• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of jamiaJAMIA - The Journal of the American Medical Informatics AssociationInstructions for authorsCurrent TOC
J Am Med Inform Assoc. 1995 Nov-Dec; 2(6): 342–350.
PMCID: PMC116277

Bridges between health care research evidence and clinical practice.

Abstract

Research is producing increasing amounts of important new evidence for health care, but there is a large gap between what this evidence shows can be done and the care that most patients actually receive. An important reason for this gap is the extensive processing that evidence requires before application. This article discusses a three-step model for bridging research evidence to management of clinical problems: getting the evidence straight, formulating evidence-based clinical policies, and applying evidence-based clinical policies at the right place and time. This model is purposely broad in scope and provides a framework for coordinating efforts to support evidence-based medical care. The authors' purpose is to represent the roles of health informatics in the context of the roles of all the key players, including health care researchers and practitioners, health care organizations, and the public. Health informatics has already made important contributions to bridging evidence to practice, including improving evidence retrieval, evaluation, and synthesis; new evidence-based information products; and computerized aids for facilitating the use of these products during clinical decision making. However, much more innovation and coordination are needed. The authors call for health informaticians to pay balanced attention to 1) the quality of evidence embodied in information innovations, 2) the performance of technologies and systems that retrieve, prepare, disseminate, and apply evidence, and 3) the fit of information tools to the specific clinical circumstances in which evidence is to be applied. Effective interdisciplinary teams that include health services researchers and other evidence experts, clinical practitioners, informaticians, and health care managers are needed to achieve success. Informaticians can make increasingly important contributions to the transfer of health care research by joining such teams.

