Translation of research findings into sustainable improvements in clinical outcomes and patient outcomes remains a substantial obstacle to improving the quality of care. Up to two decades may pass before the findings of original research becomes part of routine clinical practice. Translating Research Into Practice-II is an initiative that focuses on implementation techniques and factors associated with successfully translating research findings into diverse applied settings.
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The TRIP Initiative /
Special Areas of Interest to TRIP-II /
Collaborative Strategies /
TRIP Projects /
In September 2000, the Agency for
Healthcare Research and Quality
(AHRQ) funded 13 new projects to
evaluate different strategies for
translating research findings into
clinical practice. The aim of these 3-year cooperative agreements is to
identify sustainable and reproducible
- Help accelerate the impact of health
services research on direct patient
- Improve the outcomes, quality,
effectiveness, efficiency, and/or cost
effectiveness of care through
partnerships between health care
organizations and researchers.
The new projects join 14 others funded
in 1999 as part of a major initiative by
AHRQ to close the gap between
knowledge and practice—between what
we know and what we do—to ensure
continuing improvements in the quality
of the Nation's health care.
It may take as long as one or two
decades for original research to be put
into routine clinical practice. Thus, the
translation of research findings into
sustainable improvements in clinical
practice and patient outcomes remains
a substantial obstacle to improving the
quality of health care.
What has been
learned in the research setting often is
not implemented into daily clinical
practice. A 1998 review of published
studies on the quality of care received
by Americans, for example, found that
only about three of five patients with chronic
conditions received recommended
Moreover, many of the examples
of success in translating research into
practice have involved inpatient care or
settings in which most providers
practice in close proximity. The list of
"best practices" that involve dispersed
outpatient settings—the predominant
mode of clinical practice today—is
much more limited.
This translational hurdle exists despite a
wide range of strategies for
implementing research in practice that includes:
- Provider reminder systems.
- Local opinion leaders.
- Computer decision support systems.
- Financial incentives.
It appears that some
strategies work best in certain contexts
but success may be influenced by the
care setting, the patient, organizational
factors, and the desired behavior
change. A 1999 systematic review of
the literature found that, while some
health care interventions were effective
under some circumstances, none was
effective under all circumstances.2
Also, few studies have addressed
whether a strategy that is successful in
one clinical setting will also be
successful in another setting.
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The TRIP Initiative
In fiscal year 1999, AHRQ (then the
Agency for Health Care Policy and
Research) published its first Translating
Research Into Practice (TRIP) initiative.
The purpose of TRIP-I was to generate
new knowledge about approaches that
promote the utilization of rigorously
derived evidence to improve patient
care. The Agency's goal was to enhance
the use of research findings, tools, and
scientific information that would work
in diverse practice settings, among
diverse populations, and under diverse
The 14 studies
supported under TRIP-I address a
variety of health care problems,
primarily through randomized
controlled trials. These studies, which
represent important prototypes of what
is possible under ideal circumstances,
generally require an elaborate strategy
for superimposing data collection on
the demands of routine practice.
Building on earlier initiatives, TRIP-II
is aimed at applying and assessing
strategies and methods that were
developed in idealized practice settings
or that are in current use but have not
been previously or rigorously evaluated.
Furthermore, increased demands for
accountability in health care, including
reporting of clinical performance using
standardized quality measures, have
created a sense of urgency regarding
improvement within health care
With this as a basis,
TRIP-II focuses on implementation
techniques and factors—such as
organizational and clinical
successfully translating research findings
into diverse applied settings.
TRIP-II focuses on the
implementation techniques and the
organizational and clinical factors
associated with translating research
into applied settings.
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Special Areas of Interest to
Two areas of particular importance to
TRIP-II are improving the health care
of minority populations and using
information technology to translate
research findings into health care
improvements and health policy.
Reducing Disparities in Health Care
TRIP-II joins a number of AHRQ
initiatives addressing conditions—such
as diabetes and cardiovascular disease—that disproportionately affect minority
populations. Past research has
identified important clinical areas in
which gaps in health care exist.
