From breakthrough research to healthcare policy and practice — a long and winding road

test tubes.

Published July 17, 2019

“Guided by the overarching goal of the CTSI to perform innovative research to improve the health of our community and the nation, it will be important for us to find ways to better communicate key findings so that we can enable more advances in healthcare like the striking examples of UB researchers.”
Timothy Murphy, MD, Director, Clinical and Translational Science Institute
murphy.
“No human being can keep up with everything one need to know, so clinicians depend on a variety of ‘focus filters’ to stay abreast of important advances in their clinical fields.”
Nancy Nielsen, MD, PhD, Senior Associate Dean for Health Policy
Nielsen.

For clinical investigators, discovering a new drug, treatment or device is only the first goal of research. The real reward comes when the discovery makes it into the hands of the patients who will benefit from it.

Incorporating research findings into healthcare policy and practice is not a quick or easy process. Inherent delays can stretch the process out for years – experts estimate the average turnaround time from laboratory to doctors’ offices is 17 years, depending on the field of study.

“We in research identify ways to improve healthcare,” said Timothy Murphy, MD, Director of the University at Buffalo Clinical and Translational Science Institute (CTSI). “A key question is, how do we get discoveries to people so that they can benefit? There is not a formal structure for translating research into policy. That’s a real problem.”

A major cause for the delays is the time required to review and test the research. Selecting expert members for review panels, allowing them time to review the research materials, and convening them to discuss and possibly make recommendations takes time, Murphy said.

Compounding this is the vast amount of new knowledge that has emerged from the information explosion of the last decade, according to Nancy Nielsen, MD, PhD, Senior Associate Dean for Health Policy, Jacobs School of Medicine and Biomedical Sciences.

“No human being can keep up with everything one needs to know, so clinicians depend on a variety of ‘focus filters’ to stay abreast of important advances in their clinical fields.” These may include widely read scientific journals, professional medical associations, national conferences and regional opinion leaders, she said.

Even with these tools to help vet research, persuading clinicians to change their minds about treatments is challenging, Nielsen said. Distrust of published – but limited – studies; concerns about health insurer coverage of new and potential expensive drugs or devices; and the retesting of accepted practices all slow the pace of developing healthcare policy, Nielsen said.

Murphy agrees that getting relevant research information into the hands of practicing physicians is a major obstacle.

“Providers are bombarded with information, and some of it is biased, so judging its veracity is difficult,” Murphy said. “It’s tough to critically evaluate the information. That’s why we need to enhance communication and partnerships between clinicians and researchers. Clinicians help frame the real life clinical questions that need to be addressed and clinical researchers are able to critically evaluate the information to help answer the questions.”

When evaluating new discoveries with the goal of changing policy and practice, bias is a big concern. “The evaluators have to avoid conflict of interest, or even the appearance of conflict of interest,” Murphy said. Since many investigations are funded at least partially by pharmaceutical companies, the potential for bias is significant.

Some drug companies have influenced research by emphasizing favorable results and downplaying negative findings in publications, Nielsen said. With enormous amounts of money at stake … business interests put pressure on Congress and regulators such as the Food and Drug Administration to prove new drugs and devices and new (uses) for older drugs,” Nielsen said.

But not all the news is discouraging. Every day new, promising findings are making their way into common practice. 

leddy willer.

Breakthrough work by John Leddy, MD, clinical professor in the Department of Orthopaedics, and Barry Willer, PhD, professor in the Department of Psychiatry, both in the Jacobs School, in the treatment of traumatic brain injury is already being incorporated into treatment protocols. They found that adolescent athletes with sport-related concussions recovered more quickly when they underwent a supervised, aerobic exercise regimen, which contradicts the conventional approach of nearly total rest and elimination of most activities.

talal.

The research of Andrew Talal, MD, MPH, professor in the Department of Medicine, Jacobs School, has focused on the use of telemedicine to treat patients with the hepatitis C virus in opioid treatment programs and to conduct evidence-based research in the area of substance abuse disorder. He recently shared his findings with the National Academy of Medicine as part of its investigation of best practices to integrate substance use treatment and infectious disease treatment programs.

quattrin.

Using a novel family-based, weight control intervention approach, Teresa Quattrin, MD; Director, CTSI Integrating Special Populations Core; Senior Associate Dean for Research Integration; and professor in the Department of Pediatrics, Jacobs School, found that treatment of overweight and obese preschoolers works better when it targets both parent and child. This work is leading to changes in how pediatric obesity is treated and prevented.

clemency.

Research of post-naloxone treatment by Brian Clemency, DO, MBA, associate professor of Emergency Medicine, Jacobs School, provides a clinical assessment and validates a rule pertaining to the standard observation time before opioid overdose patients can be discharged from the emergency department. This work has immediate impact on decisions regarding when to safely discharge patients from the emergency room following naloxone treatment.

According to Nielsen, there are several positive influences that can lead to incorporating investigative findings into healthcare practice. Using influential regional champions to spearhead efforts to change and to monitor report results; gaining support from insurers and the health system to back changes in the policy pipeline in order to implement new findings into the workflow of a clinical day; and providing feedback on results once changes have been made can all help accelerate the process, she said.

“Addressing these obstacles will take commitment and cooperation from multiple stakeholders, including researchers, medical societies, providers, policy makers, healthcare systems and payers,” Murphy said. “Guided by the overarching goal of the CTSI to perform innovative research to improve the health of our community and the nation, it will be important for us to find ways to better communicate key findings so that we can enable more advances in healthcare like the striking examples of UB researchers.”