Full Text

The Full Text of this article is available as a PDF (1.0M).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Evans CE, Haynes RB, Gilbert JR, Taylor DW, Sackett DL, Johnston M. Educational package on hypertension for primary care physicians. Can Med Assoc J. 1984 Mar 15;130(6):719–722. [PMC free article] [PubMed]
  • Rodman JH, Jelliffe RW, Kolb E, Tuey DB, de Guzman MF, Wagers PW, Haywood LJ. Clinical studies with computer-assisted initial lidocaine therapy. Arch Intern Med. 1984 Apr;144(4):703–709. [PubMed]
  • Yusuf S, Collins R, Peto R. Why do we need some large, simple randomized trials? Stat Med. 1984 Oct-Dec;3(4):409–422. [PubMed]
  • Covell DG, Uman GC, Manning PR. Information needs in office practice: are they being met? Ann Intern Med. 1985 Oct;103(4):596–599. [PubMed]
  • Woo B, Woo B, Cook EF, Weisberg M, Goldman L. Screening procedures in the asymptomatic adult. Comparison of physicians' recommendations, patients' desires, published guidelines, and actual practice. JAMA. 1985 Sep 20;254(11):1480–1484. [PubMed]
  • Eraker SA, Eeckhoudt LR, Vanbutsele RJ, Lebrun TC, Sailly JC. To test or not to test--to treat or not to treat: the decision-threshold approach to patient management. J Gen Intern Med. 1986 May-Jun;1(3):177–182. [PubMed]
  • Evans CE, Haynes RB, Birkett NJ, Gilbert JR, Taylor DW, Sackett DL, Johnston ME, Hewson SA. Does a mailed continuing education program improve physician performance? Results of a randomized trial in antihypertensive care. JAMA. 1986 Jan 24;255(4):501–504. [PubMed]
  • McDowell I, Newell C, Rosser W. Comparison of three methods of recalling patients for influenza vaccination. CMAJ. 1986 Nov 1;135(9):991–997. [PMC free article] [PubMed]
  • Detsky AS, Redelmeier D, Abrams HB. What's wrong with decision analysis? Can the left brain influence the right? J Chronic Dis. 1987;40(9):831–838. [PubMed]
  • Kassirer JP, Moskowitz AJ, Lau J, Pauker SG. Decision analysis: a progress report. Ann Intern Med. 1987 Feb;106(2):275–291. [PubMed]
  • Oxman AD, Guyatt GH. Guidelines for reading literature reviews. CMAJ. 1988 Apr 15;138(8):697–703. [PMC free article] [PubMed]
  • Gonzalez ER, Vanderheyden BA, Ornato JP, Comstock TG. Computer-assisted optimization of aminophylline therapy in the emergency department. Am J Emerg Med. 1989 Jul;7(4):395–401. [PubMed]
  • McDowell I, Newell C, Rosser W. Computerized reminders to encourage cervical screening in family practice. J Fam Pract. 1989 Apr;28(4):420–424. [PubMed]
  • Fletcher RH, Fletcher SW. Clinical practice guidelines. Ann Intern Med. 1990 Nov 1;113(9):645–646. [PubMed]
  • Haynes RB. Loose connections between peer-reviewed clinical journals and clinical practice. Ann Intern Med. 1990 Nov 1;113(9):724–728. [PubMed]
  • Haynes RB, McKibbon KA, Walker CJ, Ryan N, Fitzgerald D, Ramsden MF. Online access to MEDLINE in clinical settings. A study of use and usefulness. Ann Intern Med. 1990 Jan 1;112(1):78–84. [PubMed]
  • Haynes RB, Mulrow CD, Huth EJ, Altman DG, Gardner MJ. More informative abstracts revisited. Ann Intern Med. 1990 Jul 1;113(1):69–76. [PubMed]
  • Wallingford KT, Humphreys BL, Selinger NE, Siegel ER. Bibliographic retrieval: a survey of individual users of MEDLINE. MD Comput. 1990 May-Jun;7(3):166–171. [PubMed]
  • Anderson FA, Jr, Wheeler HB, Goldberg RJ, Hosmer DW, Forcier A, Patwardhan NA. Physician practices in the prevention of venous thromboembolism. Ann Intern Med. 1991 Oct 15;115(8):591–595. [PubMed]
  • Haynes RB, Ramsden MF, McKibbon KA, Walker CJ. Online access to MEDLINE in clinical settings: impact of user fees. Bull Med Libr Assoc. 1991 Oct;79(4):377–381. [PMC free article] [PubMed]
  • Krahn M, Naylor CD, Basinski AS, Detsky AS. Comparison of an aggressive (U.S.) and a less aggressive (Canadian) policy for cholesterol screening and treatment. Ann Intern Med. 1991 Aug 15;115(4):248–255. [PubMed]
  • Osheroff JA, Forsythe DE, Buchanan BG, Bankowitz RA, Blumenfeld BH, Miller RA. Physicians' information needs: analysis of questions posed during clinical teaching. Ann Intern Med. 1991 Apr 1;114(7):576–581. [PubMed]