Eliminating disparities requires
enhanced efforts at preventing disease,
promoting health, and delivering
appropriate care. Several TRIP-II
projects are evaluating how
implementation methods and tools
affect the health outcomes of minority
populations in several clinical areas.
Using Information Technology
The potential for technology to translate
research findings into sustainable health
care improvements has long been
recognized. Technology may be utilized
to accelerate the implementation of
research throughout organizations more
rapidly than would occur if translation
strategies depended on individuals or
personal interactions. A number of
TRIP-II projects will evaluate how
computer-based interventions improve
quality of care for minority as well as
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A key to TRIP-II
is the presence of partnerships
between researchers and health care
organizations such as:
- Integrated service delivery systems.
- Practice-based networks.
- Academic health centers.
- Managed care organizations.
The structural and organizational
diversity of these health systems may
help to facilitate the evaluation of
models and tools for research
translation to actual care settings that
might not otherwise occur.
In addition, these partnership
arrangements may help to accelerate
and magnify the impact of the research
on health care practice by:
- Disseminating evidence-based
knowledge to audiences that include
practitioners, patients, and
- Identifying information important
to health care organizations efforts
to improve the quality of health
- Providing practical assistance to
physicians, and other health care
providers in implementing research
in direct patient care.
- Supporting the further development
and refinement of successful and
sustainable strategies to translate
research into practice that improves
Cooperative Agreement Activities
A steering committee composed of
grantees and AHRQ staff is
undertaking activities to strengthen
individual studies and facilitate
synergism between the studies. Several
work groups have been formed to
discuss common issues, data elements,
methods, tools, and outcomes. The goal
of these activities is to help advance the
scientific base for clinical research
A key to TRIP-II is the presence of
partnerships between researchers
and health care organizations.
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Better Pediatric Outcomes Through
Chronic Care. Evaluates use of
affordable technology and family-focused
program to improve the asthmatic
conditions of poor, inner-city, minority
children, ages 5-18, who are enrolled in
a community health center-based
Medicaid managed care organization.
Principal Investigator: Judith Fifield,
University of Connecticut Health
Center, Hartford, CT.
Developing an Asthma Management
Model for Head Start. Develops and
tests an evidence-based asthma case
management model for low-income
minority children enrolled in 29 Head
Start programs. Outcomes to be
measured include asthma-related school
absences, symptoms, quality of life,
emergency department visits, and
Perla A. Vargas, Arkansas Children's
Hospital, Little Rock, AR. Partnering
organizations: Pulaski County Head
Start and Arkansas Foundation for
Diabetes Education Multimedia for
Vulnerable Populations. Compares
usual care with patient education via an
interactive, multimedia computer
program to improve diabetes-related
knowledge, attitudes, self-efficacy and
compliance with self-care
recommendations. The study takes
place at clinics serving predominantly
African American and Hispanic
Principal Investigator: Ben S.
Gerber, University of Illinois, Chicago,
IL. Partnering organizations:
Community Health Clinic and the
Cook County Hospital Ambulatory
Implementing Adolescent Preventive
Guidelines. Compares usual care with
an office-based intervention, consisting
of tools and clinician training, and
evaluating the outcome of delivery of
preventive services during routine well-care
Charles E. Irwin, University of
California, San Francisco, CA.
Improving Pain Management in
Nursing Homes. Develops and
implements a culturally competent,
evidence-based educational and
behavioral intervention to improve the
quality of pain assessment and
management in two nursing homes.
Influence and changes of organizational
variables and cost-effectiveness of the
intervention to nursing homes will be
Katherine R. Jones, University of
Colorado Health Sciences Center,
Improving Quality With Outpatient
Decision Support. Assesses physician
compliance with paper-based and
electronic guidelines, reminders, and
alerts for outpatient settings. Target
areas for the reminders and alerts are
disease management, medication
management, and ancillary test
Principal Investigator: David
Bates, Brigham and Women's Hospital,
Boston, MA. Partnering organizations:
Beth Israel and Massachusetts General
Hospitals and their outpatient clinics.
