When an epidemic like the Zika virus emerges, a sense of urgency arises in the medical and scientific research communities to determine its virology, transmission, clinical manifestations and method of diagnosis. A key part of controlling a disease outbreak is translating what is found out about the disease from research to the clinicians who are screening patients. In a recent study by Baylor College of Medicine and UT Health, researchers seek to address the gap in this translation process and develop a framework for implementing research into clinical practice in a timelier manner. Their findings appear in the New England Journal of Medicine.
“Previous research has estimated that it takes roughly 17 years for research evidence to reach clinical practice,” said Dr. Stephanie Morain, assistant professor in the Center for Medical Ethics and Health Policy at Baylor and first author on the study. “In the case of a virus like Zika, which affects infants as they develop in the womb, we do not have 17 years to wait; the need for concise translation of research findings to the clinic is much more immediate.”
In explaining why this clinical gap exists, Morain and colleagues cite several key barriers to effective translation of recommendations, including providers’ lack of awareness of recommendations or lack of agreement with them, patient preferences, lack of resources and cost.
To address these barriers impeding the translation of Zika guidelines into the clinical space, the research team developed a series of recommendations to create an overarching framework for sharing information in a disease response.
Overcoming a lack of awareness could be achieved by expanding the reach of education programming through provider associations such as the American Academy of Pediatrics and the American Congress of Obstetricians and Gynecologists, thereby sharing new and updated resources with clinicians.
Incentivizing pediatric and family practice physicians to complete Zika trainings in order to maintain certification could help encourage broader participation among existing members.
But, as many of these physician associations require memberships, Morain and colleagues propose a number of strategies to increase the uptake of Zika-related resources, including forming creative partnerships to offer shared programming or enrolling in joint memberships.
“Many rural counties in Texas do not have convenient access to physicians or obstetricians, so engaging a wide network of primary care providers is crucial in treating Zika in these areas that have seen active transmission, but may not have the knowledge or resources to screen or refer patients,” Morain said.
The research team also explored opportunities for peer-to-peer learning through the use of media platforms such as telementoring, which links pediatricians in various communities together while also connecting them with academic specialists to achieve rapid, multidirectional exchange of information over the phone or through mobile applications.
There also could be potential barriers to actually implementing research guidelines in a clinical setting, which the authors suggest can be solved through adding decision support systems in electronic health records (EHRs) to assist in incorporating new knowledge into routine clinical care. In addition to providing decision support, many EHRs have travel screening functions, which could be integrated into healthcare workflows to enable pregnant patients to receive screening at each prenatal visit.
A key external barrier to implementing Zika-related findings lies in insufficient care coordination between obstetric and pediatric providers. One strategy the authors proposed to address this issue is to create links between infant and maternal charts in both inpatient and outpatient settings to facilitate a flow of information on Zika testing history and risk factors.
“Zika is a relatively new epidemic, but this challenge of translating clinical recommendations is not. There is such a crucial need to not only conduct rapid clinical and scientific research but also to circulate and implement these findings in the clinic,” Morain said. “For many viruses and diseases, 17 years is far too large of a gap, and we need to begin adopting these principles for translating recommendations in order to protect the health of current and future populations. We need not only to learn, but also to do.”
Other contributors to this work include Catherine Eppes with Baylor College of Medicine and Susan Wootton with The University of Texas Health Science Center. See a list of funding organizations.