Review Article
Systematic reviews examining implementation of research into practice and impact on population health are needed

https://doi.org/10.1016/j.jclinepi.2014.12.008Get rights and content

Abstract

Objectives

To examine the research translation phase focus (T1–T4) of systematic reviews published in the Cochrane Database of Systematic Reviews (CDSR) and Database of Abstracts of Reviews of Effects (DARE). Briefly, T1 includes reviews of basic science experiments; T2 includes reviews of human trials leading to guideline development; T3 includes reviews examining how to move guidelines into policy and practice; and T4 includes reviews describing the impact of changing health practices on population outcomes.

Study Design and Setting

A cross-sectional audit of randomly selected reviews from CDSR (n = 500) and DARE (n = 500) was undertaken. The research translation phase of reviews, overall and by communicable disease, noncommunicable disease, and injury subgroups, were coded by two researchers.

Results

A total of 898 reviews examined a communicable, noncommunicable, or injury-related condition. Of those, 98% of reviews within CDSR focused on T2, and the remaining 2% focused on T3. In DARE, 88% focused on T2, 8.7% focused on T1, 2.5% focused on T3, and 1.3% focused on T4. Almost all reviews examining communicable (CDSR 100%, DARE 93%), noncommunicable (CDSR 98%, DARE 87%), and injury (CDSR 95%, DARE 88%) were also T2 focused.

Conclusion

Few reviews exist to guide practitioners and policy makers with implementing evidence-based treatments or programs.

Introduction

What is new?

Key findings

  1. Almost all systematic reviews published in the Cochrane Database of Systematic Reviews (CDSR 98%) and Database of Abstracts of Reviews of Effects (DARE 88%) and within communicable diseases, noncommunicable diseases, and injury-related conditions were focused on T2 phase research (T2: research involving human trials to generate evidence-based guidelines).

What this adds to what was known?
  1. Few T3 (research examining how to move evidence-based guidelines into practice) and T4 (research examining the impact of implementation of evidence-based guidelines on population health) focused systematic reviews are available in CDSR and DARE.

  2. Practitioners and policy makers may have little evidence to guide practice and policy decisions.

What is the implication and what should change now?
  1. Efforts to increase the production of T3 and T4 systematic reviews including issuing targeted calls for such reviews, establishing funding schemes, and creating more specialist journals for dissemination are needed.

To maximize the benefits of investments in health research, basic science discoveries need to be tested via clinical trials to determine their efficacy, effectiveness, and cost effectiveness. Those interventions found to be effective and cost effective must then be adopted as part of clinical or public health practice in order for community benefit to be achieved [1], [2]. The process of moving research into practice is known as translational research and encompasses four distinct but related phases [3]. Phase 1 (T1) research involves moving basic science discoveries, such as understanding disease mechanisms, into research involving human patients. Phase 2 (T2) research aims to facilitate movement from human patient–oriented research into evidence-based guidelines. Phase 3 (T3) research involves examining how to move evidence-based guidelines into health practice in organizations and communities, and phase 4 (T4) research examines the impact of changing health practices on population health outcomes [3].

Despite the importance of each phase of research translation, analysis of research funding and activity suggests that most research output has focused on the first two phases of translation (innovation development and testing in humans), with little attention given to improving methods of dissemination or uptake of evidence-based practice [4]. Although systematic reviews are key to facilitating research translation [5], to date there has been no examination of the proportion of systematic reviews that report findings from trials within each different research translation phase (T1–T4). Therefore, this study aimed to describe the translation phase focus (T1–T4) of systematic reviews published in two databases of high quality—the Cochrane Database of Systematic Reviews (CDSR) and the Database of Abstracts of Reviews of Effects (DARE). A secondary aim of the study was to describe post hoc the proportion of T1–T4 reviews examining communicable diseases, noncommunicable diseases, and injury-related conditions within these databases.

Section snippets

Methods

Titles and abstracts of a randomly selected subsample of systematic reviews published in the CDSR (n = 500) and DARE (n = 500) between January 2012 and August 2013 were extracted. These databases were selected as they are widely accessed, international databases that publish high-quality reviews of health care interventions. The translation stage focus was coded independently by two researchers based on the following definitions used by the National Institute of Health [3]: (1) T1—reviews of

Results

Of the 1,000 reviews, 102 (10%) did not examine a condition included in the GBD taxonomy leaving 898 reviews included in the analyses. Almost all reviews (98%) (95% CI: 97%, 100%) in the CDSR focused on T2 phase research. Only 2% (95% CI: 0.4%, 2.7%) focused on T3 phase research, with no reviews conducted for T1 or T4 (see Table 1). This result was similar within the disease subgroups for CDSR with 100% of communicable disease reviews, 98% (95% CI: 97%, 100%) of noncommunicable disease reviews,

Discussion

This study highlights that an overwhelming proportion of systematic reviews published in the two databases (98% in CDSR and 88% in DARE) focused on research trials from translation phase 2: T2. The findings were consistent across the primary causes of death and disability, where almost all research within communicable diseases (CDSR 98%, DARE 93%), noncommunicable diseases (CDSR 98%, DARE 87%), and injury (CDSR 95%, DARE 88%) subgroups also focused on T2 phase research.

An absence of reviews

Acknowledgments

The authors thank Ms. Eliza Skelton for assistance with coding of included reviews.

References (9)

There are more references available in the full text version of this article.

Cited by (15)

  • How are leaders using benchmarking information in occupational health and safety decision-making?

    2019, Safety Science
    Citation Excerpt :

    Within the OHS domain, little has been explored in the way of knowledge user needs for decision-making (Lavis et al., 2003) and how to tailor knowledge to determine its impact on knowledge utilization (Kramer and Cole, 2003, Kramer et al., 2004, Van Eerd and Saunders, 2017). There remains a great need to understand knowledge use in OHS decision making practices and especially what tools can be developed to support knowledge utilization (Loeppke et al., 2015, Rondinone et al., 2010, Schulte et al., 2003, Yoong et al., 2015, Zardo et al., 2014). Most decision-making in an organization starts with leaders.

  • Developing implementation science to improve the translation of research to address low back pain: A critical review

    2016, Best Practice and Research: Clinical Rheumatology
    Citation Excerpt :

    As a scientific discipline, implementation science is in its relative infancy. For example, just 2% of systematic reviews of health interventions report the findings of implementation trials [17]. Furthermore, the quality of implementation research has been criticised [18].

View all citing articles on Scopus

Conflict of interest: None.

Funding: No external research funding was received for the production of this article. Dr. L.W. is supported by a National Health and Medical Research Council (NHMRC) Career Development Fellowship. Infrastructure support was provided by the University of Newcastle, Hunter Medical Research Institute (HMRI), and Hunter New England Population Health (HNEPH).

View full text