Optimizing Practice Through Research: A New Perspective to Solve an Old Problem

Abstract

Policy makers, researchers, clinicians, and the public are frustrated that research in the health sciences has not resulted in a greater improvement in patient outcomes. Our experience as clinicians and researchers suggests that this frustration could be reduced if health sciences research were directed by 5 broad principles:(1) the needs of patients and populations determine the research agenda; (2) the research agenda addresses contextual and implementation issues, including the development of delivery and accountability systems; (3) the research agenda determines the research methods rather than methods determines the research agenda; (4) researchers and clinicians collaborate to defi ne the research agenda, allocate resources, and implement fi ndings; and (5) the level of funding for implementation research is commensurate with and proportional to the magnitude of the task. To keep the research agenda focused on the task of improving health and to acknowledge that the effort must be seen as more comprehensive than translating or transferring research into practice (TRIP), we suggest that the task be reframed, using the term optimizing practice through research. Ann Fam Med 2008;6:459-462. DOI: 10.1370/afm.862. INTRODUCTIONP olicy leaders are frustrated that recent discoveries in the health sciences have not been incorporated rapidly and completely into clinical or community practice.1 This frustration has led to the creation of the NIH Roadmap 2 and Clinical and Translational Science Awards (CTSAs).3 Although the task of improving quality through innovation in the delivery of health services is frequently described as "translating research into practice," or TRIP, 4 our experience as researchers and clinicians leads us to believe that conceptualizing the task in this way fails to describe the process that must be set in motion if research is to improve the health status of patients and populations. It also places undue emphasis on only one component of the mission of research in the health sciences, "pursuit of fundamental knowledge about the nature and behavior of living systems."5 To retain the focus of health sciences research on its ultimate mission, "to extend healthy life and reduce the burdens of illness and disability," 5 we suggest that the task be reframed, using the term optimizing practice through research, and we suggest that the task of improving health outcomes through research be based on 5 broad principles. IMPROVING HEALTH OUTCOMES THROUGH RESEARCH Principle 1. Needs of Patients and Populations Determine the Research AgendaBefore the development of highly sophisticated basic sciences, the health sciences research agenda was defi ned by the problems that clinicians faced OP T IMIZING PR AC T ICE T HROUGH R ESE A RCHin their daily practices. Today, there are indications that the research agenda is defi ned with little apparent regard for clinical or population epidemiology.6 Claude Lenfant, the former director of the National Heart, Lung, and Blood Institute, expressed his concern ab...

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