  • Ramsey PG, Carline JD, Inui TS, Larson EB, LoGerfo JP, Norcini JJ, Wenrich MD. Changes over time in the knowledge base of practicing internists. JAMA. 1991 Aug 28;266(8):1103–1107. [PubMed]
  • Antman EM, Lau J, Kupelnick B, Mosteller F, Chalmers TC. A comparison of results of meta-analyses of randomized control trials and recommendations of clinical experts. Treatments for myocardial infarction. JAMA. 1992 Jul 8;268(2):240–248. [PubMed]
  • Cairns JA, Fuster V, Kennedy JW. Coronary thrombolysis. Chest. 1992 Oct;102(4 Suppl):482S–507S. [PubMed]
  • Chalmers I, Dickersin K, Chalmers TC. Getting to grips with Archie Cochrane's agenda. BMJ. 1992 Oct 3;305(6857):786–788. [PMC free article] [PubMed]
  • Cook DJ, Guyatt GH, Laupacis A, Sackett DL. Rules of evidence and clinical recommendations on the use of antithrombotic agents. Chest. 1992 Oct;102(4 Suppl):305S–311S. [PubMed]
  • Dalen JE, Hirsh J. Antithrombotic therapy. Introduction. Chest. 1992 Oct;102(4 Suppl):303S–304S. [PubMed]
  • Doorey AJ, Michelson EL, Topol EJ. Thrombolytic therapy of acute myocardial infarction. Keeping the unfulfilled promises. JAMA. 1992 Dec 2;268(21):3108–3114. [PubMed]
  • East TD, Böhm SH, Wallace CJ, Clemmer TP, Weaver LK, Orme JF, Jr, Morris AH. A successful computerized protocol for clinical management of pressure control inverse ratio ventilation in ARDS patients. Chest. 1992 Mar;101(3):697–710. [PubMed]
  • Lau J, Antman EM, Jimenez-Silva J, Kupelnick B, Mosteller F, Chalmers TC. Cumulative meta-analysis of therapeutic trials for myocardial infarction. N Engl J Med. 1992 Jul 23;327(4):248–254. [PubMed]
  • Oxman AD, Guyatt GH. A consumer's guide to subgroup analyses. Ann Intern Med. 1992 Jan 1;116(1):78–84. [PubMed]
  • Anderson G. Implementing practice guidelines. CMAJ. 1993 Mar 1;148(5):753–755. [PMC free article] [PubMed]
  • Battista RN, Hodge MJ. Clinical practice guidelines: between science and art. CMAJ. 1993 Feb 1;148(3):385–389. [PMC free article] [PubMed]
  • Blumenthal D. Total quality management and physicians' clinical decisions. JAMA. 1993 Jun 2;269(21):2775–2778. [PubMed]
  • Carter Anne. Background to the “Guidelines for Guidelines” series. CMAJ. 1993 Feb 01;148(3):383–383. [PMC free article]
  • Gray D, Keating NA, Murdock J, Skene AM, Hampton JR. Impact of hospital thrombolysis policy on out-of-hospital response to suspected myocardial infarction. Lancet. 1993 Mar 13;341(8846):654–657. [PubMed]
  • Guyatt GH, Rennie D. Users' guides to the medical literature. JAMA. 1993 Nov 3;270(17):2096–2097. [PubMed]
  • Guyatt GH, Sackett DL, Cook DJ. Users' guides to the medical literature. II. How to use an article about therapy or prevention. A. Are the results of the study valid? Evidence-Based Medicine Working Group. JAMA. 1993 Dec 1;270(21):2598–2601. [PubMed]
  • Haynes RB. Some problems in applying evidence in clinical practice. Ann N Y Acad Sci. 1993 Dec 31;703:210–225. [PubMed]
  • Hayward RS, Laupacis A. Initiating, conducting and maintaining guidelines development programs. CMAJ. 1993 Feb 15;148(4):507–512. [PMC free article] [PubMed]
  • Jutras D. Clinical practice guidelines as legal norms. CMAJ. 1993 Mar 15;148(6):905–908. [PMC free article] [PubMed]
  • Lomas J. Making clinical policy explicit. Legislative policy making and lessons for developing practice guidelines. Int J Technol Assess Health Care. 1993 Winter;9(1):11–25. [PubMed]
  • Lomas J. Retailing research: increasing the role of evidence in clinical services for childbirth. Milbank Q. 1993;71(3):439–475. [PubMed]
  • Mosteller F. The prospect of data-based medicine in the light of ECPC. Milbank Q. 1993;71(3):523–532. [PubMed]
  • Oxman AD. Coordination of guidelines development. CMAJ. 1993 Apr 15;148(8):1285–1288. [PMC free article] [PubMed]
  • Oxman AD, Sackett DL, Guyatt GH. Users' guides to the medical literature. I. How to get started. The Evidence-Based Medicine Working Group. JAMA. 1993 Nov 3;270(17):2093–2095. [PubMed]
  • Shin JH, Haynes RB, Johnston ME. Effect of problem-based, self-directed undergraduate education on life-long learning. CMAJ. 1993 Mar 15;148(6):969–976. [PMC free article] [PubMed]
  • Somerville MA. Ethics and clinical practice guidelines. CMAJ. 1993 Apr 1;148(7):1133–1137. [PMC free article] [PubMed]
