Skip to main content
Top
Published in: Implementation Science 1/2011

Open Access 01-12-2011 | Research

Bridging the gap between basic science and clinical practice: a role for community clinicians

Authors: Katherine Kahn, Gery Ryan, Megan Beckett, Stephanie Taylor, Claude Berrebi, Michelle Cho, Elaine Quiter, Allen Fremont, Harold Pincus

Published in: Implementation Science | Issue 1/2011

Login to get access

Abstract

Background

Translating the extraordinary scientific and technological advances occurring in medical research laboratories into care for patients in communities throughout the country has been a major challenge. One contributing factor has been the relative absence of community practitioners from the US biomedical research enterprise. Identifying and addressing the barriers that prevent their participation in research should help bridge the gap between basic research and practice to improve quality of care for all Americans.

Methods

We interviewed over 200 clinicians and other healthcare stakeholders from 2004 through 2005 to develop a conceptual framework and set of strategies for engaging a stable cadre of community clinicians in a clinical research program.

Results

Lack of engagement of community practitioners, lack of necessary infrastructure, and the current misalignment of financial incentives and research participation emerged as the three primary barriers to community clinician research participation. Although every effort was made to learn key motivators for engagement in clinical research from interviewees, we did not observe their behavior and self-report by clinicians does not always track with their behavior.

