Response to «the OFF theory of research utilization»

• Autores: Anne Walker, Jeremy Grimshaw, Martin Eccles, Nigel Pitts, Marie Johnston
• Localización: Journal of clinical epidemiology, ISSN 0895-4356, Nº. 2, 2005, págs. 117-118
• Idioma: inglés
• Texto completo no disponible (Saber más ...)
• Resumen

  • We enjoyed the paper by our colleagues and erstwhile sparring partners. We believe that we are trying to achieve the same goal: an empirically validated set of principles to inform the choice of interventions to improve quality of care. However, we clearly do not agree on how best to develop the science in this area. Our perspective has been influenced by our experiences of conducting 26 cluster randomized trials and multiple systematic reviews of different interventions. Commonly, when we have completed a study, we have been asked by colleagues about the likely generalizability of our study to other types of behaviors, health care professionals, and settings. We increasingly recognize the substantial judgment and guesswork needed to answer this question. When considering the generalizability of findings of randomized trials of drug interventions, we consider the findings from the basic sciences and epidemiology to assess the likely “biologic plausibility” that the observed effects will be generalizable to other patients. Our ability to generalize from quality improvement studies is hindered by the lack of an equivalent “behavioral plausibility.” Oxman et al. argue for addressing this issue empirically and that researchers should use their common sense to choose interventions for evaluation. Presumably, as the number of evaluations increases, some form of meta-understanding (or, dare we say it, theory?) will emerge that will form the basis of a set of principles by which to choose interventions. Some of us (JMG, ME) have just completed a review of 235 evaluations of guideline dissemination and implementation strategies conducted over 25 years. Few authors gave any rationale for their choice of interventions and presumably used their common sense to choose the interventions. The review demonstrated that such common sense improvements commonly lead to improvements in care. However, it gave no insight into which interventions are more or less likely to be helpful for different behaviors, professionals, and settings. In all health care systems, where there are limited resources available for implementation activities, this has considerable implications for the economics of such activities. We despair that the purely empirical approach advocated is unlikely to lead to development of any meta-understanding.