Inform Decis Mak 2005;5:23. 20. Chan WV, Pearson TA, Bennett GC, et al. ACC/AHA special report: clinical practice guideline implementation strategies: a summary of systematic reviews by the NHLBI Implementation Science Work Group: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2017;69:1076–1092. 21. Flodgren G, Hall AM, Goulding L, et al. Tools developed and disseminated by guideline producers to promote the uptake of their guidelines. Cochrane Database Syst Rev 2016;(8):CD010669. 22. Glasgow RE, Vinson C, Chambers D, et al. National Institutes of Health approaches to dissemination and implementation science: current and future directions. Am J Public Health 2012;102:1274–1281. 23. Damschroder LJ, Aron DC, Keith RE, et al. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci 2009;4:50. 24. Elnahal SM, Clancy CM, Shulkin DJ. A framework for disseminating clinical best practices in the VA Health System. JAMA 2017;317:255–256.