which there is strong scientific evidence and a high degree of expert consensus about best practices indicates that current dissemination efforts fail to reach many clinicians and patients, and that there are insufficient tools and incentives to promote rapid adoption of best practices. The time has come to invest in the creation of a more effective infrastructure for the application of knowledge to health care delivery.

Recommendation 8: The Secretary of the Department of Health and Human Services should be given the responsibility and necessary resources to establish and maintain a comprehensive program aimed at making scientific evidence more useful and accessible to clinicians and patients. In developing this program, the Secretary should work with federal agencies and in collaboration with professional and health care associations, the academic and research communities, and the National Quality Forum and other organizations involved in quality measurement and accountability.

It is critical that leadership from the private sector, both professional and other health care leaders and consumer representatives, be involved in all aspects of this effort to ensure its applicability and acceptability to clinicians and patients. The infrastructure developed through this public- and private-sector partnership should focus initially on priority conditions and include:

  • Ongoing analysis and synthesis of the medical evidence

  • Delineation of specific practice guidelines

  • Identification of best practices in the design of care processes

  • Enhanced dissemination efforts to communicate evidence and guidelines to the general public and professional communities

  • Development of decision support tools to assist clinicians and patients in applying the evidence

  • Establishment of goals for improvement in care processes and outcomes

  • Development of quality measures for priority conditions

More systematic approaches are needed to analyze and synthesize medical evidence for both clinicians and patients. Far more sophisticated clinical decision support systems will be required to assist clinicians and patients in selecting the best treatment options and delivering safe and effective care. Many promising private- and public-sector activities now under way can serve as excellent models and building blocks for a more expanded effort. In particular, the Cochrane Collaboration and the Agency for Healthcare Research and Quality’s Evidence-Based Practice Centers represent important efforts to synthesize medical evidence. The growth of the Internet has also opened up many new opportunities to make evidence more accessible to clinicians and consumers. The efforts of the National Library of Medicine to facilitate access to the medical literature



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