Translating Information on Comparative Effectiveness into Practice

描述（由申请人提供）：近年来，对常见疾病的药物治疗进行比较有效性研究（CER）的兴趣和投资很大。AHRQ已经投入了大量的资金和资源来推进CER。然而，很少有人知道如何将CER的研究结果转化为实践。糖尿病治疗的CER表明，所有药物对血糖控制的作用相似，但副作用存在差异，这可能影响药物依从性和治疗强化。通过决策辅助工具促进患者更多地参与决策，可以通过加强患者-提供者沟通并改善药物的吸收和依从性来提高糖尿病护理的质量，这些药物的特征和目标与患者的价值观和偏好一致。为了促进患者参与这个决定，我们已经开发并进行了一个试验性的随机试验的决定-糖尿病药物选择卡决策援助。在本申请中，我们的目的是评估方法和策略，通过进行一项实用的群集随机试验，将CER中关于口服糖尿病药物的发现转化为初级保健实践。我们将评估患者对药物的依从性和达到血糖控制目标的成功率。结合本试验，我们将应用规范化过程理论和混合方法研究（定性和定量），以确定促进将CER转化为供应商常规临床工作流程的决策辅助工具的因素。我们还将探讨这一理论如何使患者能够将他们的选择纳入日常生活。 在本试验完成时，我们将深入了解使用决策辅助工具作为将CER转化为实践的策略。这项研究还将确定成功实施的因素。最后，我们将更好地了解患者参与决定对治疗依从性的影响。

DESCRIPTION (provided by applicant): In recent years, there has been significant interest and investment for conducting comparative effectiveness research (CER) of medical treatments for common medical conditions. AHRQ has invested a significant amount of money and resources to advance CER. However, little is known about translating the findings from CER into practice. CER of diabetes treatments suggests that all medications are similar in their effects on glycemic control, but there is variability in side-effects, which may affect medication adherence and treatment intensification. Greater patient involvement in making decisions, facilitated by decision aids, may enhance the quality of diabetes care by enhancing the patient-provider communication and improving the uptake and adherence to the medication that is consistent in their features and goals with patients' values and preferences. To promote patient involvement in this decision, we have developed and conducted a pilot randomized trial of a decision -- the Diabetes Medication Choice cards decision aid. In this application, we aim to assess methods and strategies for translating the findings from the CER on oral diabetes medications into primary care practices by conducting a practical cluster randomized trial. We will assess patient adherence to medications and success in reaching glycemic control goal. In conjunction with this trial, we will apply the Normalization Process Theory and mixed methods research (qualitative and quantitative) to identify factors that promote the incorporation of decisions aids for translating CER into routine clinical workflow for providers. We will also explore how this theory may enable patients to incorporate their choice into their daily routines. At the completion of this trial, we will gain insight into the use of decision aids as a strategy for the translation of CER into practice. This research will also identify factors that allow for successful implementation into practice. Finally, we will better understand the impact of patient involvement in the decision on treatment adherence.