This examination of the evidence-based medicine movement first reviews some recent events that have accelerated the search for ways to improve the quality of practice, which tends to be defined as the degree to which practice is following evidence-based guidelines. It proposes five ways to make research more relevant to practice: The first is the conventional and most widely and aggressively pursued path of pushing evidence through a pipeline to practitioners by means of continuing education, systematic reviews of the research literature converted into evidence-based practice guidelines, and the simplification of those guidelines with chart reminders, video and computer-based information systems, and similar devices to make the dissemination and application of the evidence more efficient and manageable in practice settings. Some major limitations and consequences of this “pipeline” strategy will be reviewed. The second approach is to shift the priorities of research-funding agencies and processes of peer review. Such priorities would reorient the production of research to make it more relevant to practice. This strategy will be illustrated with the experience of the U.S. Centers for Disease Control (CDC) and the Canadian Institute for Health Research. This strategy will depend also on a reorientation of the journal editing, peer review and publishing priorities to give greater emphasis to external validity. The third approach is to put greater emphasis on participatory research that engages practitioners more actively at least in formulating the research questions and interpreting the results, if not also in collecting and analyzing the data. Some defining features of participatory research will be reviewed. The fourth approach is translating research from distant and often artificial circumstances under which the evidence was produced to the local culture and “real-world” circumstances in which the application of the evidence would be required. This would call on greater use of theory to fill gaps in the evidence. Finally, a combination of these first four into a strategy of producing a more practice-based research agenda would have the dual benefits of making the research more relevant to practice and making the practitioners more receptive to the evidence because it would be produced under circumstances more like their own.

Lawrence W. Green is Adjunct Professor of Epidemiology and Biostatistics in the School of Medicine and is Co-Leader of the Society, Diversity and Disparities Program in the Comprehensive Cancer Center at the University of California at San Francisco. He joined CDC in 1999 as Distinguished Fellow-Visiting Scientist to study what accounted for the success of tobacco control in the last third of the 20th century, and how we might take those lessons to other areas of public health. He served as Director of CDC’s World Health Organization Collaborating Center on Global Tobacco Control and as Acting Director of the Office on Smoking and Health. He then served as the Director of CDC’s Office of Science and Extramural Research. He was then Visiting Professor at the University of California at Berkeley School of Public Health and the first Health and Society Visiting Professor at the University of Maryland. For most of the 1990s, Dr. Green was the Director of the Institute of Health Promotion Research and Professor and Head of the Division of Preventive Medicine and Health Promotion, Department of Health Care and Epidemiology, at the University of British Columbia in Canada.

For more information, visit
http://rwjcsp.unc.edu/NAC/NAC_green.html

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