Conclusions

A paradigm shift involving acknowledgement of the value of clinicians in the context of community research, establishment of a stable infrastructure to support a cohort of clinicians across time and research studies, and realignment of incentives to encourage participation in clinical research is required.
Appendix
Available only for authorised users
Literature
1.
go back to reference Zerhouni E: The NIH roadmap. Science. 2003, 72 (302): 63-64. 10.1126/science.1091867.CrossRef Zerhouni E: The NIH roadmap. Science. 2003, 72 (302): 63-64. 10.1126/science.1091867.CrossRef
2.
go back to reference Sung NS, Crowley WF, Genel M: Central challenges facing the national clinical research enterprise. JAMA. 2003, 289 (10): 1278-1287. 10.1001/jama.289.10.1278.CrossRefPubMed Sung NS, Crowley WF, Genel M: Central challenges facing the national clinical research enterprise. JAMA. 2003, 289 (10): 1278-1287. 10.1001/jama.289.10.1278.CrossRefPubMed
3.
go back to reference AAMC: Task Force II on Clinical Research. Promoting translational and clinical science: the critical role of medical schools and teaching hospitals. 2006, Washington, D.C: Association of American Medical Colleges AAMC: Task Force II on Clinical Research. Promoting translational and clinical science: the critical role of medical schools and teaching hospitals. 2006, Washington, D.C: Association of American Medical Colleges
4.
go back to reference Murillo H, Reece EA, Snyderman R, Sung NS: Meeting the challenges facing clinical research: solutions proposed by leaders of medical specialty and clinical research societies. Academic Medicine. 2006, 81 (2): 107-112. 10.1097/00001888-200602000-00002.CrossRefPubMed Murillo H, Reece EA, Snyderman R, Sung NS: Meeting the challenges facing clinical research: solutions proposed by leaders of medical specialty and clinical research societies. Academic Medicine. 2006, 81 (2): 107-112. 10.1097/00001888-200602000-00002.CrossRefPubMed
5.
go back to reference Zerhouni EA: Translational and clinical science--time for a new vision. The New England Journal of Medicine. 2005, 353 (15): 1621-1623. 10.1056/NEJMsb053723.CrossRefPubMed Zerhouni EA: Translational and clinical science--time for a new vision. The New England Journal of Medicine. 2005, 353 (15): 1621-1623. 10.1056/NEJMsb053723.CrossRefPubMed
6.
go back to reference Institute of Medicine: Crossing the Quality Chasm a New Health System for the 21st Century. 2001, Washington DC: National Academy Press Institute of Medicine: Crossing the Quality Chasm a New Health System for the 21st Century. 2001, Washington DC: National Academy Press
7.
go back to reference Tunis SR, Stryer DB, Clancy CM: Pratical clinical trials: increasing the value of clinical research for decision making in clinical and health policy. JAMA. 2003, 290: 1624-1632. 10.1001/jama.290.12.1624.CrossRefPubMed Tunis SR, Stryer DB, Clancy CM: Pratical clinical trials: increasing the value of clinical research for decision making in clinical and health policy. JAMA. 2003, 290: 1624-1632. 10.1001/jama.290.12.1624.CrossRefPubMed
8.
go back to reference Macpherson H: Pragmatic clinical trials. Complement Ther Med. 2004, 12 (2-3): 136-140. 10.1016/j.ctim.2004.07.043.CrossRefPubMed Macpherson H: Pragmatic clinical trials. Complement Ther Med. 2004, 12 (2-3): 136-140. 10.1016/j.ctim.2004.07.043.CrossRefPubMed
9.
go back to reference Kahn KL, Rogers WH, Rubenstein LV: Measuring quality of care with explicit process criteria before and after implementation of the DRG-based prospective payment system. JAMA. 1990, 264 (15): 1969-1973. 10.1001/jama.264.15.1969.CrossRefPubMed Kahn KL, Rogers WH, Rubenstein LV: Measuring quality of care with explicit process criteria before and after implementation of the DRG-based prospective payment system. JAMA. 1990, 264 (15): 1969-1973. 10.1001/jama.264.15.1969.CrossRefPubMed
10.
go back to reference Higashi T, Shekelle PG, Adams JL: Quality of care is associated with survival in vulnerable older patients. Annals of Internal Medicine. 2005, 143 (4): 274-281.CrossRefPubMed Higashi T, Shekelle PG, Adams JL: Quality of care is associated with survival in vulnerable older patients. Annals of Internal Medicine. 2005, 143 (4): 274-281.CrossRefPubMed
11.
go back to reference Kahn KL, Tisnado DM, Adams JL: Does ambulatory process of care predict health-related quality of life outcomes for patients with chronic disease?. Health Serv Res. 2007, 42 (1 Pt 1): 63-83. 10.1111/j.1475-6773.2006.00604.x.CrossRefPubMedPubMedCentral Kahn KL, Tisnado DM, Adams JL: Does ambulatory process of care predict health-related quality of life outcomes for patients with chronic disease?. Health Serv Res. 2007, 42 (1 Pt 1): 63-83. 10.1111/j.1475-6773.2006.00604.x.CrossRefPubMedPubMedCentral
13.