  • Stiell IG, Greenberg GH, McKnight RD, Nair RC, McDowell I, Reardon M, Stewart JP, Maloney J. Decision rules for the use of radiography in acute ankle injuries. Refinement and prospective validation. JAMA. 1993 Mar 3;269(9):1127–1132. [PubMed]
  • Tierney WM, Miller ME, Overhage JM, McDonald CJ. Physician inpatient order writing on microcomputer workstations. Effects on resource utilization. JAMA. 1993 Jan 20;269(3):379–383. [PubMed]
  • Wilczynski NL, Walker CJ, McKibbon KA, Haynes RB. Assessment of methodologic search filters in MEDLINE. Proc Annu Symp Comput Appl Med Care. 1993:601–605. [PMC free article] [PubMed]
  • Guyatt GH, Sackett DL, Cook DJ. Users' guides to the medical literature. II. How to use an article about therapy or prevention. B. What were the results and will they help me in caring for my patients? Evidence-Based Medicine Working Group. JAMA. 1994 Jan 5;271(1):59–63. [PubMed]
  • Haynes RB, Walker CJ, McKibbon KA, Johnston ME, Willan AR. Performances of 27 MEDLINE systems tested by searches with clinical questions. J Am Med Inform Assoc. 1994 May-Jun;1(3):285–295. [PMC free article] [PubMed]
  • Haynes RB, Wilczynski N, McKibbon KA, Walker CJ, Sinclair JC. Developing optimal search strategies for detecting clinically sound studies in MEDLINE. J Am Med Inform Assoc. 1994 Nov-Dec;1(6):447–458. [PMC free article] [PubMed]
  • Jaeschke R, Guyatt GH, Sackett DL. Users' guides to the medical literature. III. How to use an article about a diagnostic test. B. What are the results and will they help me in caring for my patients? The Evidence-Based Medicine Working Group. JAMA. 1994 Mar 2;271(9):703–707. [PubMed]
  • Johnston ME, Langton KB, Haynes RB, Mathieu A. Effects of computer-based clinical decision support systems on clinician performance and patient outcome. A critical appraisal of research. Ann Intern Med. 1994 Jan 15;120(2):135–142. [PubMed]
  • Laupacis A, Wells G, Richardson WS, Tugwell P. Users' guides to the medical literature. V. How to use an article about prognosis. Evidence-Based Medicine Working Group. JAMA. 1994 Jul 20;272(3):234–237. [PubMed]
  • Levine M, Walter S, Lee H, Haines T, Holbrook A, Moyer V. Users' guides to the medical literature. IV. How to use an article about harm. Evidence-Based Medicine Working Group. JAMA. 1994 May 25;271(20):1615–1619. [PubMed]
  • McDonald CJ, Overhage JM. Guidelines you can follow and can trust. An ideal and an example. JAMA. 1994 Mar 16;271(11):872–873. [PubMed]
  • Moher D, Dulberg CS, Wells GA. Statistical power, sample size, and their reporting in randomized controlled trials. JAMA. 1994 Jul 13;272(2):122–124. [PubMed]
  • Oxman AD, Cook DJ, Guyatt GH. Users' guides to the medical literature. VI. How to use an overview. Evidence-Based Medicine Working Group. JAMA. 1994 Nov 2;272(17):1367–1371. [PubMed]
  • Stiell IG, McKnight RD, Greenberg GH, McDowell I, Nair RC, Wells GA, Johns C, Worthington JR. Implementation of the Ottawa ankle rules. JAMA. 1994 Mar 16;271(11):827–832. [PubMed]
  • Wilczynski NL, Walker CJ, McKibbon KA, Haynes RB. Quantitative comparison of pre-explosions and subheadings with methodologic search terms in MEDLINE. Proc Annu Symp Comput Appl Med Care. 1994:905–909. [PMC free article] [PubMed]
  • Browman GP, Levine MN, Mohide EA, Hayward RS, Pritchard KI, Gafni A, Laupacis A. The practice guidelines development cycle: a conceptual tool for practice guidelines development and implementation. J Clin Oncol. 1995 Feb;13(2):502–512. [PubMed]
  • Davidoff F, Case K, Fried PW. Evidence-based medicine: why all the fuss? Ann Intern Med. 1995 May 1;122(9):727–727. [PubMed]
  • Davis DA, Thomson MA, Oxman AD, Haynes RB. Changing physician performance. A systematic review of the effect of continuing medical education strategies. JAMA. 1995 Sep 6;274(9):700–705. [PubMed]

Articles from Journal of the American Medical Informatics Association : JAMIA are provided here courtesy of American Medical Informatics Association

Formats:

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...

Links

  • Cited in Books
    Cited in Books
    PubMed Central articles cited in books
  • PubMed
    PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...