Narrowing the 17-Year Research to Practice Gap

D eveloping evidence to improve clinical practice and disseminating it to be used by clinicians to improve outcomes for individual patients is important. How long does it take to get evidence into practice? The standard refrain of “17 years to move evidence into practice” is repeated by researchers and clinicians alike with despair.1,2 Rather than accepting the inevitability of a long lag in translating research to the bedside, we believe it is worthwhile to examine the origin of the “17-year gap,” to scrutinize how it applies to interdisciplinary research in critical care, and to suggest ways to close that gap. In March of 2001, the Institute of Medicine report Crossing the Quality Chasm3 stated, “It now takes an average of 17 years for new knowledge generated by randomized controlled trails to be incorporated into practice, and even then application is highly uneven.” Recently, the National Institutes of Health (NIH) strategic plan4 estimated that moving a new drug or medical device from conception to market takes 14 years and costs $2 billion. This includes 6.5 years for laboratory-based drug discovery and preclinical testing, 6 years for clinical trials of promising drug candidates, and 1.5 years for US Food and Drug Administration (FDA) approval of those that are brought to market. The Investigative Process Traditional clinical investigations proceed through multiple sequential steps. The process of planning a project, completing it, and disseminating results can be lengthy. A testable idea must be formulated and refined, and a research team assembled. Preliminary data may need to be gathered to guide a larger investigation. Permissions must be obtained and regulatory requirements met. Support must be obtained for essential resources such as personnel and supplies, which may entail seeking internal and external grant funding. Subjects must be enrolled, interventions delivered, data collected, and analyses performed. The final step for an individual research project entails dissemination of the findings through presentations and publications. Each of these steps is essential, and each takes time. For pharmaceuticals, basic and preclinical research require a large investment of time and money. Only 5% of compounds initially screened in early research will move forward to market.4 Fortunately, not all critical care research involves pharmaceuticals, and not all critical care research requires lengthy accumulation of basic science and preclinical studies prior to development of clinically relevant research questions. Where FDA approval is not required, the process can move more quickly.