go back to reference Federation of Practice Based Research Networks: FPBRN Network Inventory November 2006. To navigate to this publicaton go to the American Academy of Family Physician (AAFP). Please note: the weblink must be copied and pasted into your browser. Once you open the AAFP home page, navigate to "Clinical & Research," "Research," "Federation of Practice Based Research Networks," "FPBRN Member Networks." Accessed January 27, 2011, [http://www.aafp.org/] Federation of Practice Based Research Networks: FPBRN Network Inventory November 2006. To navigate to this publicaton go to the American Academy of Family Physician (AAFP). Please note: the weblink must be copied and pasted into your browser. Once you open the AAFP home page, navigate to "Clinical & Research," "Research," "Federation of Practice Based Research Networks," "FPBRN Member Networks." Accessed January 27, 2011, [http://​www.​aafp.​org/​]
16.
go back to reference Westfall JM, Mold J, Fagnan L: Practice-based research--'Blue Highways' on the NIH roadmap. JAMA. 2007, 297 (4): 403-406. 10.1001/jama.297.4.403.CrossRefPubMed Westfall JM, Mold J, Fagnan L: Practice-based research--'Blue Highways' on the NIH roadmap. JAMA. 2007, 297 (4): 403-406. 10.1001/jama.297.4.403.CrossRefPubMed
17.
go back to reference Green LA, Hickner J: A short history of primary care practice-based research networks: from concept to essential research laboratories. J Am Board Fam Med. 2006, 19 (1): 1-10. 10.3122/jabfm.19.1.1.CrossRefPubMed Green LA, Hickner J: A short history of primary care practice-based research networks: from concept to essential research laboratories. J Am Board Fam Med. 2006, 19 (1): 1-10. 10.3122/jabfm.19.1.1.CrossRefPubMed
18.
go back to reference Kaufman R: Needs assessment, needs analysis, objectives and evaluation. Performance & Instruction. 1985, 24-21 Kaufman R: Needs assessment, needs analysis, objectives and evaluation. Performance & Instruction. 1985, 24-21
19.
go back to reference Witkin Br: Assessing needs in educational and social programs. 1984, San Francisco: Jossey-Bass Witkin Br: Assessing needs in educational and social programs. 1984, San Francisco: Jossey-Bass
20.
go back to reference Witkin BR, Altschuld JW: Planning and conducting needs assessment: a practical guide. 1995, Newbury Park: Sage Witkin BR, Altschuld JW: Planning and conducting needs assessment: a practical guide. 1995, Newbury Park: Sage
21.
go back to reference Marconi km, Rudzinski ka: A formative model to evaluate health services research. Evaluation Review. 1995, 19 (5): 501-510. 10.1177/0193841X9501900501.CrossRef Marconi km, Rudzinski ka: A formative model to evaluate health services research. Evaluation Review. 1995, 19 (5): 501-510. 10.1177/0193841X9501900501.CrossRef
22.
go back to reference Goodman LA: Snowball Sampling. Annals of Mathematical Statistics. 1961, 32 (1): 148-170. 10.1214/aoms/1177705148.CrossRef Goodman LA: Snowball Sampling. Annals of Mathematical Statistics. 1961, 32 (1): 148-170. 10.1214/aoms/1177705148.CrossRef
23.
go back to reference Ryan GW, Bernard HR: Techniques to Identify Themes. Field Methods. 2003, 15 (1): 85-109. 10.1177/1525822X02239569.CrossRef Ryan GW, Bernard HR: Techniques to Identify Themes. Field Methods. 2003, 15 (1): 85-109. 10.1177/1525822X02239569.CrossRef
24.
go back to reference Eddy DM, Billings J: The quality of medical evidence: implications for quality of care. Health Aff (Millwood). 1988, Spring 7 (1): 19-32. 10.1377/hlthaff.7.1.19.CrossRef Eddy DM, Billings J: The quality of medical evidence: implications for quality of care. Health Aff (Millwood). 1988, Spring 7 (1): 19-32. 10.1377/hlthaff.7.1.19.CrossRef
25.
go back to reference Cherkin DC, Deyo RA, Battie M, Street J, Barlow W: A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain. The New England Journal of Medicine. 1998, 339 (15): 1021-1029. 10.1056/NEJM199810083391502.CrossRefPubMed Cherkin DC, Deyo RA, Battie M, Street J, Barlow W: A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain. The New England Journal of Medicine. 1998, 339 (15): 1021-1029. 10.1056/NEJM199810083391502.CrossRefPubMed
26.
go back to reference March JS, Silva SG, Compton S, Shapiro M, Califf R, Krishnan R: The case for practical clinical trials in psychiatry. Am J Psychiatry. 2005, 162 (5): 836-846. 10.1176/appi.ajp.162.5.836.CrossRefPubMed March JS, Silva SG, Compton S, Shapiro M, Califf R, Krishnan R: The case for practical clinical trials in psychiatry. Am J Psychiatry. 2005, 162 (5): 836-846. 10.1176/appi.ajp.162.5.836.CrossRefPubMed
27.
go back to reference Hoyo C, Reid ML, Godley PA, Parrish T, Smith L, Gammon M: Barriers and strategies for sustained participation of African-American men in cohort studies. Ethnicity & Disease. 2003, Fall 13 (4): 470-476. Hoyo C, Reid ML, Godley PA, Parrish T, Smith L, Gammon M: Barriers and strategies for sustained participation of African-American men in cohort studies. Ethnicity & Disease. 2003, Fall 13 (4): 470-476.
28.
go back to reference Osei K: Recruitment and retention of African Americans in clinical studies: fiction, myths, and reality: National Institute of Health, Office of Researh on Women's Health, Task Force Group. 2003, Washington D.C.: National Institutes of Health Osei K: Recruitment and retention of African Americans in clinical studies: fiction, myths, and reality: National Institute of Health, Office of Researh on Women's Health, Task Force Group. 2003, Washington D.C.: National Institutes of Health
29.
