Date: 24 May 2016
We all know that research-based practice is important, but it is much harder to agree on how best to implement this. The volume of research evidence is now overwhelming, which is itself a healthy symptom of increased research activity and awareness. Five years ago, a study estimated that seventy five trials and eleven systematic reviews were produced a day. Today, this has probably grown and it is unrealistic to expect busy clinicians, managers or patients to keep up with the latest evidence. It is also difficult to work out which studies are reliable or what they mean. Individual authors can over-sell their findings and research carried out in other countries may not be relevant to the UK context. A GP works within constraints - NICE guidelines, QOF targets, local referral thresholds and clinical audit frameworks, and it is hard to know how recent research sits alongside these factors.
Another problem is that many decisions are complex and changes to services will have knock-on effects across the wider health and care system. Commissioners have been given greater responsibilities and are hungry for evidence on problems but their questions - `should I decommission inpatient eating disorder services?’ or `what kind of stroke rehabilitation package is most cost-effective?’ - are rarely addressed directly by single reviews. These tend to be narrowly defined to maximise reliability. Nurses taking part in a recent tweetchat using #wenurses noted that research often asks different questions from the ones arising in everyday nursing practice. The answers from research are often complex and nuanced, so the trick, as Andy Oxman once said, is to make evidence as simple as possible, but not simpler.
The new NIHR Dissemination Centre was set up in April 2015 to help decision-makers in the NHS to make better use of reliable evidence. We recently posted our first NIHR Signals – short, critical summaries with headline findings put into context. We assess the quality of the study and what the results might mean for the service. Signals will be issued every week from a pool of around 500 possible published articles. These are mainly systematic reviews, as the most reliable forms of evidence, but the Centre also draws on high quality research funded by the NIHR (the research arm of the NHS) to address particular research gaps for the service. Using a pool of several hundred raters – doctors, nurses, therapists, commissioners, managers and patients – to help us to decide which are most relevant and important pieces of research, Signals provide rich and useful context. They also include commentaries from frontline staff and clinical leaders on what this means for them.
The Centre is helped in its work by an expert advisory group, reflecting the range of decision-makers we want to reach. One of these is Nigel Beasley, an ENT surgeon who is co-Chair of East Midlands Clinical Senate, a multi-professional group of clinicians providing independent strategic advice to commissioners. He says:
"Signals provide an easily readable high level summary of the latest andmost important research evidence. They will help commissioners, and bodiesthat advise commissioners such as such as the senates and strategicclinical networks, buy safe, effective services for patients in theirlocal area. They provide a useful update to the latest NICE guidance andwill ensure that commissioners are informed of new developments in a timely manner."
This week's Signals cover a range of topics – from treatment of troublesome varicose veins to financial incentives to change health behaviours. We are developing a collection of Signals and will be tagging individual summaries to make it easier to sort by area of interest over time. We’d love to hear back from you on these early Signals and how we can help to get the right evidence in a helpful form to those who need it. It’s a noisy world out there.
We all know that research-based practice is important, but it is much harder to agree on how best to implement this.
Deputy Director of the NIHR Dissemination Centre