Improving Utilization of Ischemic
Stroke Research. Assesses the
effectiveness of a model for accelerating
the use of evidence-based treatment
guidelines for acute ischemic stroke in
24 urban and rural hospitals in
Catherine Borbas, Minneapolis Medical
Research Institute, Minneapolis, MN.
Partnering organizations: Harvard Medical School and the University of
Minnesota School of Nursing.
An Internet Intervention To Increase
Chlamydia Screening. Tests Internet-based
learning modules designed to
increase primary care physician
screening of at-risk female patients and
decrease incidence of pelvic
Principal Investigator: Jeroan Allison, University
of Alabama, Birmingham, AL.
Partnering organization: U.S. Quality
Managed Care Organization (MCO) Use of a Pediatric Asthma
Management Program. Compares a
specially modified version of the Easy
Breathing program with an asthma
management program presently being
used in a large MCO in the Hartford
Principal Investigator: Michele
M. Cloutier, University of Connecticut
Health Center, Hartford, CT.
Partnering organizations: ConnectiCare
and the Connecticut Children's Medical
A Model for Use of the Urinary
Incontinence Guideline in U.S.
Nursing Homes. Tests the effectiveness
of a model of care implemented by
nurse practitioners in collaboration with
nurses and physicians to translate the
AHRQ Urinary Incontinence Guideline
into practice in 10 New York nursing
Principal Investigator: Nancy
M. Watson, University of Rochester
School of Nursing, Rochester, NY.
Optimizing Antibiotic Use in Long-Term
Care. Assesses whether an
evidence-based clinical algorithm for
managing urinary tract infections in
older adults in residential long-term
care facilities (LTCFs) can reduce the
overall use of antibiotics in LTCFs.
Principal Investigator: Mark B. Loeb,
McMaster University, Hamilton,
Ontario, Canada. Partnering
organizations: University of Toronto,
Queen's University, St. Joseph's Health
Care System Research Network nursing
homes, and nursing homes in Ontario.
Primary and Secondary Prevention of
Coronary Heart Disease and Stroke.
Evaluates the impact of a quality
improvement model using academic
detailing and electronic medical records
on adherence with clinical practice
guidelines for prevention of
cardiovascular disease and stroke in 22
primary care settings across the United
Principal Investigator: Steven
M. Ornstein, Medical University of
South Carolina, Charleston, SC.
Partnering organizations: 22 affiliated
Practice Partner Research Network
Translating Prevention Research Into
Practice. Compares two methods of
integrating preventive services in a
group practice plan serving a low-income
minority Medicaid population.
Clinical areas addressed are infant
mortality, cardiovascular disease, cancer
screening, HIV/AIDS and
Robert A. Levine, Meharry Medical
College, Nashville, TN. Partnering
organization: Tennessee State University
Center for Health Research.
Several TRIP-II projects evaluate
how implementation methods and
tools affect health outcomes of
minorities in six clinical areas.
Do Urine Tests Increase Chlamydia
Screening in Teens? Uses a small-group
educational program for clinic
personnel augmented with weekly
supervision and followup to reinforce
the educational content to improve
screening for sexually transmitted
diseases among asymptomatic, sexually
active adolescents attending Kaiser
Permanente outpatient clinics.
Principal Investigator: Mary-Ann
Shafer, University of California, San
Evidence-based Practice: From Book
to Bedside. Evaluates a
approach to implementation of an
evidence-based guideline for acute pain
management of elderly patients (65
years and older) hospitalized for hip
fracture in nonintensive settings.
Principal Investigator: Marita Titler,
University of Iowa, Iowa City, IA.
Evidence-based 'Reminders' in Home
Health Care. Investigates providers'
use of evidence-based guidelines in the
treatment of two highly prevalent
chronic diseases—congestive heart
failure and cancer—and how the use of
guidelines affects quality and cost of
Principal Investigator: Penny
Feldman, Visiting Nurses Service of
New York, New York, NY.