go back to reference Pinto HA, McCaskill-Stevens W, Wolfe P, Marcus AC: Physician perspectives on increasing minorities in cancer clinical trials: an Eastern Cooperative Oncology Group (ECOG) Initiative. Ann Epidemiol. 2000, 10 (8 Suppl): S78-84. 10.1016/S1047-2797(00)00191-5.CrossRefPubMed Pinto HA, McCaskill-Stevens W, Wolfe P, Marcus AC: Physician perspectives on increasing minorities in cancer clinical trials: an Eastern Cooperative Oncology Group (ECOG) Initiative. Ann Epidemiol. 2000, 10 (8 Suppl): S78-84. 10.1016/S1047-2797(00)00191-5.CrossRefPubMed
32.
go back to reference Crowley WF, Sherwood L, Salber P: Clinical research in the United States at a crossroads: proposal for a novel public-private partnership to establish a national clinical research enterprise. JAMA. 2004, 291 (9): 1120-1126. 10.1001/jama.291.9.1120.CrossRefPubMed Crowley WF, Sherwood L, Salber P: Clinical research in the United States at a crossroads: proposal for a novel public-private partnership to establish a national clinical research enterprise. JAMA. 2004, 291 (9): 1120-1126. 10.1001/jama.291.9.1120.CrossRefPubMed
33.
go back to reference Ryan G, Berrebi C, Beckett M: Reengineering the clinical research enterprise to involve more community providers. Implementation Science. 2011, Ryan G, Berrebi C, Beckett M: Reengineering the clinical research enterprise to involve more community providers. Implementation Science. 2011,
35.
go back to reference Emanuel EJ, Wood A, Fleischman A: Oversight of human participants research: identifying problems to evaluate reform proposals. Annals of Internal Medicine. 2004, 141 (4): 282-291.CrossRefPubMed Emanuel EJ, Wood A, Fleischman A: Oversight of human participants research: identifying problems to evaluate reform proposals. Annals of Internal Medicine. 2004, 141 (4): 282-291.CrossRefPubMed
36.
go back to reference Cassileth BR: Clinical trials: time for action. J Clin Oncol. 2003, 21 (5): 765-766. 10.1200/JCO.2003.12.070.CrossRefPubMed Cassileth BR: Clinical trials: time for action. J Clin Oncol. 2003, 21 (5): 765-766. 10.1200/JCO.2003.12.070.CrossRefPubMed
37.
go back to reference Mainous AG, Hueston WJ: Characteristics of community-based primary care physicians participating in research. J Fam Pract. 1995, 40 (1): 51-56.PubMed Mainous AG, Hueston WJ: Characteristics of community-based primary care physicians participating in research. J Fam Pract. 1995, 40 (1): 51-56.PubMed
38.
go back to reference Hsiao WC, Braun P, Yntema D, Becker ER: Estimating physicians' work for a resource-based relative-value scale. The New England Journal of Medicine. 1988, 319 (13): 835-841. 10.1056/NEJM198809293191305.CrossRefPubMed Hsiao WC, Braun P, Yntema D, Becker ER: Estimating physicians' work for a resource-based relative-value scale. The New England Journal of Medicine. 1988, 319 (13): 835-841. 10.1056/NEJM198809293191305.CrossRefPubMed
39.
go back to reference Morreim EH: Clinical trials litigation: practical realities as seen from the trenches. Account Res. 2005, 12 (1): 47-67.PubMed Morreim EH: Clinical trials litigation: practical realities as seen from the trenches. Account Res. 2005, 12 (1): 47-67.PubMed
40.
go back to reference Glasgow RE, McKay HG, Piette JD, Reynolds KD: The RE-AIM framework for evaluating interventions: what can it tell us about approaches to chronic illness management?. Patient Educ Couns. 2001, 44 (2): 119-127. 10.1016/S0738-3991(00)00186-5.CrossRefPubMed Glasgow RE, McKay HG, Piette JD, Reynolds KD: The RE-AIM framework for evaluating interventions: what can it tell us about approaches to chronic illness management?. Patient Educ Couns. 2001, 44 (2): 119-127. 10.1016/S0738-3991(00)00186-5.CrossRefPubMed
41.
go back to reference Green LW, Glasgow RE: Evaluating the relevance, generalization, and applicability of research: issues in external validation and translation methodology. Eval Health Prof. 2006, 29 (1): 126-153. 10.1177/0163278705284445.CrossRefPubMed Green LW, Glasgow RE: Evaluating the relevance, generalization, and applicability of research: issues in external validation and translation methodology. Eval Health Prof. 2006, 29 (1): 126-153. 10.1177/0163278705284445.CrossRefPubMed
42.
go back to reference Glasgow RE, Lichtenstein E, Marcus AC: Why don't we see more translation of health promotion research to practice? Rethinking the efficacy-to-effectiveness transition. American Journal of Public Health. 2003, 93 (8): 1261-1267. 10.2105/AJPH.93.8.1261.CrossRefPubMedPubMedCentral Glasgow RE, Lichtenstein E, Marcus AC: Why don't we see more translation of health promotion research to practice? Rethinking the efficacy-to-effectiveness transition. American Journal of Public Health. 2003, 93 (8): 1261-1267. 10.2105/AJPH.93.8.1261.CrossRefPubMedPubMedCentral
Metadata
Title
Bridging the gap between basic science and clinical practice: a role for community clinicians
Authors
Katherine Kahn
Gery Ryan
Megan Beckett
Stephanie Taylor
Claude Berrebi
Michelle Cho
Elaine Quiter
Allen Fremont
Harold Pincus
Publication date
01-12-2011
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2011
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/1748-5908-6-34

Other articles of this Issue 1/2011

Implementation Science 1/2011 Go to the issue