Five Reasons That Many Comparative Effectiveness Studies Fail To Change Patient Care And Clinical Practice

Abstract

Despite widespread enthusiasm about the potential impact of new investments in comparative effectiveness research, recent history suggests that scientific evidence may be slow to change clinical practice. Reflecting on studies conducted over the past decade, we identify five causes that underlie the failure of many comparative effectiveness studies to alter patient care. These are financial incentives, such as fee-for-service payment, that may militate against the adoption of new clinical practices; ambiguity of study results that hamper decision making; cognitive biases in the interpretation of new information; failure of the research to address the needs of end users; and limited use of decision support by patients and clinicians. Policies that encourage the development of consensus objectives, methods, and evidentiary standards before studies get under way and that provide strong incentives for patients and providers to use resources efficiently may help overcome at least some of these barriers and enable comparative effectiveness results to alter medical practice more quickly.

Effectiveness and Safety of Patient Activation Interventions for Adults with Type 2 Diabetes: Systematic Review, Meta-Analysis, and Meta-regression

“…needed for integration, lack of health insurance coverage across insurers, and lack of clarity on the best strategies to incorporate. 11,12 Understanding the impact of patient activation interventions on health outcomes in adults with diabetes, and identifying which intervention strategies, if any, are most effective is vitally important to adults with diabetes and to those who develop, implement, and fund diabetes intervention programs.…”

“…7,9 Despite the growing evidence suggesting improved patient outcomes by engaging patients, 4-6,10 these interventions are often not integrated into practice due to uncertainty about benefit, lack of resources needed for integration, lack of health insurance coverage across insurers, and lack of clarity on the best strategies to incorporate. 11,12 Understanding the impact of patient activation interventions on health outcomes in adults with diabetes, and identifying which intervention strategies, if any, are most effective is vitally important to adults with diabetes and to those who develop, implement, and fund diabetes intervention programs.Patient activating strategies, as a subset of behavioral interventions, are thought to be promising clinical tools, but have not been rigorously evaluated. Also, most prior systematic reviews of behavioral or quality improvement interventions have focused on limited clinical outcomes such as A1c and weight.…”

Can the pharmaceutical industry embrace comparative effectiveness research? A view from inside

“…This would be short-sighted, however, since this only would reinforce the status quo where comparative effectiveness studies have limited impact in changing patient care and clinical practice [14].…”

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“…8 In fact, EHRs that facilitate generating a high Evaluation and Management level note may actually impair inter-physician communication. 9 Just as fee-forservice prevents adoption of new research, 10 fee-for-service payment hinders meaningful use of EHRs.…”