Evidence-based Surfactant Therapy
for Preterm Infants. Tests the effect of
standardizing the current variability in
surfactant administration practices for
the prevention and treatment of
neonatal respiratory distress syndrome
to reduce both mortality and morbidity
for preterm infants.
Principal Investigator: Jeffrey D. Horbar,
University of Vermont, Burlington,
Improving Diabetes Care
Collaboratively in the Community.
Assesses health outcomes and quality of
care for indigent, vulnerable patients
with diabetes who receive primary care
at rural and urban community health
centers in medically underserved areas.
Principal Investigator: Marshall H.
Chin, University of Chicago, Chicago,
Improving the Evidence for Unstable
Angina Guidelines. Investigates
whether agreement with unstable
angina guideline recommendations for
triage is associated with decreased MI
and mortality rates and decreased short-term health care utilization rates (e.g.,
David Katz, University of Wisconsin,
Interventions To Improve Pain
Outcomes. Develops and implements
three combinations of different quality
improvement interventions to measure
their impact on hospital patients' self-reported
pain intensity, pain relief,
expectations for pain management, and
satisfaction with care.
Principal Investigator: R. Sean Morrison, Mount
Sinai School of Medicine, New York,
Pediatric EBM—Getting Evidence
Used at the Point of Care. Uses
randomized controlled trials in three
settings to investigate whether use of an
evidence-based decision support system
will improve outpatient care for specific
pediatric diseases—otitis media, acute
sinusitis, bronchiolitis, allergic rhinitis.
Principal Investigator: Robert Davis,
University of Washington, Seattle, WA.
Point of Care Delivery of Research
Evidence. Assesses strategies for the
automated selection of credible and
substantial research evidence, matching
of patient data with the clinical
evidence, and direct delivery of high-quality
evidence to the point of clinical
E. Andrew Balas, University of
Missouri, Columbia, MO.
Practice Profiling To Increase
Tobacco Cessation. Evaluates the
impact of tobacco cessation profiling on
provider and practice behavior,
including screening for tobacco use and
provision of tobacco cessation
treatment, and assesses effects of the
practice interventions on the quitting
behavior of smokers.
Principal Investigator: Susan H. Swartz, Maine
Medical Assessment Foundation,
Reducing Adverse Drug Events in the
Nursing Home. Tests whether a
computer-based clinical decision-support
system can lower the rate of
adverse drug events and potential
adverse drug events in nursing homes.
Principal Investigator: Jerry Gurwitz,
University of Massachusetts Medical
Center, Worcester, MA.
Smoking Control in Maternal and Child Health (MCH) Clinics:
Dissemination Strategies. Tests two
and access to a centralized telephone
counseling service—vs. a control group
in their effectiveness to disseminate the
"It's Time" smoking cessation program
and the AHRQ smoking cessation
guidelines in local public MCH clinics.
Principal Investigator: Clara Manfredi, University
of Illinois, Chicago, IL.
Translating Chlamydia Screening
Guidelines Into Practice. Compares
standard guideline implementation
procedures to three other
- One with only provider-specific components.
- One with only patient-specific components.
- One with both provider- and
The researchers are investigating their effects on chlamydia
Robert Thompson, Center for Health
Studies, Seattle, WA.
Translating Research: Patient
Examines the effectiveness of the Heart
After-hospital Recovery Planner
(HARP)—a combined decision-support
and coaching intervention—in
improving physician medication
prescribing, patient secondary
prevention, and participatory
decisionmaking after hospitalization for
Principal Investigator: Margaret Holmes-Rovner,
Michigan State University, East
TRIP-II aims to help accelerate the
impact of health services research
on direct patient care.
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1. Schuster M, McGlynn E, Brook R.
How good is the quality of health care
in the United States? Milbank
Quarterly 1998; 76: 517-63.
2. NHS Center for Reviews and
Dissemination. Getting evidence into
practice. Effective Health Care 1999
February; bull. 5(1).
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AHRQ Publication No. 01-P017
Current as of March 2001
Translating Research Into Practice (TRIP)-II. Fact Sheet. AHRQ Publication No. 01-P017, March 2001. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/trip2fac.htm